This study examined 115 patients with GCA who had evidence of large vessel vasculitis at diagnosis based on positron emission tomography (PET) scan with a computed tomography (CT) scan. The study found that more patients treated with tocilizumab and glucocorticoids demonstrated resolution of inflammation than patients treated with glucocorticoids alone (76% vs. 41%).
Aortic aneurysms are one of the most feared complications of GCA and may occur years after the initial diagnosis, even among patients whose disease seems to be well controlled. This study implies that treatment with tocilizumab may decrease chronic aortitis among patients with GCA, leading to better long-term outcomes. However, it is still unclear whether PET/CT scan is an appropriate surrogate marker because other studies have demonstrated no association between fluorodeoxyglucose/PET activity and long-term outcomes.11
6. Cranial MRI in Relapsing GCA
Zeng et al., Abstract 270312
Relatively few objective methods exist for diagnosing relapse in a patient with a known history of GCA. This study examined the use of cranial vessel wall magnetic resonance imaging (MRI) as a marker of relapse.
In this study, four patients with a cranial or ocular relapse of GCA had evidence of increased vascular wall MRI enhancement in at least one cranial structure. In two of these patients, the MRI changes preceded clinical evidence of disease flare. Two patients who experienced a relapse comprising polymyalgia rheumatica without cranial symptoms had persistent, but not increased, enhancement, whereas seven of eight patients in sustained remission had decreased or normal enhancement on follow-up.
One of the greatest challenges when managing a patient with GCA is distinguishing a cranial relapse from other causes of headache. Preliminary, this study implies that direct visualization of the temporal artery through MRI may be the answer to this conundrum and potentially spare many patients needless courses of empiric glucocorticoids.
7. The Glucocorticoid Burden & The Perception of Advanced Therapies
Dua et al., Abstract 073813
Multiple studies have demonstrated the efficacy of several agents for the treatment of GCA and the harms associated with chronic glucocorticoid therapy. This study examined the impact of these findings on clinical care by surveying the practice patterns of 189 rheumatologists from the U.S., the EU and the UK. These rheumatologists completed patient record forms on 846 patients with GCA.
Overall, most rheumatologists agreed that most patients should be given advanced therapies, such as tocilizumab or methotrexate, early in the disease course and should be tapered off of glucocorticoids after two years. However, the patient record forms indicated that the median time from diagnosis to receiving tocilizumab or methotrexate was approximately five months. Also, after four years of treatment, 75% of patients continued to take low-dose prednisone (5.3 mg/day).
