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About a Third of Patients with GCA will Relapse

June 13 2015 4:00 AM ET via RheumReports RheumReports

Imagine you are treating a new patient with biopsy-proven GCA. As the dose of glucocorticoids is being reduced the question that arises is if and when will their disease flare? At EULAR 2015 a study was presented which aimed to define the frequency of disease flare in a series of patients with biopsy-proven GCA.

This was a retrospective review of 156 patients treated from 1986 to 2007 with a median follow-up of 80 months. The mean age of the patients was 74 and about 80% were female. 

The authors graded all of the biopsies for the severity of inflammation and graded it as mild, moderate, or severe. 

The initial dose of prednisone was 50 mg/day. The median time to reduce to 5 mg per day was 8.5 months and the time to completely stop glucocorticoids was 21 months (range: 12.5 to 36). 66 patients (42%) were able to stop treatment without flares.

Of the 156 patients studied, 57 (36.5%) had at least 1 fare. A flare was defined as a reappearance of signs/symptoms of GCA, resolution of signs/symptoms after starting glucocorticoids, ESR increased above 40 mm/hr and CRP greater that 0.5 mg/dl, and other causes were excluded. The main symptoms at the time of flare was PMR in 44% and headache in 37%. 

The predictive variables of flare included severe inflammation on initial pathology and the presence of a fever at initial diagnosis.

A recent review of the literature (Kermani, J Rheumatol 2015) showed a similar relapse rate of 34%. Other studies have shown slightly higher relapse rates of 41-64%.

The authors did not comment on the use of other immunosuppressants (i.e. MTX) in the treatment of GCA in their population.

The take home point is about a third (1/3) of patients with GCA will flare. The commonest clinical manifestations of a flare include headache and symptoms of PMR. Patients with severe inflammation on initial biopsy and who are febrile at the time of initial diagnosis are at increased risk for flare. This makes sense as more severe disease will likely be more challenging to control. The other question is what effect would the addition of other immunosuppressants have on the rate of flare? 


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About the Author

Dr. Andy Thompson
Dr. Andy Thompson

Dr. Andy Thompson is an Associate Professor at Western University and founder of Rheuminfo.com, Rheumtalks.com, and RheumReports.com.

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