Relapses in giant cell arteritis: Updated review for clinical practice.

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.