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Mahr A, Hachulla E, de Boysson H, Guerroui N, Héron E, Vinzio S, Broner J, Lapébie FX, Michaud M, Sailler L, Zenone T, Djerad M, Jouvray M, Shipley E, Tieulie N, Armengol G, Bouldoires B, Viallard JF, Idier I, Paccalin M, Devauchelle-Pensec V. Presentation and Real-World Management of Giant Cell Arteritis (Artemis Study). Front Med (Lausanne) 2021; 8:732934. [PMID: 34859001 PMCID: PMC8631900 DOI: 10.3389/fmed.2021.732934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Few studies of daily practice for patients with giant cell arteritis (GCA) are available. This French study aimed to describe the characteristics and management of GCA in a real-life setting. Methods: Cross-sectional, non-interventional, multicenter study of patients ≥50 years old who consulted hospital-based specialists for GCA and were under treatment. Patient characteristics and journey, diagnostic methods and treatments were collected. Descriptive analyses were performed. Results: In total, 306 patients (67% females, mean age 74 ± 8 years old) were recruited by 69 physicians (internists: 85%, rheumatologists: 15%); 13% of patients had newly diagnosed GCA (diagnosis-to-visit interval <6 weeks). Overall median disease duration was 13 months (interquartile range 5–26). Most patients were referred by general practitioners (56%), then ophthalmologists (10%) and neurologists (7%). Most common comorbidities were hypertension (46%), psychiatric disorders (10%), dyslipidemia (12%), diabetes (9%), and osteoporosis (6%). Initial GCA presentations included cranial symptoms (89%), constitutional symptoms (74%), polymyalgia rheumatica (48%), and/or other extra-cranial manifestations (35%). Overall, 85, 31, 26, and 30% of patients underwent temporal artery biopsy, high-resolution temporal artery Doppler ultrasonography, 18FDG-PET, and aortic angio-CT, respectively. All patients received glucocorticoids, which were ongoing for 89%; 29% also received adjunct medication(s) (methotrexate: 19%, tocilizumab: 15%). A total of 40% had relapse(s); the median time to the first relapse was 10 months. Also, 37% had comorbidity(ies) related to or aggravated by glucocorticoids therapy. Conclusion: This large observational study provides insight into current medical practices for GCA. More than one third of patients had comorbidities related to glucocorticoid therapy for a median disease duration of 13 months. Methotrexate and tocilizumab were the most common adjunct medications.
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Affiliation(s)
- Alfred Mahr
- Department of Internal Medicine, University Hospital Paris (AP-HP, Saint Louis), Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Nassim Guerroui
- Department of Rheumatology, European Hospital of Marseille, Marseille, France
| | - Emmanuel Héron
- Department of Internal Medicine, Hospital Quinze-Vingts, Internal Medicine, Paris, France
| | - Stéphane Vinzio
- Department of Internal Medicine, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Jonathan Broner
- Department of Internal Medicine, University Hospital Centre Nimes, Nimes, France
| | | | - Martin Michaud
- Department of Internal Medicine, Hopital Joseph Ducuing Toulouse, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, University Hospital of Toulouse, Toulouse, France
| | - Thierry Zenone
- Department of Internal Medicine, General Hospital of Valence, Valence, France
| | - Mohamed Djerad
- Department of Internal Medicine, General Hospital of Nevers, Nevers, France
| | - Mathieu Jouvray
- Department of Internal Medicine, General Hospital of Arras, Arras, France
| | - Emilie Shipley
- Department of Rheumatology, General Hospital of Dax, Dax, France
| | - Nathalie Tieulie
- Department of Rheumatology, University Hospital of Nice, Nice, France
| | - Guillaume Armengol
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Bastien Bouldoires
- Department of Internal Medicine, Civil Hospital of Colmar, Colmar, France
| | | | - Isabelle Idier
- Medical Affairs, Chugai Pharma France, Paris La Défense, Paris, France
| | - Marc Paccalin
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
