Biomarker trajectories and risk of relapse in giant cell arteritis: a multicenter study
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Published on: February 8, 2019
Samuel Pichon1, Amélie Leurs2, Léa Mortain3
1Univ. Lille, CHU Lille, Service de Médecine Interne, Centre de référence des Maladies Auto-Immunes et Auto-inflammatoires Systémiques rares de l'Adulte du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Inserm, INFINITE, U1286, Lille, France.
Objective:
The relative value of plasma fibrinogen (PF) compared with C-reactive protein (CRP) for longitudinal monitoring in giant cell arteritis (GCA) is uncertain. We assessed their performance as biomarkers of disease activity and predictors of relapse.
Methods:
We conducted a multicenter retrospective study of 465 patients diagnosed with GCA between 2000 and 2023 fulfilling GiACTA inclusion criteria. Baseline demographic, clinical, laboratory, imaging, and treatment data were collected. In a subset of 135 patients diagnosed from 2017 to 2022, CRP and PF were collected until relapse or up to 2 years. Associations between biomarker dynamics and relapse were analyzed using joint modeling.
Results:
Among 465 patients, 34.2% experienced ≥ 1 relapse within 5 years. At diagnosis, headache, jaw claudication and aortic FDG uptake on PET-CT were associated with higher relapse risk. PF normalization at 1 month was associated with a lower relapse risk over 2 years (HR 0.14, 95% CI 0.07-0.28; p < 0.001). PF at month 1 showed good discrimination for relapse (AUC 0.82, bootstrap 95% CI 0.69-0.91), with an exploratory ROC-derived cut-off of 3.77 g/L (bootstrap 95%CI, 3.45-3.97) yielding a sensitivity of 71.8%, and a specificity of 90.0%. Individual trajectories of CRP and PF were heterogeneous and identified distinct phenotypes associated with different relapse risks.
Conclusion:
In our GCA cohort, relapse risk was associated with cranial manifestations and aortic uptake on PET-CT at diagnosis. PF normalization at 1 month was identified as an early marker of a lower relapse risk, although this biomarker requires external validation. CRP and PF trajectories identified distinct phenotypes associated with different relapse risks, supporting further evaluation of longitudinal biomarker-guided follow-up.