Epidemiologie und Vergleich der Behandlung von Riesenzellarteriitis Patient*Innen aus den Jahren 2013 – 2019. Eine Registerstudie des Patientenkollektivs der Universität Erlangen

Objectives Giant cell arteritis (GCA) is one of the most common vasculitides and particularly affects women over the age of 60. In this work, current epidemiological data of patients affected by GCA from the database from the university hospital Erlangen were retrospectively evaluated. Design & Methods Patients with new diagnosis or relapse of GCA were retrospectively recorded in the period from 2013 to 2019. At least three follow-up examinations per patient were performed during the observation period with documentation of symptoms, laboratory parameters, therapies and (serious) adverse events ((S)AE). Furthermore, descriptive parameters as well as survival - time analyses at baseline and time of relapse were compared. Observations & Results 89 patients, 65 women (73.0%) and 24 men (27.0%), fitted the inclusion criteria and their data were evaluated. The mean age was 67 years. 29 (32.6%) patients had a cranial giant cell arteritis (C - GCA), 36 (40.5%) a large vessel arteritis (LV - GCA) and 24 (26.9%) a mixed type of GCA. 52 (58.4%) cases were diagnosed by imaging, 15 (16.9%) by temporal artery biopsy (TAB) and 22 (24.7%) clinically. Most common concomitant diseases were arterial hypertension (55.1%) and osteoporosis (33.7%). Symptoms at baseline were fatigue (51.7%), followed by headache (44.9%), weight loss (32.6%) and night sweats (30.3%). The mean follow - up period was 37.2 months and during this period 45 relapses were diagnosed in 31 patients (34.8%). 22 (71.0%) patients had one relapse, nine (29.0%) patients had two or more. The average time to first relapse was 17.3 months (median: 12.5). 17.3% patients had developed a relapse after one year, 36.7% after three years. Most common symptoms at relapse were fatigue (33.3%), polymyalgia rheumatica (PMR) symptoms (33.3%) and headache (24.4%). 14 (31,1%) relapses occurred under prednisolon monotherapy (mean: 10.0 mg/d), 14 (31,1%) under MTX, seven (15,6%) under TCZ, one (2,2%) under azathioprine and nine (20,0%) had no therapy at the time of relapse. Comparing the baseline characteristics of non - relapse to relapse patients, jaw claudication (p = 0.011) and lower extremity claudication (p = 0.004) showed significant higher probability for getting a relapse in the relapse - group. The value of C - reactive protein (CRP) was significantly increased at the time of relapse compared to the previous examination (p = 0.02). 33 SAE were recorded, including three (9.1%) letal, four (12.1%) life - threatening events and 26 (78.8%) hospitalizations due to GCA. Conclusions Compared to previous examinations, the value of CRP in conjunction with other clinical findings can contribute to the diagnosis of a relapse in our study. The symptoms of jaw claudication and claudication of the lower extremities at baseline are possible predictors of getting a relapse.