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Relapses in giant cell arteritis: Updated review for clinical practice
Marco A Alba1, Tanaz A Kermani2, Sebastian Unizony3
1Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
Insights
Giant cell arteritis (GCA) relapses are common, especially with glucocorticoid (GC) treatment, leading to increased risks. Understanding GCA relapse patterns is key to improving patient outcomes and managing treatment side effects.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Giant cell arteritis (GCA) is the most common primary vasculitis in adults, affecting large arteries.
- High-dose glucocorticoids (GC) induce remission but >40% of patients experience relapses, often within two years.
- Relapses increase GC exposure and adverse effects; tocilizumab offers GC-sparing benefits but relapses can occur post-discontinuation.
Purpose of the Study:
- To review the key features of relapses in GCA.
- To explore the definition, classification, frequency, and characteristics of GCA relapses.
- To discuss pathophysiology, predictive factors, treatment options, and outcomes for relapsing GCA patients.
Main Methods:
- Narrative review of existing literature on GCA relapses.
- Analysis of clinical, laboratory, and imaging data related to GCA recurrence.
- Examination of treatment strategies and patient outcomes in relapsing GCA.
Main Results:
- Relapses are frequent in GCA, particularly in GC-treated patients.
- Understanding relapse characteristics, chronology, and predictive factors is crucial.
- Tocilizumab can reduce GC burden but relapses post-discontinuation are noted.
Conclusions:
- Effective management of GCA relapses is essential to minimize GC toxicity and improve long-term outcomes.
- Further research into predictive factors and optimized treatment strategies for relapsing GCA is warranted.
- Comprehensive understanding of GCA relapse dynamics can guide clinical decision-making and enhance patient care.
Abstract:
Giant cell arteritis (GCA), the most common primary vasculitis in adults, is a granulomatous systemic vasculitis usually affecting the aorta and its major branches, particularly the carotid and vertebral arteries. Although remission can be achieved in most patients with GCA using high-dose glucocorticoids (GC), relapses are frequent, occurring in >40% of GC-only treated patients, mostly during the first two years after diagnosis. Relapsing courses lead to high GC exposure, increasing the risk of treatment-related adverse effects. Although tocilizumab is an efficacious GC-sparing therapy that allows increased sustained remission and reduced cumulative GC doses, relapses are common after drug discontinuation. This narrative review examines the most relevant features of relapses in GCA, including its definition, classification, frequency, clinical, laboratory, and imaging characteristics, chronology, probable pathophysiology, and predictive factors. In addition, we discuss treatment options for relapsing patients and the effect of relapses on patient outcomes.
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