Abstract | OBJECTIVE: To assess whether the intensity of the initial systemic inflammatory response is able to predict response to therapy in patients with giant cell arteritis (GCA). METHODS: Retrospective review of 75 patients (49 women and 26 men) with biopsy-proven GCA who had regular followup and were treated according to uniform criteria. Four parameters were used to evaluate the baseline inflammatory response at diagnosis: fever, weight loss, erythrocyte sedimentation rate > or = 85 mm/hour, and hemoglobin < 110 gm/liter. Patients were considered to have a weak inflammatory response if they had 2 or fewer inflammatory parameters (group 1) and a strong inflammatory response if 3 or 4 parameters were present (group 2). Time required to achieve a maintenance dose of less than 10 mg prednisone/day was recorded and analyzed by the Kaplan-Meier survival analysis method. Tumor necrosis factor alpha ( TNFalpha) and interleukin 6 (IL-6) serum levels were also determined in 62 patients and 15 controls. RESULTS: Forty patients had a weak (group 1) and 35 had a strong (group 2) initial inflammatory response. Patients in group 2 had significantly higher levels of circulating TNFalpha (31.9 +/- 16.8 versus 22.3 +/- 9 pg/ml; P = 0.01) and IL-6 (28.2 +/- 17.4 versus 16.6 +/- 13 pg/ml; P = 0.004) than patients in group 1. In group 1, 50% of patients required a median of 40 weeks (95% CI 37-43) to reach a maintenance dose of <10 mg, whereas in group 2 a median of 62 weeks (95% CI 42-82) was necessary (P = 0.0062). Patients in group 2 experienced more flares than patients in group 1 (P = 0.01) and received higher cumulative steroid doses (8.974 +/- 3.939 gm versus 6.893 +/- 3.075 gm; P = 0.01). CONCLUSION:
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Authors | José Hernández-Rodríguez, Ana García-Martínez, Jordi Casademont, Xavier Filella, María-José Esteban, Alfonso López-Soto, Joaquim Fernández-Solà, Alvaro Urbano-Márquez, Josep M Grau, Maria C Cid |
Journal | Arthritis and rheumatism
(Arthritis Rheum)
Vol. 47
Issue 1
Pg. 29-35
(Feb 2002)
ISSN: 0004-3591 [Print] United States |
PMID | 11932875
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Inflammatory Agents
- Glucocorticoids
- Interleukin-6
- Tumor Necrosis Factor-alpha
- Prednisone
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Topics |
- Aged
- Aged, 80 and over
- Anti-Inflammatory Agents
(administration & dosage, therapeutic use)
- Dose-Response Relationship, Drug
- Female
- Giant Cell Arteritis
(blood, drug therapy, physiopathology)
- Glucocorticoids
(administration & dosage, therapeutic use)
- Humans
- Interleukin-6
(blood)
- Male
- Middle Aged
- Prednisone
(administration & dosage, therapeutic use)
- Retrospective Studies
- Time Factors
- Tumor Necrosis Factor-alpha
(analysis)
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