Treating Patients with Giant Cell Arteritis Is Complicated by Relapses

Patients with giant cell arteritis (GCA) often are treated successfully with steroids, but tapering steroids can be difficult. In addition, relapses are common in GCA patients, and no steroid-sparing secondary therapies are uniformly successful. In this multicenter longitudinal study, U.S. investigators evaluated the frequency and features of relapses in 128 patients with GCA who were followed for a median 21 months. All patients (80% women; mean age at diagnosis, 70) met modified 1990 American College of Rheumatology criteria for GCA (Arthritis Rheum 1990; 33:1122), which do not require temporal artery biopsy for diagnosis; in this study, biopsy was done in 103 patients and was consistent with GCA in 80 patients. Relapse was defined as either new disease activity after a period of remission or worsening disease activity.

During follow-up, 59 relapses occurred in 44 patients (34%). The most common GCA symptoms at the time of relapse were headache (42%) and polymyalgia rheumatica (51%); ischemic symptoms (limb claudication, jaw or tongue claudication, and vision problems) were noted in 29%. Most relapses (73%) occurred while patients were still taking glucocorticoids (median prednisone dose at the time of relapse, 7.5 mg daily); only 11 relapses (17%) occurred after stopping prednisone. Of note, erythrocyte sedimentation rates and C-reactive protein levels were normal in eight relapses. Other medications patients were taking at the time of relapse included methotrexate (13 relapses), anti–tumor necrosis factor therapies (2 relapses), and mycophenolate mofetil (2 relapses).