Presentation and Real-World Management of Giant Cell Arteritis (Artemis Study)

Abstract

Background: Few studies of daily practice for patients with giant cell arteritis (GCA) are available. This French study aimed to describe the characteristics and management of GCA in a real-life setting. Methods: Cross-sectional, non-interventional, multicenter study of patients ≥50 years old who consulted hospital-based specialists for GCA and were under treatment. Patient characteristics and journey, diagnostic methods and treatments were collected. Descriptive analyses were performed. Results: In total, 306 patients (67% females, mean age 74 ± 8 years old) were recruited by 69 physicians (internists: 85%, rheumatologists: 15%); 13% of patients had newly diagnosed GCA (diagnosis-to-visit interval <6 weeks). Overall median disease duration was 13 months (interquartile range 5-26). Most patients were referred by general practitioners (56%), then ophthalmologists (10%) and neurologists (7%). Most common comorbidities were hypertension (46%), psychiatric disorders (10%), dyslipidemia (12%), diabetes (9%), and osteoporosis (6%). Initial GCA presentations included cranial symptoms (89%), constitutional symptoms (74%), polymyalgia rheumatica (48%), and/or other extra-cranial manifestations (35%). Overall, 85, 31, 26, and 30% of patients underwent temporal artery biopsy, high-resolution temporal artery Doppler ultrasonography, ¹⁸FDG-PET, and aortic angio-CT, respectively. All patients received glucocorticoids, which were ongoing for 89%; 29% also received adjunct medication(s) (methotrexate: 19%, tocilizumab: 15%). A total of 40% had relapse(s); the median time to the first relapse was 10 months. Also, 37% had comorbidity(ies) related to or aggravated by glucocorticoids therapy. Conclusion: This large observational study provides insight into current medical practices for GCA. More than one third of patients had comorbidities related to glucocorticoid therapy for a median disease duration of 13 months. Methotrexate and tocilizumab were the most common adjunct medications.

Keywords: giant cell arteritis; glucocorticoids (GCs); management - healthcare; methotrexate; observational; phenotype [mesh]; tocilizumab.

Figure 1

Clinical phenotypes of giant cell arteritis at diagnosis. *The subset of cranial manifestations includes patients with strokes and transient ischemic attack(s). ^#The subset of large vessel involvement includes aortic aneurysm or dilatation, aortitis and/or involvement of aortic branch(s) in imaging, claudication of a limb, sign(s) of subclavian stenosis.

Figure 2

Diagnostic tests for giant cell arteritis. Proportion of patients (%). CT, computed tomography; MRI, magnetic resonance imaging; ¹⁸FDG-PET, ¹⁸F-fluorodesoxyglucose positron emission tomography.