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Published on: February 8, 2019
Characteristics of patients with major relapse in giant cell arteritis: a multicenter case-control study
Alice Rubinsztajn1, Simon Parreau2, Laurent Sailler3
1Service de Médecine Interne Et Pathologies Vasculaires, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre-Bénite, France.
Insights
Younger age at diagnosis is the primary predictor of major relapses in giant cell arteritis (GCA). Relapse types, cranial or large-vessel, often reflect the initial GCA presentation.
Area of Science:
- Rheumatology
- Internal Medicine
- Vasculitis Research
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis affecting large arteries.
- Understanding relapse predictors is crucial for managing GCA and preventing complications.
- Major relapses (MR) in GCA can significantly impact patient outcomes.
Purpose of the Study:
- To identify independent predictors of major relapses (MR) in patients diagnosed with giant cell arteritis (GCA).
- To compare the clinical characteristics of different major relapse phenotypes in GCA.
- To investigate potential associations between initial disease presentation and relapse patterns.
Main Methods:
- A multicenter retrospective case-control study involving patients meeting GCA diagnostic criteria.
- Cases were defined as patients experiencing MR based on 2018 EULAR criteria; controls were GCA patients without MR (1:3 ratio).
- Univariate and multivariate logistic regression analyses were employed to identify independent predictors of MR, with subclassification into cranial-MR and large-vessel-MR.
Main Results:
- Younger age at diagnosis was the sole independent predictor of MR (OR=0.93 per 10 years, p=0.043).
- No other significant clinical, laboratory, or imaging risk factors for MR were identified.
- Cranial-MR (48.6%) and large-vessel-MR (51.4%) showed distinct clinical features, often mirroring initial GCA presentation, with cranial-MR associated with older age and cranial symptoms, and large-vessel-MR with female sex and aortitis.
Conclusions:
- Younger age at diagnosis is a key risk factor for major relapses in GCA.
- Distinct clinical phenotypes of cranial and large-vessel GCA relapses exist, correlating with initial disease presentation.
- This study highlights the importance of age at diagnosis in predicting GCA relapse and suggests distinct GCA subtypes based on relapse patterns.
Objectives:
The objective was to identify predictive factors for major relapses (MR) in patients with giant cell arteritis (GCA) and to compare clinical characteristics between MR phenotypes.
Method:
This multicenter retrospective case-control study included patients fulfilling GiaCTA criteria for GCA. Cases were patients experiencing MR according to 2018 EULAR definitions. Controls were GCA patients without MR with a 1:3 ratio. Data were collected and analyzed using univariate and multivariate logistic regression to determine factors independently associated with MR. MR was subclassified into cranial-MR and large-vessel-MR which were compared using appropriate statistical tests.
Results:
258 patients were included, 70 cases and 188 controls (48.4% minor relapse, and 24.4% without relapse). The mean age at diagnosis was 72.5 ± 8.6 years, 70,9% were females. Younger age at diagnosis was associated with an increased risk of MR (OR = 0.93 per 10 years, 95% CI [0.87; 0.999], p = 0.043). No other clinically significant risk factors were identified. Among the 70 cases, 48.6% had a cranial-MR and 51.4% a large-vessel-MR. Patients with a cranial-MR were older (74.3 ± 6.3 years vs. 67.3 ± 7.0 years, p < 0.001) and were more likely to have cranial symptoms at diagnosis of GCA (91.2% vs. 69.4%, p = 0.023) compared to those with a large-vessel-MR. Compared with cranial-MR, large-vessel MR was more frequent in women (80.5% vs. 52.9%, p < 0.01) and tended to be associated with aortitis at diagnosis (70.0% vs. 43.5%, p = 0.052).
Conclusions:
Younger age at diagnosis was the only independent predictor of MR. Relapse patterns mirrored initial disease phenotype, supporting the existence of cranial and large-vessel GCA subtypes. Key Points •Younger age at diagnosis is associated with a higher risk of major relapse in giant cell arteritis. •Cranial and large-vessel major relapses display distinct clinical patterns, often mirroring the initial disease phenotype. •No strong laboratory or imaging predictor of major relapse was identified in this multicentre case-control study.
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