Resolution of vascular inflammation in patients with new-onset giant cell arteritis: data from the RIGA study.
Rheumatology (Oxford)
; 60(8): 3851-3861, 2021 08 02.
Article
em En
| MEDLINE
| ID: mdl-33831144
ABSTRACT
OBJECTIVES:
Efficacy evaluation of GCA treatment is primarily based on non-specific symptoms and laboratory markers. We aimed to assess the change in vascular inflammation in patients with large vessel (LV)-GCA under different treatments using [18F]FDG PET/CT.METHODS:
Observational study on patients with new-onset, active LV-GCA starting treatment with either prednisolone monotherapy (PRED) or combination with MTX or tocilizumab (TOC). All patients underwent baseline and follow-up PET/CT. The aorta and its major branches were assessed using PET vascular activity score (PETVAS) by independent readers. Cumulative glucocorticoid doses and cessation of glucocorticoid treatment were documented in all patients.RESULTS:
We included 88 LV-GCA patients, 27 were treated with PRED, 42 with MTX and 19 with TOC. PETVAS decreased from 18.9-8.0 units at follow-up in the overall population (P <0.001). PETVAS changes were numerically higher in patients receiving MTX (-12.3 units) or TOC (-11.7 units) compared with PRED (-8.7). Mean cumulative prednisolone dosages were 5637, 4418 and 2984 mg in patients treated with PRED, MTX and TOC (P =0.002). Risk ratios for glucocorticoid discontinuation at the time of follow-up PET/CT were 6.77 (95% CI 1.01, 45.29; P =0.049) and 16.25 (95% CI 2.60, 101.73; P =0.003) for MTX and TOC users compared with PRED users.CONCLUSION:
Treatment of LV-GCA inhibits vascular inflammation in the aorta and its major branches. While similar control of vascular inflammation was achieved with PRED, MTX and TOC treatments, TOC showed a strong glucocorticoid sparing effect, supporting the concept of initial combination therapy.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Arterite de Células Gigantes
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Antirreumáticos
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Glucocorticoides
Tipo de estudo:
Observational_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article