Henningson Hampus, Hammar Björn, Mohammad Aladdin J
Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden.
Department of Clinical Sciences, Ophthalmology, Lund, Lund, Sweden.
Rheumatology (Oxford). 2025 Apr 1;64(4):2083-2090. doi: 10.1093/rheumatology/keae459.
To determine clinical characteristics, outcome and occurrence of comorbidities in patients with biopsy-confirmed giant cell arteritis (GCA) treated with intravenous methylprednisolone (IVMP) vs those receiving oral glucocorticoids (OGC) only.
A retrospective study included patients with GCA diagnosed from 2004 through 2019. Clinical and laboratory characteristics, and cumulative GC dose were compared in patients receiving IVMP vs OGCs. Changes in visual acuity (VA), occurrence of comorbidities after GCA diagnosis, and mortality were analysed.
A total of 419 patients (69% female) were included. In total, 111 patients were initially treated with IVMP, 104 (94%) of whom showed visual manifestations at onset and 308 received OGCs only. Ninety patients (21.5%) exhibited visual involvement at onset, verified by an ophthalmologist. Compared with OGC, patients receiving IVMP exhibited lower inflammatory response at presentation. There was a tendency for improvement in VA with the use of IVMP, but the results were not statistically significant (OR 1.19, 95% CI 0.35-4.01). Patients treated with IVMP had a higher risk of newly diagnosed diabetes mellitus within a year of GCA diagnosis (OR 2.59, 95% CI 1.19-5.63). This risk remained elevated after adjusting for cumulative OGC dose at three months (adjusted OR 3.30, 95% CI 1.29-8.43). There was no difference in survival between treatment groups.
Our study found no evidence supporting any benefit of using IVMP in improving VA or survival. IVMP may increase diabetes risk within a year of GCA diagnosis. Further studies are needed to evaluate the value of IVMP in GCA.
确定经活检确诊的巨细胞动脉炎（GCA）患者接受静脉注射甲泼尼龙（IVMP）治疗与仅接受口服糖皮质激素（OGC）治疗的临床特征、结局及合并症的发生情况。
一项回顾性研究纳入了2004年至2019年诊断为GCA的患者。比较接受IVMP与OGC治疗的患者的临床和实验室特征以及糖皮质激素累积剂量。分析视力（VA）变化、GCA诊断后合并症的发生情况及死亡率。
共纳入419例患者（69%为女性）。总计111例患者最初接受IVMP治疗，其中104例（94%）在发病时出现视觉表现，308例仅接受OGC治疗。90例患者（21.5%）在发病时出现视觉受累，经眼科医生证实。与OGC相比，接受IVMP治疗的患者在就诊时炎症反应较低。使用IVMP有VA改善的趋势，但结果无统计学意义（OR 1.19，95%CI 0.35 - 4.01）。接受IVMP治疗的患者在GCA诊断后一年内新诊断糖尿病的风险较高（OR 2.59，95%CI 1.19 - 5.63）。在调整三个月时的OGC累积剂量后，该风险仍然升高（调整后OR 3.30，95%CI 1.29 - 8.43）。治疗组之间的生存率无差异。
我们的研究未发现支持使用IVMP改善VA或生存率有任何益处的证据。IVMP可能会增加GCA诊断后一年内患糖尿病的风险。需要进一步研究来评估IVMP在GCA中的价值。
