Towards a holistic approach of Giant Cell Arteritis management: Predictors of relapse after initial treatment - results of a prospective follow up study

Abstract

Background
This study was carried out aiming to: 1. Assess the prognostic role of the clinical as well as ultrasound (US) measures of inflammation for predicting the risk of relapse, and the need for adjunctive biologic therapy. 2. Evaluate the rapidity and sensitivity to change of US measures in the initial months following the diagnosis and initiation of treatment of GCA. 3. Stratify Giant Cell Arteritis (GCA) patients according to their risk of relapse and the possibility of early prediction and classification of the individual subject. This was based on a prospective follow up study which included 67 GCA patients diagnosed according to the EULAR/ACR classification criteria and monitored for 12-months period.


Results
Ultrasound OMERACT ultrasonography score for giant cell arteritis (OGUS) scores significantly improved between baseline and 4 weeks (P = 0.001) and the improvement was persistent from 2–12 months (P = 0.01) in non-relapsing patients, whereas negative changes in the OGUS scores, as early as 8-12-weeks of therapy, in comparison to the baseline or last assessment visit, were an early predictor of relapse. Negative changes in the patient’s functional ability and worsening of the disease activity score were also predictors of relapse (p< 0.001).


Conclusion
The extent and severity of GCA disease assessed and monitored by health-related quality of life measure, disease activity status as well as ultrasound measures have a prognostic role. US is a useful tool for monitoring GCA disease activity and in association with other conventional biomarkers and disease activity score, they can predict the disease relapse.