Abstract：
BACKGROUND: Steroids and anti-IL6 biotherapy are highly effective in obtaining remission in patients with giant cell arteritis (GCA) but the risk of relapses remains high. We aimed to identify predictors of relapse in GCA.
METHODS: All consecutive patients admitted with a new diagnosis of GCA - according to the 2022 American College of Rheumatology/EULAR (ACR/EULAR) classification criteria - between May 2011 and May 2022 were eligible for this study. The primary outcome was the GCA relapse rate over the 36-months follow up. Factors associated with the primary outcome and time to first relapse were analyzed.
RESULTS: One hundred and eight patients (74 [69-81] years, 64.8% women) with a new diagnosis of GCA were studied. GCA was biopsy-proven in 65 (60.2%) cases. Ninety-eight (90.7%) FDG/PET CT scans performed at diagnosis were available for review. All patients received steroids given for 21.0 [18.0-28.5] months, associated with methotrexate (n=1, 0.9%) or tocilizumab (n=2, 1.9%). During a median follow-up of 27.5 [11.4-35.0] months, relapse occurred in 40 (37%) patients. Multivariable Cox regression model, including general signs, gender, aortic wall thickness, FDG uptake in arterial wall and IV steroid pulse as covariates, showed that both general signs (HR 2.0 [1.0-4.0, P<0.05) and FDG uptake in limb arteries (HR 2.7 [1.3-5.5], P<0.01) at diagnosis were associated with GCA relapse.
CONCLUSIONS: FDG uptake in limb arteries at diagnosis is a predictor of relapse in newly diagnosed GCA.
METHODS: All consecutive patients admitted with a new diagnosis of GCA - according to the 2022 American College of Rheumatology/EULAR (ACR/EULAR) classification criteria - between May 2011 and May 2022 were eligible for this study. The primary outcome was the GCA relapse rate over the 36-months follow up. Factors associated with the primary outcome and time to first relapse were analyzed.
RESULTS: One hundred and eight patients (74 [69-81] years, 64.8% women) with a new diagnosis of GCA were studied. GCA was biopsy-proven in 65 (60.2%) cases. Ninety-eight (90.7%) FDG/PET CT scans performed at diagnosis were available for review. All patients received steroids given for 21.0 [18.0-28.5] months, associated with methotrexate (n=1, 0.9%) or tocilizumab (n=2, 1.9%). During a median follow-up of 27.5 [11.4-35.0] months, relapse occurred in 40 (37%) patients. Multivariable Cox regression model, including general signs, gender, aortic wall thickness, FDG uptake in arterial wall and IV steroid pulse as covariates, showed that both general signs (HR 2.0 [1.0-4.0, P<0.05) and FDG uptake in limb arteries (HR 2.7 [1.3-5.5], P<0.01) at diagnosis were associated with GCA relapse.
CONCLUSIONS: FDG uptake in limb arteries at diagnosis is a predictor of relapse in newly diagnosed GCA.
摘要：
简介类固醇和抗IL6生物疗法在巨细胞动脉炎（GCA）患者中获得缓解方面非常有效，但复发的风险仍然很高。我们旨在确定GCA复发的预测因子。方法2011年5月至2022年5月，根据2022年美国风湿病学/EULAR（ACR/EULAR）分类标准，所有新诊断为GCA的连续患者均符合本研究的条件。主要结果是36个月随访期间的GCA复发率。分析与主要结局和首次复发时间相关的因素。结果108例患者（74[69-81]年，64.8％的女性）对GCA的新诊断进行了研究。65例（60.2%）患者经活检证实为GCA。诊断时进行的98（90.7％）FDG/PETCT扫描可供审查。所有患者接受类固醇治疗21.0[18.0-28.5]个月，与甲氨蝶呤（n=1，0.9％）或托珠单抗（n=2，1.9％）相关。在27.5[11.4-35.0]个月的中位随访期间，40例(37%)患者出现复发.多变量Cox回归模型，包括一般标志，性别,主动脉壁厚度,动脉壁FDG摄取和静脉类固醇脉冲作为协变量，显示肢体动脉的一般体征（HR2.0[1.0-4.0，p<0.05）和FDG摄取（HR2.7[1.3-5.5]，诊断时p<0.01)与GCA复发相关。结论诊断时肢体动脉中FDG的摄取是新诊断GCA复发的预测因素。
