LAUSR

Giant cell arteritis (GCA) is a granulomatous vasculitis that affects the large vessels, occurring in people over 50 years of age. GCA frequently overlaps with polymyalgia rheumatica (PMR), which affects the proximal joints in the shoulders and hips. Both GCA and PMR patients require long-term treatment with glucocorticoids (GCs). Investigation of new treatment options is required because many GCA and PMR patients experience GC-related adverse events. These include hypercholesterolemia, hypertension, diabetes mellitus, cataract, and infections.(1) Previous studies suggest that unhealthy metabolic features and a higher Body Mass Index (BMI) might be protective in the development of GCA (2). However, data are limited.We aimed to elaborate more-in depth on the metabolic features, BMI and prevalence of comorbidities of GCA and PMR patients at the time of diagnosis and during treatment, to characterize patients for improved treatment options.This study included two independent cohorts: the GPS (Groningen) cohort, and the Aarhus cohort for validation of baseline data (Table 1). Patients in the GPS cohort were prospectively followed with visits at 3 months, 1, 2, and 5 years. Laboratory measurements, metabolic co-morbidities were assessed at every visit. At baseline, we assessed whether comorbidities and BMI predicted the duration of GC treatment.Table 1.Baseline characteristics. P-values were calculated with Mann-Whitney U test and Fischer Exact test. Numbers in bold: significance between HC and GCA/PMR patients from GPS cohort. *: significance between GCA and PMR of GPS cohort. a: significance between two cohorts.GCAGPS cohort (n=50)PMRGPS cohort (n=44)HCsGPS cohort (n=65)GCA Aarhus cohort(n=52)PMR Aarhus cohort(n=25)Age, median7173706768Female, %3526433213Follow-up duration in months, median4240NANANABMI, median24.326.625.42426.4Systolic BP (mmHg), median140140145135143Diastolic BP (mmHg), median79.5*808076.583HbA1c (mmol/mol), median4340394340CRP (mg/L), median544247653ESR (mm/h), median94*5797751Diabetes mellitus, %122312158Hypercholesterolemia, %2214171524Hypertension, %66a55603836Cataract, %141634NANAFrequencies of metabolic features in GCA/PMR patients from the GPS cohort were not significantly different in comparison to healthy controls (HCs). Higher HbA1c levels were detected in GCA patients than in HCs. Data on metabolic features from the Aarhus cohort compared well with the GPS cohort data and thus validated these findings (Table 1). Next, the effect of co-existing co-morbidities on the clinical manifestations was investigated. GCA patients with cataract had reduced CRP and ESR whereas PMR patients with cataract had a higher ESR than patients without cataract (p=0,034). Analysis of GC treatment effect on co-morbidities revealed a significant increase in prevalence of diabetes (after 3 months) and cataract (after 5 years) compared to baseline. BMI was significantly higher after one year and five years of GC treatment. PMR patients with cataract at baseline required longer treatment with GCs (p=0.023). Presence of other metabolic features at the time of GCA or PMR diagnosis did not affect the treatment duration (Figure 1).Newly-diagnosed GCA and PMR patients did not appear to have a healthier metabolic profile than HCs. As expected, GC treatment resulted in the development of an unhealthier metabolic profile in GCA patients. In PMR patients, the presence of cataract at baseline was predictive for a prolonged treatment period which could be explained by higher ESR levels in PMR patients with cataract. Together, our findings emphasize the importance of novel GC sparing therapeutic agents and personalized medicine in GCA and PMR.[1]Buttgereit F,et al. Prevention of glucocorticoid morbidity in giant cell arteritis. Rheumatol (United Kingdom). 2018.[2]Ungprasert P, et al. Lower body mass index is associated with a higher risk of giant cell arteritis: A systematic review and meta-analysis. Ann Transl Med. 2015.Idil Esen: None declared, Philip Therkildsen: None declared, Berit Dalsgaard NIelsen: None declared, Anna van ‘t Ende: None declared, Annemieke Boots Consultant of: Grunenthal, Peter Heeringa: None declared, Ellen-Margrethe Hauge: None declared, Elisabeth Brouwer Speakers bureau: Roche, fees paid to UMCG, Yannick van Sleen: None declared