巨细胞动脉炎患者的疾病复发：一项前瞻性纵向队列研究。
Disease Relapses among Patients with Giant Cell Arteritis: A Prospective, Longitudinal Cohort Study.
作者信息
Kermani Tanaz A, Warrington Kenneth J, Cuthbertson David, Carette Simon, Hoffman Gary S, Khalidi Nader A, Koening Curry L, Langford Carol A, Maksimowicz-McKinnon Kathleen, McAlear Carol A, Monach Paul A, Seo Philip, Merkel Peter A, Ytterberg Steven R
机构信息
From the Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania; The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; University of California at Los Angeles (UCLA), Los Angeles, California, USA.T.A. Kermani, MD, MS, UCLA; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic College of Medicine; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. Maksimowicz-McKinnon, DO, Division of Rheumatology and Clinical Immunology, University of Pittsburgh; C.A. McAlear, MA, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine, and Division of Rheumatology, University of Pennsylvania School of Medicine; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University
出版信息
J Rheumatol. 2015 Jul;42(7):1213-7. doi: 10.3899/jrheum.141347. Epub 2015 Apr 15.
OBJECTIVE
To evaluate the frequency, timing, and clinical features of relapses in giant cell arteritis (GCA).
METHODS
Patients with GCA enrolled in a prospective, multicenter, longitudinal study were included in the analysis. Relapse was defined as either new disease activity after a period of remission or worsening disease activity.
RESULTS
The study included 128 subjects: 102 women (80%) and 26 men (20%). Mean ± SD age at diagnosis of GCA was 69.9 ± 8.6 years. Mean followup for the cohort was 21.4 ± 13.9 months. Median (interquartile range) duration of disease at study enrollment was 4.6 months (1.2, 16.8). During followup, 59 relapses were observed in 44 patients (34%). Ten patients (8%) experienced 2 or more relapses. The most common symptoms at relapse were headache (42%) and polymyalgia rheumatica (51%), but ischemic (some transient) manifestations (visual symptoms, tongue or jaw claudication, and/or limb claudication) occurred in 29% of relapses (12% cohort). Forty-three relapses (73%) occurred while patients were taking glucocorticoid therapy at a median (range) prednisone dose of 7.5 (0-35) mg. In 21% of relapses, both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal. Among 69 patients enrolled in the cohort with newly diagnosed disease, 24% experienced a first relapse within 12 months after diagnosis.
CONCLUSION
Among patients with GCA, relapses are common, often occurring during treatment. ESR and CRP are frequently normal at times of clinical relapse, highlighting the need for better biomarkers to assess disease activity in GCA. There remains a need for effective therapeutic alternatives to glucocorticoids in GCA.
目的
评估巨细胞动脉炎（GCA）复发的频率、时间及临床特征。
方法
纳入一项前瞻性、多中心、纵向研究的GCA患者进行分析。复发定义为缓解期后出现新的疾病活动或疾病活动加重。
结果
该研究纳入128例受试者，其中102例女性（80%），26例男性（20%）。GCA诊断时的平均年龄±标准差为69.9±8.6岁。队列的平均随访时间为21.4±13.9个月。研究入组时疾病的中位（四分位间距）病程为4.6个月（1.2，16.8）。随访期间，44例患者（34%）出现59次复发。10例患者（8%）经历2次或更多次复发。复发时最常见的症状是头痛（42%）和风湿性多肌痛（51%），但缺血性（部分为短暂性）表现（视觉症状、舌或颌部跛行和/或肢体跛行）在29%的复发中出现（占队列的12%）。43次复发（73%）发生在患者服用糖皮质激素治疗期间，泼尼松剂量的中位值（范围）为7.5（0 - 35）mg。21%的复发中，红细胞沉降率（ESR）和C反应蛋白（CRP）均正常。在队列中69例新诊断疾病的患者中，24%在诊断后12个月内出现首次复发。
结论
在GCA患者中，复发很常见，且常发生在治疗期间。临床复发时ESR和CRP常正常，这凸显了需要更好的生物标志物来评估GCA的疾病活动。GCA仍需要有效的糖皮质激素替代治疗方案。
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