Abstract
Objectives: To describe the impact of cumulative glucocorticoid (GC) doses on related adverse events (AEs) in giant cell arteritis (GCA) in a real-life setting. Methods: The medical charts of the last 139 consecutive GCA patients followed in a tertiary centre were retrospectively analysed. The cumulative GC doses were calculated, and the main GC-related AEs were collected during the follow-up. Results: After a median follow-up duration of 35.6 (2–111) months, the median cumulative GC dose in the 139 patients was 9184 (1770–24,640) mg, and 131 patients (94%) presented at least one GC-related AE. Infections (63%) were the most frequently reported GC-related AE, followed by metabolic events (63%), including weight gain in 51% of them. Cardiovascular and neuropsychiatric events occurred in 51% and 47% of patients, respectively. Osteoporotic fractures, muscular involvement, digestive events, geriatric deterioration, skin fragility, ophthalmologic complications and hypokalaemia were reported in <35% of patients. Cardiovascular events (p = 0.01), osteoporotic fractures (p = 0.004), cataract occurrence (p = 0.03), weight gain (p = 0.04) and infections (p = 0.01) were significantly associated with GC cumulative doses > 9 g. Longer GC durations were associated with cataract occurrence (p = 0.01), weight gain (p = 0.03) and all-grade infections (p = 0.048), especially herpes zoster occurrence (p = 0.003). Neuropsychiatric and metabolic events appeared within the first months after GC introduction, whereas herpes zoster recurred, and most cardiovascular AEs emerged after 1 year. Geriatric events, especially osteoporotic fractures, occurred 2 years after GC introduction. Conclusion: This study highlights how frequent GC-related AEs are and the impact of prolonged GC and cumulative doses.
Highlights
Giant cell arteritis (GCA) is a large vessel vasculitis affecting the aorta and its collaterals, mostly vessels with cephalic destiny [1]
We included and analysed in this study all patients with (1) a diagnosis of GCA depending on the presence of a vasculitis demonstration on temporal artery biopsy or vascular imaging or a clinical presentation suggestive of GCA with a good response to GC and the absence of an alternative diagnosis during the follow-up in a few patients and (2) enough information in the medical files about the daily GC doses to calculate the cumulative doses
Cranial symptoms were present in 112 patients (81%), ophthalmologic involvement in 40 patients (29%) and polymyalgia rheumatica in 51 patients (37%) at diagnosis
Summary
Giant cell arteritis (GCA) is a large vessel vasculitis affecting the aorta and its collaterals, mostly vessels with cephalic destiny [1]. This is the most frequent form of vasculitis among patients over 50 years old. The risk of acute ischaemic complications, especially ophthalmologic involvement with a risk of bilateralization, increases the severity of this vasculitis and pushes for the introduction of an effective initial treatment [2]. The inability to decrease GC doses under a certain dose, usually between 7 and 15 milligrams per day of prednisone equivalent, without disease relapses is generally considered a GC-dependent disease. The adjunction of a GC-sparing immunosuppressant is recommended in this setting
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