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Dammacco R, Alessio G, Giancipoli E, Leone P, Cirulli A, Resta L, Vacca A, Dammacco F. Giant Cell Arteritis: The Experience of Two Collaborative Referral Centers and an Overview of Disease Pathogenesis and Therapeutic Advancements. Clin Ophthalmol 2020; 14:775-793. [PMID: 32210531 PMCID: PMC7073434 DOI: 10.2147/opth.s243203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Giant cell arteritis (GCA), a chronic vasculitis of the large and medium-sized arteries, affects people >50 years of age. This study assessed the prevalence of visual manifestations and other clinical features at presentation in an Italian cohort of GCA patients. Recent advances in the pathophysiology, diagnosis, and therapy of GCA are also reviewed. Methods This retrospective, single-center study conducted by the ophthalmology and internal medicine clinics of one university recruited 56 patients from 2005 to 2016 and followed them for 11-54 months. Results Ocular involvement was diagnosed in 19 patients (33.9%), with permanent vision loss in 19.6% (7.1% of the cohort with bilateral vision loss). Arteritic anterior and posterior ischemic optic neuropathy were diagnosed in 11 patients (57.9%) and 1 patient (5.3%), respectively, cotton wool spots in 3 patients (15.8%), central retinal artery occlusion in 2 patients (10.5%), and anterior segment ischemia and multifocal choroidal ischemia in 1 patient each (5.3%). Polymyalgia rheumatica was associated with GCA in 44.6% of the patients. The most common extra-ocular manifestation was constitutional symptoms (82.1% of the patients). Large-vessel involvement, including of the ascending aorta, aortic arch, and left axillary artery, was diagnosed by magnetic resonance or computed tomography (CT) angiography and 18FDG positron emission/CT. Glucocorticoids (GCs) remain the standard-of-care worldwide, but methotrexate, provided as a steroid-sparing drug in 41% of the patients, resulted in earlier tapering, a lower cumulative dose of GCs, and a lower rate of relapse. Among the combinations of GCs and immunosuppressive drugs proposed to treat GCA, only tocilizumab has effectively induced and maintained disease remission. Conclusion According to our data and literature reports: a) GCA is a systemic disease; b) its diagnosis is expedited by the adjunct use of imaging techniques; c) insights into the pathogenesis of GCA may allow an improved, differentiated therapeutic approach.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Ermete Giancipoli
- Department of Biomedical Sciences, Ophthalmology Unit, University of Sassari, Sassari, Italy
| | - Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Anna Cirulli
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Leonardo Resta
- Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
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Update on the epidemiology, risk factors, and outcomes of systemic vasculitides. Best Pract Res Clin Rheumatol 2018; 32:271-294. [DOI: 10.1016/j.berh.2018.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
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De Smit E, Clarke L, Sanfilippo PG, Merriman TR, Brown MA, Hill CL, Hewitt AW. Geo-epidemiology of temporal artery biopsy-positive giant cell arteritis in Australia and New Zealand: is there a seasonal influence? RMD Open 2017; 3:e000531. [PMID: 29225921 PMCID: PMC5706482 DOI: 10.1136/rmdopen-2017-000531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 11/04/2022] Open
Abstract
Objective Previous studies, although inconclusive, have suggested possible associations of environmental risk factors with the development of giant cell arteritis (GCA). We aim to investigate seasonal influence on the incidence of GCA across Australia and New Zealand. Methods In establishing an international study to investigate the molecular aetiology of GCA, archived temporal artery biopsy (TAB) specimens primarily from Australia and New Zealand were obtained. Demographic details including age, sex and date of TAB were collected from collaborating pathology departments. The season in which GCA was diagnosed was determined and compared with previous reports investigating the association between environmental risk factors and GCA. Results Our study comprises data from 2224 TAB-positive patients with GCA; 2099 of which were from patients in Australia and New Zealand. The mean age at time of diagnosis was 76.4 years of age. The female-to-male ratio was 2.2:1. We noted equal distribution of the incidence rate across all four seasons (530-580 cases diagnosed every quarter). Statistical analysis of seasonal variation by Poisson regression and cosinor methods showed no incidence preponderance across seasons. Our results do not support a seasonal component contributing to the onset of disease. Our literature search identifies no consistent environmental risk factor in association with GCA. Conclusion This is the largest GCA data set reported outside of Europe. Our results demonstrate equal distribution of the incidence rate across all four seasons. In contrast to some earlier reports, we did not identify evidence of a seasonal component contributing to the onset of disease.
