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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Polymyalgia rheumatica is a risk factor for more recalcitrant disease in giant cell arteritis: A retrospective cohort
Lien Moreel1, Albrecht Betrains1, Lennert Boeckxstaens2
1Department of General Internal Medicine, UZ Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
Insights
Giant cell arteritis (GCA) patients with polymyalgia rheumatica (PMR) symptoms experience more persistent disease, requiring longer glucocorticoid (GC) treatment and facing a higher relapse risk. These patients also show a reduced incidence of thoracic aortic aneurysms.
Area of Science:
- Rheumatology
- Internal Medicine
- Vasculitis Research
Background:
- Giant cell arteritis (GCA) is a large-vessel vasculitis.
- Polymyalgia rheumatica (PMR) is often associated with GCA.
- Understanding GCA presentation and outcomes in relation to PMR is crucial for patient management.
Purpose of the Study:
- To compare the clinical presentation and disease outcomes of GCA patients with and without concurrent PMR symptoms.
- To identify differences in treatment response and long-term complications between these patient groups.
Main Methods:
- Retrospective analysis of 398 GCA patients diagnosed between 2000-2020.
- Patients were followed for at least 12 months.
- Comparison of demographic, clinical, and treatment data between GCA patients with and without PMR symptoms.
Main Results:
- 45% of GCA patients had PMR symptoms, presenting with longer symptom duration.
- PMR-associated GCA patients required higher glucocorticoid (GC) doses, had a lower probability of GC cessation, and longer treatment duration.
- Increased risk of relapse (64% vs 51%) and a higher number of relapses were observed in patients with PMR symptoms.
- GCA patients with PMR symptoms had less frequent thoracic aortic aneurysms (3% vs 11%).
Conclusions:
- GCA patients with PMR symptoms exhibit a more recalcitrant disease course.
- These patients necessitate longer and higher-dose glucocorticoid therapy.
- The presence of PMR symptoms is linked to an elevated risk of disease relapse.
Objectives:
To evaluate differences in presentation and outcome of giant cell arteritis (GCA) patients with and without polymyalgia rheumatica (PMR) symptoms.
Methods:
Consecutive patients diagnosed with GCA between 2000 and 2020 and followed for ≥12 months at the University Hospitals Leuven (Belgium), were included retrospectively.
Results:
We included 398 GCA patients, of which 181 (45%) with PMR symptoms. Patients with PMR symptoms had a longer symptom duration (11 vs 6 weeks, p < 0.001). They less frequently reported fever (19% vs 28%, p = 0.030) and fatigue (52% vs 64%, p = 0.015) and tended to have less permanent vision loss (12% vs 19%, p = 0.052). There was no difference in the cumulative oral GC dose at 2 years (4.4 vs 4.3 g methylprednisolone, p = 0.571). However, those with PMR symptoms were treated with higher GC doses during subsequent follow-up (p < 0.05 from 38 months after diagnosis) and had a lower probability of stopping GC (62% vs 71%, HR 0.74 [95%CI 0.58-0.94], p = 0.018) with a longer median duration of GC treatment (29 vs 23 months, p = 0.021). In addition, presence of PMR symptoms was associated with an increased risk of relapse (64% vs 51%, HR 1.38 [95%CI 1.06-1.79], p = 0.017) with a higher number of relapses (1.47 [95%CI 1.30-1.65] vs 1.16 relapses [95%CI 1.02-1.31], p = 0.007). Patients with PMR symptoms less frequently developed thoracic aortic aneurysms during follow-up (3% vs 11%, p = 0.005).
Conclusion:
GCA patients with PMR symptoms had more recalcitrant disease with a higher risk of relapse and longer duration of GC treatment with need for higher GC doses.
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