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

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

Publicated to:Rheumatology (Oxford, England). (): - - 2025-05-09 (), DOI: 10.1093/rheumatology/keaf237

Authors: Narváez J; Domínguez-Álvaro M; Hernández-Rodríguez I; de Miguel E; Silva-Díaz M; Belzunegui JM; Moriano C; Sánchez-Martín J; Lluch J; Calvo I; Aldasoro V; Abasolo L; Loricera J; Garrido N; Castañeda S; Vasques-Rocha M; Iñiguez CL; Hernández-Hernández V; Campos-Fernández C; Alcalde-Villar M; Juan-Mas A; Blanco R

Affiliations

- Author

Department of Rheumatology, Complejo Hospitalario de Navarra., Pamplona, Spain. - Author

Department of Rheumatology, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain. - Author

Department of Rheumatology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. - Author

Department of Rheumatology, Consorci Hospital General Universitari de Valencia. Valencia, Spain. - Author

Department of Rheumatology, Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain. - Author

Department of Rheumatology, Hospital Universitario Marqués de Valdecilla- Immunopathology Group-IDIVAL, Santander, Spain. - Author

Department of Rheumatology. Department of Rheumatology. Hospital, Universitario de Canarias. Santa Cruz de Tenerife, Spain. - Author

Department of Rheumatology., Hospital Universitari Son Llàtzer. Palma de Mallorca, Spain. - Author

Department of Rheumatology., Hospital Universitario 12 de octubre, Madrid, Spain. - Author

Department of Rheumatology., Hospital Universitario Araba, Vitoria-Gasteiz, Spain. - Author

Department of Rheumatology., Hospital Universitario de Basurto, Bilbao, Spain. - Author

Department of Rheumatology., Hospital Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. - Author

Department of Rheumatology., Hospital Universitario de Bellvitge., Barcelona. - Author

Department of Rheumatology., Hospital Universitario de La Princesa. IIS-Princesa, cátedra UAM-Roche, Universidad Autónoma de Madrid, Madrid, Spain. - Author

Department of Rheumatology., Hospital Universitario de León. León, Spain. - Author

Department of Rheumatology., Hospital Universitario Donosti, San Sebastián, Spain. - Author

Department of Rheumatology., Hospital Universitario La Paz, Madrid, Spain. - Author

Department of Rheumatology., Hospital Universitario Marqués de Valdecilla- Immunopathology Group-IDIVAL, Santander, Spain. - Author

Department of Rheumatology., Hospital Universitario Severo Ochoa Leganes, Madrid, Spain. - Author

Department of Rheumatology., Hospital Universitario Virgen del Rocío, Sevilla, Spain. - Author

Department of Rheumatology., Hospital, Universitario Lucus Augusti, Lugo, Spain. - Author

Research Unit Sociedad Española de Reumatología, Madrid, Spain. - Author

Abstract

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. A retrospective review of patients from the Spanish multicentre GCA registry (ARTESER) was conducted. Relapses were classified using 2018 EULAR definitions. We included 1,284 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. 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.

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