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Affiliation(s)
- Elisabeth De Smit
- Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Linda Clarke
- Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Paul G Sanfilippo
- Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Tony R Merriman
- Department of Biochemistry, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Matthew A Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Catherine L Hill
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Alex W Hewitt
- Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.,Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
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Broder MS, Sarsour K, Chang E, Collinson N, Tuckwell K, Napalkov P, Klearman M. Corticosteroid-related adverse events in patients with giant cell arteritis: A claims-based analysis. Semin Arthritis Rheum 2016; 46:246-252. [PMID: 27378247 DOI: 10.1016/j.semarthrit.2016.05.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/16/2016] [Accepted: 05/27/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Corticosteroids (CS) are standard treatment for giant cell arteritis (GCA), but concerns persist over toxicities associated with long-term use. In this retrospective study of medical claims data, we estimated risks for adverse events (AEs) in CS-treated GCA patients. METHODS Cox regression analyses with CS use as a time-dependent variable were conducted on data from the 2003 to 2012 Truven Health Analytics MarketScan Database. Patients 50 years of age and older who had ≥2 claims of newly diagnosed GCA, ≥1 filled oral CS prescription, and no AEs before GCA diagnosis were included. The primary outcome was presence of a new CS-related AE. RESULTS In total, 2497 patients were included. Their mean age was 71.0 years, and 71% were women. Follow-up was 9680 patient-years (PY). CS treatment continued for a mean (SD) of 1.196 (729.2) days; mean (SD) prescribed cumulative CS dose was 6983.3mg (6519.9). The overall AE rate was 0.43 events/PY; the most frequent AEs were cataract and bone disease. For each 1000-mg increase in CS exposure, the hazard ratio (HR) increased by 3% (HR = 1.03; 95% CI: 1.02-1.05; P < 0.001). Additionally, statistically significant individual associations between increased CS exposure and AE risk were observed for bone-related AEs (P < 0.001), cataract (P < 0.001), glaucoma (P = 0.005), pneumonia (P = 0.003), and diabetes mellitus (P < 0.001 in a subset of patients with no previous history of diabetes). CONCLUSION CS exposure significantly increased risk for potentially serious AEs, emphasizing a need for new treatment options for GCA patients.
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Affiliation(s)
- Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA
| | - Khaled Sarsour
- Real World Data Science/Global Product Development, Genentech, 1 DNA Way, South San Francisco, CA 94080-4990.
| | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA
| | | | | | - Pavel Napalkov
- Real World Data Science/Global Product Development, Genentech, 1 DNA Way, South San Francisco, CA 94080-4990
| | - Micki Klearman
- Real World Data Science/Global Product Development, Genentech, 1 DNA Way, South San Francisco, CA 94080-4990
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Koster MJ, Warrington KJ, Kermani TA. Update on the Epidemiology and Treatment of Giant Cell Arteritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2016. [DOI: 10.1007/s40674-016-0046-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Labarca C, Koster MJ, Crowson CS, Makol A, Ytterberg SR, Matteson EL, Warrington KJ. Predictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study. Rheumatology (Oxford) 2016; 55:347-56. [PMID: 26385368 PMCID: PMC4939727 DOI: 10.1093/rheumatology/kev348] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/13/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate characteristics of relapse, relapse rates, treatment and outcomes among patients with biopsy-proven GCA in a large, single-institution cohort. METHODS We conducted a retrospective review of all patients with biopsy-proven GCA from 1998 to 2013. Demographic, clinical, laboratory and treatment data at presentation and during follow-up were collected. Comparisons by relapse rate were performed using chi-square tests. Prednisone discontinuation by initial oral dose ≤40 and >40 mg/day was compared using Cox models. RESULTS The cohort included 286 patients [74% female, mean age at diagnosis 75.0 years (s.d. 7.6), median follow-up 5.1 years). During follow-up, 73 patients did not relapse, 80 patients had one relapse and 133 had two or more relapses. The first relapse occurred during the first year in 50% of patients, by 2 years in 68% and by 5 years in 79%. More patients with established hypertension (P = 0.007) and diabetes (P = 0.039) at GCA diagnosis were in the high relapse rate group ( ≥ 0.5 relapses/year) and more females were in the low or high relapse groups than in the no relapse group (P = 0.034). Patients receiving an initial oral prednisone dose >40 mg/day were able to reach a dose of <5 mg/day [hazard ratio (HR) 1.46 (95% CI 1.09, 1.96)] and discontinue prednisone [HR 1.56 (95% CI 1.09, 2.23)] sooner than patients receiving ≤40 mg/day without an increase in observed glucocorticoid-associated adverse events. CONCLUSION Females and patients with hypertension or diabetes at GCA diagnosis have more relapses during follow-up. Patients treated with an initial oral prednisone dose >40 mg/day achieved earlier prednisone discontinuation.
