P250 - GIANT CELL ARTERITIS: IS ROUTINE CLINICAL PRACTICE COMPREHENSIVE ENOUGH?
Hospital General Universitario Gregorio Marañón. Madrid.
Introduction: Recommendations to collect the most relevant information on disease course, treatment and outcomes in giant cell arteritis (GCA) has been proposed by EULAR to facilitate clinical research and to improve clinical care.
Objectives: To assess the quality of data collection in routine clinical practice according to EULAR recommendations and to describe baseline and follow-up characteristics of a retrospective cohort of patients with GCA.
Methods: We reviewed medical records of patients diagnosed with GCA in a tertiary academic center between 2004-2018. We included patients with available data at diagnosis and one year of follow-up. Data extraction included: demographics, diagnosis, GCA-related signs and symptoms, laboratory, imaging modalities, comorbidities and treatment. Data in the chart was then compared with the core set of parameters proposed for GCA registries and databases by EULAR. Major relapse, according to the EULAR 2018 definition, was independently assessed by two rheumatologists.
Results: 58 patients were identified, 39 met predefined inclusion criteria with 151 visits during first-year follow-up. Headache (100%; 80.4%), ocular symptoms (89.7%; 81.2%), constitutional symptoms (89.7%; 80.4%), polymyalgia rheumatica (89.7%; 82%) and jaw claudication (87%; 81.2%) were the most frequently collected items at baseline and follow-up. Weight and height (2.6%; 2.6%), peripheral pulses (8%; 4.5%), smoking status (41%; 21%), and blood pressure (61.5%; 4.5%) were the less frequently collected. Most patients lacked differential pressure measurement. Myocardial infarction, malignancy, serious infections, arterial hypertension, diabetes and osteoporosis were collected in every patient (39, 100%). Only 2 mayor relapses were identified (5%). Two (2) patients died during the one-year follow-up period. The table provides information on GCA-related signs and symptoms, laboratory and therapeutic data.
|
GCA-related signs and symptoms, laboratory and therapeutic data |
||||
|
Item |
Performed baseline |
Baseline (n = 39) |
Performed Follow-up |
Follow-up (n = 112) |
|
Ocular symptoms |
35/39 (89.7%) |
15/35 (42.9%) |
91/112 (81.2%) |
29/91 (31.9%) |
|
Permanent ocular symptoms |
34/39 (87%) |
9/34 (26.5%) |
92/112 (82%) |
28/92 (30.4%) |
|
Headache |
39 (100%) |
30/39 (77%) |
90/112 (80.4%) |
13/90 (14.4%) |
|
Scalp tenderness |
31/39 (79.5%) |
9/31 (29.8%) |
88/112 (78.6%) |
4/88 (4.5%) |
|
Jaw claudication |
34/39 (87%) |
19/34 (55.85) |
91/112 (81.2%) |
6/91 (6.6%) |
|
Cranial artery abnormality |
27/39 (69.2%) |
17/27 (63%) |
69/112 (61.6%) |
3/69 (4.3%) |
|
Constitutional symptoms |
35/39 (89.7%) |
19/35 (54.3%) |
90/112 (80.4%) |
11/90 (12.2%) |
|
PMR |
35/39 (89.7%) |
18/35 (51.4%) |
92/112 (82%) |
9/92 (9.8%) |
|
ESR mean (SD) |
33/39 (84.6%) |
58.7 (32.1) |
83/112 (74%) |
14.6 (18.8) |
|
CRP mean (SD) |
31/39 (79.5%) |
8.4 (7.9) |
70/112 (62.5%) |
1.3 (3.3) |
|
Haemoglobin mean (SD) |
38/39 (97.4%) |
12.0 (1.7) |
90/112 (80.4%) |
12.9 (1.5) |
|
Peripheral pulses |
9/39 (8%) |
3/9 (33.3%) |
5/112 (4.5%) |
2/5 (40%) |
|
Large vessel involvement |
8/39 (20.5%) |
5/8 (62.5%) |
7/112 (6.25%) |
3/7 (42.8%) |
|
Glucocorticoids median (IQR) |
39 (100%) |
102.5 (50-250) |
112 (100%) |
10.0 (5-15) |
|
Synthetic DMARD |
39 (100%) |
8/39 (20.5%) |
111/112 (99%) |
17/39 (43.6%) |
|
Biological DMARD |
39 (100%) |
0/39 (0%) |
111/112 (99%) |
3/39 (7.7%) |
|
Antiplatelet agents |
39 (100%) |
6/39 (15.4%) |
110/112 (98%) |
25/110 (22.7%) |
|
PMR: polymyalgia rheumatica; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; SD: standard deviation; IQR: interquartile range; DMARD: disease modifying antirheumatic drugs. |
||||
Conclusions: Although data collection in routine care is usually comprehensive enough according to EULAR proposed data set, key components in physical exam mostly those aiming to detect large vessel involvement, should be addressed more carefully.
References
- Ehlers L, et al. Ann Rheum Dis. 2019;78(9):1160-6.
- Hellmich B, et al. Ann Rheum Dis. 2019;1-12.
