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Multicenter Study
. 2025 Sep 1;64(9):4985-4994.
doi: 10.1093/rheumatology/keaf237.

Epidemiology of major and minor relapses in giant cell arteritis according to EULAR definitions: insights from the ARTESER registry

Javier Narváez  1 , Marta Domínguez-Álvaro  2 , Iñigo Hernández-Rodríguez  3 , Eugenio de Miguel  4 , Maite Silva-Díaz  5 , Joaquín M Belzunegui  6 , Clara Moriano  7 , Julio Sánchez-Martín  8 , Judit Lluch  9 , Itziar Calvo  10 , Vicente Aldasoro  11 , Lydia Abasolo  12 , Javier Loricera  13 , Noemí Garrido  14 , Santos Castañeda  15 , Margarida Vasques-Rocha  16 , Carlota L Iñiguez  17 , Vanesa Hernández-Hernández  18 , Cristina Campos-Fernández  19 , María Alcalde-Villar  20 , Antonio Juan-Mas  21 , Ricardo Blanco  13 ; ARTESER Project Collaborative Group
Collaborators, Affiliations
Multicenter Study

Epidemiology of major and minor relapses in giant cell arteritis according to EULAR definitions: insights from the ARTESER registry

Javier Narváez et al. Rheumatology (Oxford). .

Abstract

Objective: To investigate the prevalence, timing and risk factors at diagnosis associated with relapses in giant cell arteritis (GCA), with a separate analysis of major and minor relapses.

Methods: A retrospective review of patients from the Spanish multicentre GCA registry (ARTESER) was conducted. Relapses were classified using 2018 EULAR definitions.

Results: We included 1284 patients with at least one year of follow-up. Twenty-six percent experienced relapses, with cumulative rates of 18.1%, 27.9%, 37.6% and 44.8% at 1, 2, 3 and 4 years, respectively. Multiple relapses were observed in 14.6% of patients during the first year, 10.5% in the second, 9% in the third and 17.8% in the fourth, reflecting the relapsing-remitting nature of GCA. According to EULAR definitions, major relapses represented 26.7% of all recorded relapses and affected 7.6% of patients. Younger age at diagnosis (HR: 0.976, P = 0.004) and a higher total dose of prednisone at the first relapse (HR: 0.998, P = 0.003) were associated with a reduced risk of overall relapses. Severe ischemic complications (HR: 4.126, P < 0.001) and large-vessel (LV) involvement at diagnosis (HR: 1.992, P = 0.024) significantly increased the risk of major relapses, while younger age (HR: 0.970, P = 0.002) was protective against minor relapses.

Conclusions: Major relapses are not so uncommon, representing a quarter of all relapses. The presence of severe ischemic complications and LV involvement at diagnosis substantially increase their risk.

Keywords: giant cell arteritis; major relapse; minor relapse; predictors; relapses.

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