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Affiliation(s)
- Cristian Labarca
- Department of Internal Medicine, Universidad del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
| | | | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Division of Biostatistics and
| | - Ashima Makol
- Division of Rheumatology, Department of Medicine
| | | | - Eric L Matteson
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Narula NG, Abril A. MDS and GCA: a prognostic dilemma. Clin Rheumatol 2015; 35:807-12. [PMID: 26080752 DOI: 10.1007/s10067-015-2993-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/03/2015] [Accepted: 06/07/2015] [Indexed: 12/25/2022]
Abstract
A number of autoimmune disorders, such as large vessel vasculitis, have been recognized in patients who have myelodysplastic syndrome (MDS) and myeloproliferative syndrome (MPS). The influence of an autoimmune disorder on the prognosis of patients who have MDS and MPS remains to be determined. We report three cases of myelodysplastic syndrome and large vessel vasculitis seen at our institution and provide a brief literature review of the two disease processes. More studies are needed to determine the pathophysiology of the underlying diseases and whether there truly is a relationship between the disease entities and to discover better markers for disease assessment.
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Affiliation(s)
- Neha G Narula
- Department of Rheumatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Andy Abril
- Department of Rheumatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Jakobsson K, Jacobsson L, Warrington K, Matteson EL, Liang K, Melander O, Turesson C. Body mass index and the risk of giant cell arteritis: results from a prospective study. Rheumatology (Oxford) 2014; 54:433-40. [PMID: 25193806 DOI: 10.1093/rheumatology/keu331] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine potential risk factors for GCA in a nested case-control study based on two prospective health surveys. METHODS We used two population-based health surveys, the Malmö Preventive Medicine Program (MPMP) and the Malmö Diet Cancer Study (MDCS). Individuals who developed GCA after inclusion were identified by linking the MPMP and MDCS databases to several patient administrative registers. A structured review of the medical records of all identified cases was performed. Four controls for every confirmed case, matched for sex, year of birth and year of screening, were selected from the corresponding databases. Potential predictors of GCA were examined in conditional logistic regression models. RESULTS Eighty-three patients (70% women, 64% biopsy positive, mean age at diagnosis 71 years) had a confirmed diagnosis of GCA after inclusion in the MPMP or MDCS. A higher BMI was associated with a significantly reduced risk of subsequent development of GCA [odds ratio (OR) 0.91/kg/m(2) (95% CI 0.84, 0.98)]. Smoking was not a risk factor for GCA overall [OR 1.36 (95% CI 0.77, 2.57)], although there was a trend towards an increased risk in female smokers [OR 2.14 (95% CI 0.97, 4.68)]. In multivariate analysis, adjusted for smoking and level of formal education, the inverse association between BMI and GCA remained significant (P = 0.027). CONCLUSION In this study, GCA was predicted by a lower BMI at baseline. Potential explanations include an effect of reduced adipose tissue on hormonal pathways regulating inflammation.
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Affiliation(s)
- Karin Jakobsson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Lennart Jacobsson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden. Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Kenneth Warrington
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Eric L Matteson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Kimberly Liang
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Olle Melander
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Carl Turesson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA and Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
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Abstract
A 79-year-old woman presents with new-onset pain in her neck and both shoulders. She takes 7.5 mg of prednisone per day for giant-cell arteritis. Occipital tenderness and diplopia developed 11 months before presentation. At that time, her erythrocyte sedimentation rate was elevated, at 78 mm per hour, and a temporal-artery biopsy revealed granulomatous arteritis. The diplopia resolved after 6 days of treatment with 60 mg of prednisone daily. Neither headache nor visual symptoms developed when the glucocorticoids were tapered. How should this patient’s care be managed?
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