Giant cell arteritis: side effects on steroids were common.

Clinical bottom line (level 4)

  1. Patients with giant cell arteritis or polymyalgia rheumatica who were on steroids, had a variety of side effects, with the commonest being weight gain and vertebral fractures.
  2. Half the patients may gain at least 2kg in weight and a third had suffer a side effect other than weight gain over 12-177 weeks. Major side effects afflicted 4-13%.
Kyle and Hazelman: Annals of the Rheumatic Diseases 1989; 48: 662-666
Expires February 2004

The study

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

Setting: rheumatology clinic, UK

74 patients (aged ?, ?% male) active polymyalgia rheumatica or giant cell arteritis
Patients with polymyalgia rheumatica had 10-20 mg of prednisolone daily. Patients with giant cell arteritis had 40 mg of prednisolone for 5-7 days, then 40 or 20 mg daily from then on.

100% followed for 12-177 weeks (mean 69)
Outcomes studied:
  • at least 2 kg increse in weight
  • any side effect other than weight gain
  • vertebral fracture
  • dyspepsia
  • peptic ulcer
  • diabetes mellitus
  • deep venous thrombosis/pulmonary embolism
  • cataract

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    at least 2 kg increse in weight 12-177 weeks (mean 69) 40/76 52.6%
    (41.4% to 63.9%)
    any side effect other than weight gain 12-177 weeks (mean 69) 27/76 35.5%
    (24.8% to 46.3%)
    vertebral fracture 12-177 weeks (mean 69) 10/76 13.2%
    (5.56% to 20.8%)
    dyspepsia 12-177 weeks (mean 69) 5/76 6.58%
    (2.2% to 14.7%)
    peptic ulcer 12-177 weeks (mean 69) 4/76 5.26%
    (1.5% to 12.5%)
    diabetes mellitus 12-177 weeks (mean 69) 4/76 5.26%
    (1.5% to 12.9%)
    deep venous thrombosis/pulmonary embolism 12-177 weeks (mean 69) 3/76 3.95%
    (0.8% to 11.3%)
    cataract 12-177 weeks (mean 69) 2/76 2.63%
    (0.3% to 9.2%)

    Comments

    1. Uncertain if incidence of diabetes was found through symptomatic patients only or by systematic screening.
    2. How many of these events would have occurred in these patients anyway?
    3. All the patients who experienced side effects took >20 mg per day.
    4. 33/40 (83%) of those with weight gain were women.

    Citation

    1. Kyle V, and Hazelman BL: Treatment of polymyalgia rheumatica and giant cell arteritis II: relation between steroid dose and steroid-associated side effects. Annals of the Rheumatic Diseases 1989; 48: 662-666
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer: Kev Hopayian

    Clinical Question.
    Patient giant cell arteritis or polymyalgia rheumatica
    Intervention or Exposure steroids
    Outcome side effects