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Oral or pulse glucocorticoid use at the onset of giant cell arteritis and its influence on the risk of relapse: a retrospective study

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Abstract

The objective is to investigate whether initial therapy with intravenous methylprednisolone pulses (ivMTP) or oral glucocorticoid (OG) influences the relapse rate in giant cell arteritis (GCA) patients. This is a retrospective observational study of patients with GCA from 2004 to 2021. Demographics, clinical and laboratory variables, cumulative glucocorticoid dose and relapse rate at 6-month follow-up defined according to EULAR recommendations were recorded. Univariate and multivariate logistic regression models were used to determine possible risk factors for relapse. A total of 74 GCA patients were included for analysis (54 (73%) female, mean (SD) age 77.2 (7.4) years). Overall, 47 (63.5%) patients received ivMTP at disease onset and 27 (36.5%) OG. Mean (SD) cumulative prednisone dose (mg) at 6-month follow-up was 3790.7 (1832.7) for patients with ivMTP vs 4298.1 (2930.6) for the OG group, p = 0.37. A total of 15 (20.3%) relapses occurred at 6-month follow-up. Relapse rates did not differ according to the initial therapy (19.1 vs 22.2%, respectively, p = 0.75). In the multivariate analysis, fever at disease onset (OR 4.837; CI 1.1–21.6) and dyslipidemia (OR 5.651; CI 1.1–28.4) were independent predictors for relapse. Initial therapy with ivMTP or OG does not influence the relapse rate of GCA patients. Fever at disease onset and dyslipidemia are independent predictors of disease relapse.

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All data generated or analyzed during the study are included in this published article.

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Funding

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Hospital General Universitario Gregorio Marañón (code: ACGRELREU. Date: 16th February 2022.)

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Authors and Affiliations

  1. Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007, Madrid, Spain

    Laura Trives-Folguera, Juan Molina-Collada, Katerine López, Javier Rivera, Belén Serrano-Benavente, Ana M. Anzola-Alfaro, Isabel Castrejón, José María Álvaro-Gracia & Julia Martínez-Barrio

  2. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain

    Juan Molina-Collada, Javier Rivera, Belén Serrano-Benavente, Ana M. Anzola-Alfaro, Isabel Castrejón, José María Álvaro-Gracia & Julia Martínez-Barrio

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  1. Laura Trives-Folguera
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  2. Juan Molina-Collada
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Contributions

JMB: design the study. JMB, JMO and LT: contributed to collect data. LT: drafted the manuscript, and JMB and JMO revised it critically for important intellectual content. IC: contributed to the analysis of results. All the authors (JMB, JMO, JMA, IC, JR and LT) approved the version to be published.

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Correspondence to Laura Trives-Folguera.

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Trives-Folguera, L., Molina-Collada, J., López, K. et al. Oral or pulse glucocorticoid use at the onset of giant cell arteritis and its influence on the risk of relapse: a retrospective study. Rheumatol Int 43, 1333–1340 (2023). https://doi.org/10.1007/s00296-023-05321-6

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