Trying to Understand Giant Cell Arteritis Relapse
Tanaz A. Kermani, MD, MS, Director of the Vasculitis Program at UCLA
Giant cell arteritis (GCA) is a chronic condition with frequent relapses. A better understanding of why relapses occur might help identify patients who would benefit from longer treatment duration.
Tanaz A. Kermani, MD, MS, Director of the Vasculitis Program at UCLA and others from the Vasculitis Clinical Research Consortium (VCRC) studied the frequency, timing, and clinical features of relapses seen in GCA. Their results were published in the July 2015 edition of the Journal of Rheumatology.
“Many of the previous studies on this issue evaluated relapses retrospectively using a review of records,” said Dr. Kermani. “The VCRC was well suited to answer many questions about relapses in GCA because the data was gathered systematically and patients were followed over time. This enabled us to obtain very useful data on relapses in giant cell arteritis.”
One hundred and twenty eight people were included from across the United States. All were diagnosed using American College of Rheumatology classification criteria. The patients underwent standardized clinical assessments every quarter. These included asking them about symptoms, and gathering physical exam findings and laboratory test results. They were followed for a mean of 21.4 months.
“Many previous studies evaluated relapses using a review of records which can miss important data or give us biased data,” said Dr. Kermani. “We know in recent years that GCA not only affects the temporal arteries but also other large vessels. Most previous studies on relapses included patients with involvement mainly of the temporal arteries. This study was unique because it also to gathered data on patients with GCA and large vessel involvement such as the arteries in the arm which has not been well studied in the past.”
During follow-up, 59 relapses were seen in 44 patients (34%). Ten of these experienced 2 or more relapses.
Symptoms of Relapse
The most common symptoms in relapses included headache and muscle pain and stiffness from polymyalgia rheumatica (PMR). There was increased claudication or cramping from too little blood flow to the muscles (ischemia). Most of the ischemic incidents were short-lived.
Roughly three out of four relapses happened while the person was still on glucocorticoid medications (steroids). Among the 69 people with newly diagnosed disease, 24% relapsed within the first year of diagnosis and half by 24 months.
“The study showed that GCA frequently relapses with headaches and PMR symptoms such as pain and stiffness in the shoulders or hip,” said Dr. Kermani. “The good news is that loss of vision was rare after starting treatment even during relapse.”
Symptom Return on Medication Concerning
Of concern were the findings that the majority of times when symptoms returned, patients were continuing treatment with prednisone. This shows the current treatment, while effective, has limitations.
Often the relapses occur while patients are lowering steroid medications. This results in having to increase them again resulting in additional side effects.
They also noted that the tests used as markers for inflammation were not good predictors of relapse. They could be normal even when patients had symptoms.
Continue Care and Tell Doctors About Changes in Symptoms Important
“The important message for patients is to continue care with their doctors and to bring new or worsening symptoms to their attention,” said Dr. Kermani. “We need to find better ways to assess active disease and also better treatments. Research like this is very important to meet those needs, set agendas for further studies and ultimately improve the lives of our patients.”
Disease Relapses among Patients with Giant Cell Arteritis: A Prospective, Longitudinal Cohort Study.
Kermani TA, Warrington KJ, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Seo P, Merkel PA, Ytterberg SR; Vasculitis Clinical Research Consortium..
J Rheumatol. 2015 Jul;42(7):1213-7.
By Kurt Ullman, RN.