Cronin Owen, Preston Hannah, Fahmy Heba, Kuske Barbara, Singh Malinder, Scott Naomi, Kerrigan Sean, Moran Lucy, Harvie John, Harris Helen, Hauser Barbara, McKay Neil D
Rheumatic Diseases Unit, Western General Hospital.
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh.
Rheumatol Adv Pract. 2022 Mar 9;6(1):rkac017. doi: 10.1093/rap/rkac017. eCollection 2022.
The aim was to describe a modern National Health Service (NHS) Scotland cohort of patients with GCA over 12 months of care to include clinical presentation, practices relating to assessment and treatment, and specifically, the use of tocilizumab.
A multicentre audit of patients newly diagnosed with GCA between November 2019 and October 2021 was established on behalf of the Scottish Society for Rheumatology. Clinical data were collected retrospectively by rheumatology teams at participating NHS centres using electronic patient records. An extended cohort of patients from NHS Lothian was examined to investigate outcomes of tocilizumab use for >1 year.
Sixty-three patients from three NHS Scotland health boards were included, with analysis of data from 216 clinic episodes. Mean follow-up was 371 days. Mean age was 71 years; 62% were female. The most common presenting features were headache (93.6%), scalp tenderness (82.5%) and ocular symptoms (24%). At baseline, 63% of patients had at least one existing risk factor for adverse outcomes from high-dose CS use, namely hypertension (57.1%), diabetes (24%) and osteoporosis (11%). Thirty per cent of all patients (19 of 63) received tocilizumab, with only 11% (7 of 63) receiving tocilizumab owing to glucocorticoid risk factors at baseline. One-quarter of all patients (16 of 63) experienced relapse of GCA during follow-up, of whom six were subsequently treated with tocilizumab.
This multicentre audit demonstrates that despite its availability for patients with risk factors for CS adversity and those who suffer relapse of GCA, tocilizumab is used in less than one-quarter of patients who might benefit. The reasons for this require further exploration.
旨在描述一个苏格兰国民保健服务体系（NHS）中患巨细胞动脉炎（GCA）患者的现代队列，涵盖12个月的护理情况，包括临床表现、评估和治疗相关做法，特别是托珠单抗的使用情况。
代表苏格兰风湿病学会对2019年11月至2021年10月间新诊断为GCA的患者进行了多中心审核。参与的NHS中心的风湿病团队使用电子病历回顾性收集临床数据。对NHS洛锡安地区的一个扩展患者队列进行了检查，以调查托珠单抗使用超过1年的结果。
纳入了来自苏格兰NHS三个健康委员会的63例患者，分析了216次门诊事件的数据。平均随访时间为371天。平均年龄为71岁；62%为女性。最常见的表现特征为头痛（93.6%）、头皮压痛（82.5%）和眼部症状（24%）。基线时，63%的患者至少有一项因高剂量使用糖皮质激素（CS）而导致不良后果的现有风险因素，即高血压（57.1%）、糖尿病（24%）和骨质疏松症（11%）。所有患者中有30%（63例中的19例）接受了托珠单抗治疗，因基线时存在糖皮质激素风险因素而接受托珠单抗治疗的患者仅占11%（63例中的7例）。所有患者中有四分之一（63例中的16例）在随访期间经历了GCA复发，其中6例随后接受了托珠单抗治疗。
这项多中心审核表明，尽管托珠单抗可用于有CS不良反应风险因素的患者以及GCA复发的患者，但在可能受益的患者中，使用托珠单抗的患者不到四分之一。其原因需要进一步探究。
