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Subclinical giant cell arteritis increases the risk of relapse in polymyalgia rheumatica

Eugenio De Miguel1, Rositsa Karalilova2, Pierluigi Macchioni3

  • 1Rheumatology, La Paz University Hospital, Madrid, Spain eugenio.demiguel@gmail.com.

Annals of the Rheumatic Diseases
|November 6, 2023
PubMed
Abstract

Insights

Polymyalgia rheumatica (PMR) patients with subclinical giant cell arteritis (GCA) experience more relapses. Lower initial glucocorticoid doses and rapid tapering increase relapse risk in PMR with subclinical GCA.

Area of Science:

  • Rheumatology
  • Internal Medicine
  • Clinical Immunology

Background:

  • Polymyalgia rheumatica (PMR) is a common inflammatory condition.
  • Giant cell arteritis (GCA) can be present subclinically in PMR patients.
  • Identifying subclinical GCA in PMR is crucial for optimal management.

Purpose of the Study:

  • To evaluate the clinical significance of subclinical GCA in PMR patients.
  • To determine the optimal treatment strategy for PMR with subclinical GCA.
  • To compare outcomes between isolated PMR and PMR with subclinical GCA.

Main Methods:

  • 150 PMR patients were classified into isolated PMR or PMR with subclinical GCA groups based on ultrasound.
  • Patients were followed for 2 years, monitoring relapses and treatment.
  • Outcomes including glucocorticoid use and DMARDs were compared between groups.

Main Results:

  • Patients with subclinical GCA had a significantly higher relapse rate (62%) compared to isolated PMR (16%).
  • Lower initial prednisone doses and rapid tapering within 3 months were associated with relapses in subclinical GCA.
  • No differences in age, sex, CRP, or ESR were found between relapsing and non-relapsing subclinical GCA patients.

Conclusions:

  • Subclinical GCA in PMR patients leads to a significantly higher risk of relapses.
  • Lower starting glucocorticoid doses and accelerated tapering in the first 3 months are risk factors for relapse.
  • These findings highlight the importance of tailored glucocorticoid management in PMR with subclinical GCA.
Keywords:
Giant Cell ArteritisOutcome Assessment, Health CarePolymyalgia RheumaticaTherapeuticsUltrasonography

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