Giant cell arteritis: relapses were common.

Clinical bottom line (level 2c)

  1. In patients with polymylagia rheumatica or giant cell arteritis, relapses were common in the first two years, but decrease over time. Many were after by reducing the steroid dose.
  2. Only a quarter of patients were able to stop steroids within two years.
Kyle and Hazelman: Annals of the Rheumatic Diseases 1993; 52: 847-850
Expires February 2001

The study

Prospective cohort study with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, UK

74 patients (aged mean 71 years, 77% female) active untreated polymyalgia rheumatica or giant cell arteritis, treated with steroids
Prednisolone mainly controlled by doctors.

96% followed for about 2 years, every 2-3 months
Outcomes studied:
  • relapses at 0-6 months
  • relapse at 6-12 months
  • relapse 12-24 months
  • relapse at >24 months
  • relapse in polymyalgia rheumatica
  • relapse in giant cell arteritis
  • relapse in both

    • 39 patients had polymyalgia rheumatic; 17 had giant cell arteritis; 17 both.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    relapses at 0-6 months about 2 years, every 2-3 months 37/74 50.0%
    (38.6% to 61.4%)
    relapse at 6-12 months about 2 years, every 2-3 months 14/74 18.9%
    (10.0% to 27.8%)
    relapse 12-24 months about 2 years, every 2-3 months 16/74 21.6%
    (12.2% to 31.0%)
    relapse at >24 months about 2 years, every 2-3 months 7/74 9.46%
    (2.79% to 16.1%)
    relapse in polymyalgia rheumatica about 2 years, every 2-3 months 24/39 61.4%
    (46.3% to 76.8%)
    relapse in giant cell arteritis about 2 years, every 2-3 months 4/17 23.5%
    (3.37% to 43.7%)
    relapse in both about 2 years, every 2-3 months 9/17 52.9%
    (29.2% to 76.7%)

    • Many relapses occurred when steroid dose was ~10mg/day

    Comments

    1. The context (a clinic where GPs sent cases they would normally have dealt with themselves) means that - unlike many hospital based studies - the bottom line is generalisable to general practice.
    2. 54% of relapses occurred after reducing steroid dose.
    3. Relapses were not predicted by EST, CPR or temporal artery biopsy.
    4. 24% of patients had stopped steroids at 2 years.

    Citation

    1. Kyle V, and Hazelman BL: Clinical and laboratory course of polymyalgia rheumatica/giant cell arteritis after the first two months of treatment. Annals of the Rheumatic Diseases 1993; 52: 847-850
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: Kev Hopayian

    Clinical Question.
    Patient polymyalgia rheumatica or giant cell arteritis
    Intervention or Exposure prevalence
    Outcome relapses