The use of intravenous methylprednisolone in giant cell arteritis: a population-based study.

IF 4.7 2区医学 Q1 RHEUMATOLOGY

Rheumatology Pub Date : 2025-04-01 DOI:10.1093/rheumatology/keae459

Hampus Henningson, Björn Hammar, Aladdin J Mohammad

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引用次数: 0

Abstract

Objectives: To determine clinical characteristics, outcome and occurrence of comorbidities in patients with biopsy-confirmed giant cell arteritis (GCA) treated with intravenous methylprednisolone (IVMP) vs those receiving oral glucocorticoids (OGC) only.

Methods: A retrospective study included patients with GCA diagnosed from 2004 through 2019. Clinical and laboratory characteristics, and cumulative GC dose were compared in patients receiving IVMP vs OGCs. Changes in visual acuity (VA), occurrence of comorbidities after GCA diagnosis, and mortality were analysed.

Results: A total of 419 patients (69% female) were included. In total, 111 patients were initially treated with IVMP, 104 (94%) of whom showed visual manifestations at onset and 308 received OGCs only. Ninety patients (21.5%) exhibited visual involvement at onset, verified by an ophthalmologist. Compared with OGC, patients receiving IVMP exhibited lower inflammatory response at presentation. There was a tendency for improvement in VA with the use of IVMP, but the results were not statistically significant (OR 1.19, 95% CI 0.35-4.01). Patients treated with IVMP had a higher risk of newly diagnosed diabetes mellitus within a year of GCA diagnosis (OR 2.59, 95% CI 1.19-5.63). This risk remained elevated after adjusting for cumulative OGC dose at three months (adjusted OR 3.30, 95% CI 1.29-8.43). There was no difference in survival between treatment groups.

Conclusions: Our study found no evidence supporting any benefit of using IVMP in improving VA or survival. IVMP may increase diabetes risk within a year of GCA diagnosis. Further studies are needed to evaluate the value of IVMP in GCA.

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巨细胞动脉炎中甲基强的松龙的静脉注射--一项基于人群的研究。

研究目的确定活检证实的巨细胞动脉炎（GCA）患者接受静脉甲基强的松龙（IVMP）治疗与仅接受口服糖皮质激素（OGC）治疗的患者的临床特征、预后和合并症发生情况：回顾性研究纳入了2004年至2019年期间确诊的GCA患者。比较了接受IVMP与OGCs治疗的患者的临床和实验室特征以及累积糖皮质激素剂量。分析了视力（VA）的变化、GCA确诊后合并症的发生以及死亡率：共纳入了 419 名患者（69% 为女性）。117名患者最初接受了IVMP治疗，其中104人（94%）在发病时有视觉表现，308人仅接受了OGCs治疗。经眼科医生证实，90 名患者（21.5%）在发病时表现出视觉受累。与 OGC 相比，接受 IVMP 治疗的患者发病时的炎症反应较轻。使用 IVMP 有改善视力的趋势，但结果没有统计学意义（OR 1.19，95% CI 0.35-4.01）。接受 IVMP 治疗的患者在确诊 GCA 后一年内新诊断糖尿病的风险较高（OR 2.59，95% CI 1.19-5.63）。在调整三个月的累积 OGC 剂量后，这一风险仍然较高（调整 OR 3.30，95% CI 1.29-8.43）。治疗组之间的生存率没有差异：我们的研究没有发现任何证据支持使用 IVMP 有助于改善 VA 或生存率。IVMP可能会增加GCA确诊后一年内患糖尿病的风险。需要进一步研究来评估 IVMP 在 GCA 中的价值。

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

Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

7.30%

发文量

1091

审稿时长

2 months

期刊介绍： Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.