Prognostic factors and long term evolution in a cohort of 133 patients with giant cell arteritis

Objective Survival in patients with giant cell arteritis (GCA) has generall y been found to be similar to that of the general population The aim of our study was to assess outcome and survival of different subgroups of patient s with GCA in relation to clinical, biological data or treatment modalities . Methods From 1977 and 1995, 176 patients were treated in the Department of Internal Medicine for GCA. The patient, family or local practitioner,were c ontacted prior to the study (July-October 1995). Treatment modalities and f ollow-up were obtained for 133 patients. All patients (except 11) had 3 or more 1990 ACR classification criteria for GCA. The I I patients with 2 crit eria had a positive temporal biopsy and were included in the study. Results Relapse during corticosteroid tapering treatment was observed in 83 patients (62.4%) with a mean 1.57 relapses per patient. No correlation was found in age, sex, initial dose or type of steroid used (i.e. prednisone o r prednisolone). Only a slight correlation in the initial erythrocyte sedim entation rate (ESR) was observed (p < 0.01, r = 0.23). In 56 patients free of treatment (mean treatment duration: 40 months), 27 (48%) developed a rel apse of the disease I to 25 months later No correlation was found in age, s ex, initial dose of steroid number of relapses during treatment, or initial ESR. Survival analysis was performed using the Kaplan-Meier and Mantel-Men szel methods for comparison of groups. Ar the time of the study: 41 patient s had died (30.7%). A significant reduction of survival M was found with th e presence of permanent visual loss vs absence (p = 0.04), in patients rt h o required more than 10 mg/d of glucocorticoid (p < 0.001) at 6 months trea tment and in patients treated with prednisone (vs prednisolone) (p < 0.01). However, these factors were not independantly associated with sun il al in the multivariate analysis. Conclusion Relapse was observed in 62.4% of the patients during corticoster oid tapering (correlated with initial ESR). A relapse of the disease was al so observed in 48% of patients 1 to 25 months after the end of the treatmen t and was associated with prednisolone use. Long term survival was better i n patients,with no initial ocular manifestations, in patients who took less than 10 mg/day of corticosteroids at 6 months of the treatment and in pati ents treated with prednisolone.