Giant cell arteritis: steroids were used for an average of about two years.

Clinical bottom line (level 4)

  1. In patients with polymyalgia rheumatica or temporal arteritis who were given corticosteroids, a fifth had a relapse within 11 years, a quarter had steroid-related adverse effects and nearly a tenth had visual or neurological complications.
  2. Patients were at an increased risk of visual or neurological complications if they were male (NNF = 3 for 11 years) .
  3. The mean duration of steroid treatment was 28 months.
Delecoeuillerie et al: Annals of Rheumatic Diseases 1988; 47: 733-739
Expires November 2004

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, France

230 patients (aged mean 75 years, 66% female) with polymyalgia rheumatica (PMR) or temporal arteritis (TA), and were closely followed up. 132 had pure PMR; 38 pure TA; 40 mixed TA/ PMR
All patients had laboratory investigations including ESR, haemoglobin, white cell count, alkaline phosphatase, plasma proteins, creatine kinase, rheumatoid factor and antinuclear antibodies. Patients were treated with corticosteroids.

91% followed for 11 years
Outcomes studied:
  • relapse
  • steroid-related adverse effects
  • visual or neurological complications

    • 20 patients did not have enough information in notes to complete the study.
    • Patients were split into group A and group B:
      • A: clinically pure PMR (pain or morning stiffness in shoulder/pelvis, aged >50y, raised inflammatory indicators, absence of evidence of other autoimmune disease, prompt response to steroid treatment)
      • B: clinical TA (recent temporal arterial pain, jaw claudication, tender or swollen artery, pthalic problems, fever weight loss or fatigue, aged >50, increased inflammatory markers, with any factors of PMR)

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    relapse 11 years 37/210 18%
    (12% to 23%)
    steroid-related adverse effects 11 years 51/210 24%
    (18% to 30%)
    visual or neurological complications 11 years 15/210 7%
    (3.7% to 11%)

    prognostic factor for
    visual or neurological complications     		time to outcome control rate (%) unadjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    male 11 years 5/68
    (7.3%)     		4.30
    (1.30 to 14.2)     		3
    (2 to 22)

    • Mean (standard deviation) duration of corticosteroid treatment (months):
      • group A: 25.7 (137)
      • group B: 30.9 (124)
      . There was no significant difference.
    • Visual complications
      • group A: None (upper limit 4 people; 2.8%)
      • group B: 15
    • Relapse:
      • group A: 16
      • group B: 21
    • Steroid-related adverse effects:
      • group A: 10
      • group B: 41

    Citation

    1. Delecoeuillerie G, Joly P, Cohen de Lara A, et al: Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients). Annals of Rheumatic Diseases 1988; 47: 733-739
    Contributor: Clare Wotton and Bob Phillips, November 2000
    Reviewer:

    Clinical Question.
    Patient PMR or TA
    Intervention or Exposure corticosteroids
    Outcome length of treatment, side effects, relapse