Clinical Manifestations and Prognosis of Giant Cell Arteritis: A Retrospective Cohort Study

IF 0.8 4区生物学 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY

Doklady Biochemistry and Biophysics Pub Date : 2024-07-13 DOI:10.1134/S1607672924700984

E. E. Fedorinova, N. M. Bulanov, A. D. Meshkov, O. O. Borodin, I. O. Smitienko, E. V. Chachilo, A. A. Nartov, A. L. Filatova, A. V. Naumov, P. I. Novikov, S. V. Moiseev

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Abstract

The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA).

. A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan–Meier method.

. The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0–54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined.

Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

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巨细胞动脉炎的临床表现和预后：一项回顾性队列研究

研究旨在评估巨细胞动脉炎（GCA）患者的临床表现和存活率。一项回顾性研究纳入了 166 名新确诊的 GCA 患者。临床、实验室和仪器数据以及三套分类标准用于确诊：美国风湿病学会（ACR）1990 年标准、2016 年修订版 ACR 标准和/或 ACR 和欧洲风湿病学协会联盟（EULAR）2022 年新标准。部分患者接受了仪器检查：颞动脉超声多普勒（61例）、对比增强计算机断层扫描（5例）、CT血管造影（6例）、磁共振成像（4例）、MR血管造影（3例）和18F-FDG PET/CT（47例）。采用生存表和 Kaplan-Meier 法分析总生存率和无复发生存率。GCA最常见的首发症状是头痛（81.8%）、乏力（64%）、发热（63.8%）和风湿性多肌痛症状（56.6%）。61 名患者中有 44 人在彩色双相扫描中发现颞动脉发生变化。所有同意接受治疗的患者（158 人）都接受了转基因药物治疗，158 名患者中有 49 人使用了甲氨蝶呤，9 人使用了来氟米特。在 158 例患者中，有 45 例（28.5%）患者在接受 GC 单一疗法后病情得到稳定缓解；有 120 例（75.9%）患者需要长期接受 GCs 维持疗法以防止病情恶化，其中 71 例（44.9%）患者与甲氨蝶呤或其他免疫抑制剂联合使用。有复发史的患者的随访时间为 21.0（8.0-54.0）个月。73例（46.2%）患者复发。总的一年生存率为97.1% [95% CI 94.3; 99.9]，五年生存率为94.6% [95% CI 90.2; 99.0]。一年无复发生存率为86.4% [95% CI 80.5; 92.3]，五年无复发生存率为52.4% [95% CI 42.0; 62.8]。166名患者中有12人（7.2%）死亡。两名患者的死因是心肌梗死，两名患者是中风，一名患者是乳腺癌；其余七名患者的死因未确定：结论：鉴于 GCA 患者病情恶化的频率很高，需要对其进行长期随访，尤其是在确诊后的第一年。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Doklady Biochemistry and Biophysics 生物-生化与分子生物学

CiteScore

1.60

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Doklady Biochemistry and Biophysics is a journal consisting of English translations of articles published in Russian in biochemistry and biophysics sections of the Russian-language journal Doklady Akademii Nauk. The journal''s goal is to publish the most significant new research in biochemistry and biophysics carried out in Russia today or in collaboration with Russian authors. The journal accepts only articles in the Russian language that are submitted or recommended by acting Russian or foreign members of the Russian Academy of Sciences. The journal does not accept direct submissions in English.