Clinical presentation and treatment response in patients with polymyalgia rheumatica and giant cell arteritis during a 40-week follow-up

Amir Emamifar; Søren Hess; Torkell Ellingsen; Oke Gerke; Ziba Ahangarani Farahani; Per Syrak Hansen; Inger Marie Jensen Hansen; Peter Thye-Rønn

doi:10.1093/rap/rkab091

Clinical presentation and treatment response in patients with polymyalgia rheumatica and giant cell arteritis during a 40-week follow-up

Rheumatol Adv Pract. 2021 Nov 24;5(3):rkab091. doi: 10.1093/rap/rkab091. eCollection 2021.

Authors

Amir Emamifar^{1

2

3

4}, Søren Hess^{5

6}, Torkell Ellingsen⁷, Oke Gerke^{8

9}, Ziba Ahangarani Farahani⁹, Per Syrak Hansen², Inger Marie Jensen Hansen³, Peter Thye-Rønn^{1

2}

Affiliations

¹ Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense.
² Diagnostic Center.
³ Department of Rheumatology, Svendborg Hospital, OUH, Svendborg.
⁴ OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense.
⁵ Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg.
⁶ Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark.
⁷ Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark.
⁸ Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark.
⁹ Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.

Abstract

Objectives: The aim was to study the clinical features of PMR/GCA and clinical predictors of treatment response during a 40-week follow-up period.

Methods: Clinical data on 77 patients with newly diagnosed PMR/GCA who were treated with oral glucocorticoids were gathered at baseline and during a 40-week follow-up period. A unilateral temporal artery biopsy (TAB) and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT were undertaken at diagnosis. In total, each patient was seen on five occasions (i.e. baseline and weeks 4, 16, 28 and 40). Treatment response was assessed by considering clinical evaluations and results of inflammatory markers.

Results: Of 77 patients [49 (63.6%) female; mean age 71.8 (8.0) years], 64 (83.1%) patients had pure PMR, 10 (13.0%) concomitant PMR and GCA, and 3 (3.9%) pure GCA. The patients reported that clinical symptoms, apart from scalp pain and duration of morning stiffness, improved significantly at week 4 and remained lower at week 40 compared with the relative frequencies at baseline. Besides, all components of physical examination showed significant improvement and remained lower at week 40 compared with the baseline. A complete response was seen in 68.7, 62.9, 44.1 and 33.3% of patients at weeks 4, 16, 28 and 40, respectively. Several clinical features, including female biological sex, younger age, fewer relapses and a lower level of baseline ESR, were significantly associated with a better treatment response. Treatment response during the follow-up period was independent of TAB results and fluorodeoxyglucose uptakes on ¹⁸F-FDG PET/CT at diagnosis.

Conclusion: Obtaining valid disease-specific outcome measures for evaluating treatment efficacy in PMR and GCA that can be applied universally is clearly an unmet clinical need.

Trial registration: ClinicalTrials.gov, https://clinicaltrials.gov, NCT02985424.

Keywords: 18F-fluorodeoxyglucose PET/CT; Polymyalgia rheumatica; giant cell arteritis; temporal artery biopsy; treatment response.

Associated data

ClinicalTrials.gov/NCT02985424