Risk factors associated with disease relapse in healing/healed arterial injury and biopsy-proven giant cell arteritis.

Abstract

Objective: To compare characteristics of relapses in patients with biopsy-proven giant cell arteritis (GCA) and healing/healed (HH) arterial injury on temporal artery biopsy (TAB).

Design: Single-centre, retrospective cohort study.

Participants: One hundred thirty-five consecutive patients with GCA-positive or HH arterial injury on TAB and minimum 12-month follow-up from January 2009 to December 2018.

Methods: Clinical characteristics and serological markers were evaluated for their potential as risk factors for symptomatic or biochemical relapses.

Results: Relapse rates were 16.9% and 25.7% in the HH and GCA-positive groups, respectively (p = 0.21). Median length of follow-up was 34.8 months in the HH group and 36.6 months in the GCA-positive group. No statistically significant difference between groups with respect to time to relapse, steroid doses at relapse, and presence of symptoms and elevated biomarkers at relapse. In GCA-positive patients, aortitis was associated with relapse (p = 0.050) and with earlier relapse rates (p = 0.007). Aortitis (HR 7.96; p = 0.007) and jaw claudication (HR 5.08; p = 0.019) were found to be independent risk factors for relapse. In HH arterial injury patients, aortitis and aortic aneurysm were associated with earlier relapses (p = 0.044 and p = 0.047, respectively) and were associated with disease relapses on univariable analysis (p = 0.044 and p = 0.047, respectively) but not on multivariable analysis.

Conclusions: The presence of large-vessel vasculitis is associated with disease relapse in both HH and GCA-positive biopsy patients. Similar relapse characteristics between both HH and biopsy-proven patients may suggest that clinicians manage these patients similarly in context of clinical history rather than modify management purely based on pathology findings.