Aussedat Marie, Lobbes Hervé, Samson Maxime, Euvrard Romain, Lega Jean-Christophe, Mainbourg Sabine
Institut du Vieillissement I-Vie, Hôpital des Charpennes, Hospices Civils de Lyon, Lyon, France.
Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, F-63100 Clermont-Ferrand, France.
Autoimmun Rev. 2022 Jan;21(1):102930. doi: 10.1016/j.autrev.2021.102930. Epub 2021 Sep 2.
The relapse rate of giant cell arteritis (GCA) is around 48%. Major relapse of GCA is defined by the European League Against Rheumatism as severe ischemic or aortic (stenosis, aneurysm, or aortic dissection) disease of GCA. The objective of the present study was to determine the prevalence and incidence, as well as the spectrum of major relapse in GCA using published data.
The MEDLINE and Cochrane databases were searched up to March 2020. Studies that included patients with newly diagnosed or relapsed GCA receiving glucocorticoids (GC) alone and/or GC-sparing therapy, detailing the number of relapsing patients and the characteristics of relapses were included. The prevalence and incidence of major relapse were pooled using a random-effects model.
Twenty-six studies (including eight randomised controlled trials) involving 2754 patients with GCA were included. The prevalence and incidence of major relapse in this population was 3.3% (95%CI [1.7;5.6]; I = 86%) and 14.5/100 patient-years (95%CI [5.2;27.2]; I = 90%). The clinical manifestations were jaw claudication (44.3%), ophthalmological involvement (32.7%), peripheral limb ischemia (12.5%), aortic (7.7%), and neurological involvements (4.8%). In the meta-regression analysis, the duration of follow-up was negatively associated with the incidence of major relapse (Beta = -0.015, 95%CI [-0.026; -0.0042]; p = 0.0063). The incidence of major relapse was significantly higher in prospective studies (55.2/100 person-years, 95%CI [15.3;114.3] than in retrospective studies (4.1/100 patient-years, 95%CI[1.1;8.4]; p = 0.000.2).
This study found that there was heterogeneity among studies, and this is partially related to study design. Jaw claudication was frequent and increases the prevalence and incidence of relapses major.
巨细胞动脉炎（GCA）的复发率约为48%。欧洲抗风湿病联盟将GCA的主要复发定义为GCA严重的缺血性或主动脉（狭窄、动脉瘤或主动脉夹层）疾病。本研究的目的是利用已发表的数据确定GCA主要复发的患病率、发病率以及复发谱。
检索MEDLINE和Cochrane数据库至2020年3月。纳入的研究包括新诊断或复发的GCA患者，这些患者接受单独的糖皮质激素（GC）和/或糖皮质激素节约疗法，并详细说明了复发患者的数量和复发特征。使用随机效应模型汇总主要复发的患病率和发病率。
纳入了26项研究（包括8项随机对照试验），涉及2754例GCA患者。该人群中主要复发的患病率和发病率分别为3.3%（95%CI[1.7；5.6]；I=86%）和14.5/100患者年（95%CI[5.2；27.2]；I=90%）。临床表现为颌部跛行（44.3%）、眼部受累（32.7%）、外周肢体缺血（12.5%）、主动脉受累（犯7%）和神经受累（4.8%）。在meta回归分析中，随访时间与主要复发的发病率呈负相关（β=-0.015，95%CI[-0.026；-0.0042]；p=0.0063）。前瞻性研究中主要复发的发病率（55.2/100人年，95%CI[15.3；114.3]）显著高于回顾性研究（4.1/100患者年，95%CI[1.1；8.4]；p=0.0002）。
本研究发现各研究之间存在异质性，这部分与研究设计有关。颌部跛行很常见，增加了主要复发的患病率和发病率。
