Epidemiology of major relapse in giant cell arteritis: A study-level meta-analysis

Area of Science:

• Rheumatology
• Clinical Epidemiology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis with a significant relapse rate, approximately 48%.
• Major relapse in GCA, defined by severe ischemic or aortic disease, poses a substantial clinical challenge.
• Understanding the prevalence and incidence of major relapse is crucial for patient management and therapeutic strategies.

Purpose of the Study:

• To determine the prevalence and incidence of major relapse in Giant cell arteritis (GCA).
• To identify the spectrum of clinical manifestations associated with major relapse in GCA.
• To explore factors influencing the incidence of major relapse in GCA patients.

Main Methods:

• A systematic review and meta-analysis of published data from MEDLINE and Cochrane databases up to March 2020.
• Inclusion of studies detailing newly diagnosed or relapsed GCA patients, treatment regimens (glucocorticoids alone or with GC-sparing therapy), and relapse characteristics.
• Pooled analysis of prevalence and incidence data using a random-effects model.

Main Results:

• Twenty-six studies involving 2754 GCA patients were analyzed.
• The prevalence of major relapse was 3.3% (95%CI [1.7;5.6]), and the incidence was 14.5/100 patient-years (95%CI [5.2;27.2]).
• Common manifestations included jaw claudication (44.3%), ophthalmological involvement (32.7%), and peripheral limb ischemia (12.5%).
• Longer follow-up duration was associated with lower major relapse incidence (p=0.0063).
• Prospective studies reported significantly higher major relapse incidence than retrospective studies (p=0.0002).

Conclusions:

• Heterogeneity among studies, partly due to study design, was observed.
• Jaw claudication is a frequent symptom and is associated with increased prevalence and incidence of major relapses.
• These findings highlight the importance of study design in evaluating GCA relapse rates and clinical characteristics.