*Result*: Characteristics of patients with major relapse in giant cell arteritis: a multicenter case-control study.
Original Publication: Brussels : Acta Medica Belgica, [1982-
Tomelleri A, Campochiaro C, Sartorelli S, Farina N, Baldissera E, Dagna L (2022) Presenting features and outcomes of cranial-limited and large-vessel giant cell arteritis: a retrospective cohort study. Scand J Rheumatol 51(1):59–66. https://doi.org/10.1080/03009742.2021.1889025. (PMID: 10.1080/03009742.2021.188902533913792)
Gribbons KB, Ponte C, Craven A, Robson JC, Suppiah R, Luqmani R, Watts R, Merkel PA, Grayson PC (2020) Diagnostic assessment strategies and disease subsets in giant cell arteritis: data from an international observational cohort. Arthritis Rheumatol 72(4):667–676. https://doi.org/10.1002/art.41165. (PMID: 10.1002/art.41165317291857113106)
Guédon AF, Froger C, Agard C, Bénichou A, Le Jeune S, Mekinian A, Morard M, Skaff Y, De Boysson H, Espitia O (2024) Identifying giant cell arteritis patients with higher risk of relapse and vascular events: a cluster analysis. QJM 117(11):769–776. https://doi.org/10.1093/qjmed/hcae105. (PMID: 10.1093/qjmed/hcae10538806178)
Agarwal A, Weisberg R, Mathew J et al (2024) Clinical features, imaging use, and management in giant cell arteritis: a retrospective single-center study. Clin Rheumatol 43:3409–3417. https://doi.org/10.1007/s10067-024-07078-0. (PMID: 10.1007/s10067-024-07078-039235497)
Salvarani C, Pipitone N, Versari A, Hunder GG (2012) Clinical features of polymyalgia rheumatica and giant cell arteritis. Nat Rev Rheumatol 8:509–521. https://doi.org/10.1038/nrrheum.2012.97. (PMID: 10.1038/nrrheum.2012.9722825731)
González-Gay MÁ, Heras-Recuero E, García-Fernández A et al (2025) Revisiting the epidemiology of giant cell arteritis. Clin Exp Rheumatol 43:742–748. https://doi.org/10.55563/clinexprheumatol/xc46ld. (PMID: 10.55563/clinexprheumatol/xc46ld40201967)
Mackie SL, Yates M, Warrington KJ (2025) Polymyalgia rheumatica and giant cell arteritis: lumping versus splitting. Rheumatol Oxf Engl keaf589. Epub ahead of print. https://doi.org/10.1093/rheumatology/keaf589.
Hellmich B, Agueda A, Monti S, et al (2019) 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis.2020 Jan;79(1):19-30. https://doi.org/10.1136/annrheumdis-2019-215672.
Maz M, Chung SA, Abril A, Langford CA, Gorelik M, Guyatt G, Archer A M, Conn DL, Full KA, Grayson PC, Ibarra MF, Imundo LF, Kim S, Merkel PA, Rhee RL, Seo P, Stone JH, Sule S, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot MA, Lin YC, Springer JM, Turgunbaev M, Villa‐Forte A, Turner AS, Mustafa RA (2021) 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis. Arthritis Rheumatol 73(8):1349–1365. https://doi.org/10.1002/art.41774. (PMID: 10.1002/art.417743423588412344528)
Mainbourg S, Addario A, Samson M, Puéchal X, François M, Durupt S, Gueyffier F, Cucherat M, Durieu I, Reynaud Q, Lega J-C (2020) Prevalence of giant cell arteritis relapse in patients treated with glucocorticoids: a meta‐analysis. Arthritis Care Res 72(6):838–849. https://doi.org/10.1002/acr.23901. (PMID: 10.1002/acr.23901)
Narváez J, Domínguez-Álvaro M, Hernández-Rodríguez I et al (2025) Epidemiology of major and minor relapses in giant cell arteritis according to EULAR definitions: insights from the ARTESER registry. Rheumatology 64:4985–4994. https://doi.org/10.1093/rheumatology/keaf237. (PMID: 10.1093/rheumatology/keaf23740343487)
de Gomes Pinho Q, Daumas A, Benyamine A et al (2023) Predictors of relapses or recurrences in patients with giant cell arteritis: a medical records review study. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 29:e25–e31. https://doi.org/10.1097/RHU.0000000000001942. (PMID: 10.1097/RHU.0000000000001942)
Muratore F, Boiardi L, Restuccia G, Cavazza A, Catanoso M, Macchioni P, Spaggiari L, Cimino L, Aldigeri R, Pipitone N, Fontana A, Casali M, Croci S, Salvarani C (2020) Relapses and long-term remission in large vessel giant cell arteritis in northern Italy: characteristics and predictors in a long-term follow-up study. Semin Arthritis Rheum 50(4):549–558. https://doi.org/10.1016/j.semarthrit.2020.04.004. (PMID: 10.1016/j.semarthrit.2020.04.00432446023)
Aussedat M, Lobbes H, Samson M, Euvrard R, Lega J-C, Mainbourg S (2022) Epidemiology of major relapse in giant cell arteritis: a study-level meta-analysis. Autoimmun Rev 21(1):102930. https://doi.org/10.1016/j.autrev.2021.102930. (PMID: 10.1016/j.autrev.2021.10293034481940)
Tsalapaki C, Lazarini A, Argyriou E et al (2024) Glucocorticoid discontinuation rate and risk factors for relapses in a contemporary cohort of patients with giant cell arteritis. Rheumatol Int 44:603–610. https://doi.org/10.1007/s00296-023-05527-8. (PMID: 10.1007/s00296-023-05527-83830026910914919)
Moreel L, Betrains A, Molenberghs G, Vanderschueren S, Blockmans D (2023) Epidemiology and predictors of relapse in giant cell arteritis: a systematic review and meta-analysis. Joint Bone Spine 90(1):105494. https://doi.org/10.1016/j.jbspin.2022.105494. (PMID: 10.1016/j.jbspin.2022.10549436410684)
Stone JH, Tuckwell K, Dimonaco S et al (2017) Trial of tocilizumab in Giant-cell arteritis. N Engl J Med 377:317–328. https://doi.org/10.1056/NEJMoa1613849. (PMID: 10.1056/NEJMoa161384928745999)
Dumont A, Parienti J-J, Delmas C et al (2020) Factors associated with relapse and dependence on glucocorticoids in giant cell arteritis. J Rheumatol 47:108–116. https://doi.org/10.3899/jrheum.181127. (PMID: 10.3899/jrheum.18112730877210)
Dejaco C, Ramiro S, Bond M et al (2024) EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice: 2023 update. Ann Rheum Dis 83:741–751. https://doi.org/10.1136/ard-2023-224543. (PMID: 10.1136/ard-2023-22454337550004)
van der Geest KSM, Sandovici M, van Sleen Y et al (2018) Review: what is the current evidence for disease subsets in giant cell arteritis? Arthritis Rheumatol 70:1366–1376. https://doi.org/10.1002/art.40520. (PMID: 10.1002/art.40520296486806175064)
Dejaco C, Duftner C, Buttgereit F, Matteson EL, Dasgupta B (2017) The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease. Rheumatology (Oxford, England) 56(4):506–515. https://doi.org/10.1093/rheumatology/kew273. (PMID: 10.1093/rheumatology/kew27327481272)
Muratore F, Kermani TA, Crowson CS, Green AB, Salvarani C, Matteson EL, Warrington KJ (2015) Large-vessel giant cell arteritis: a cohort study. Rheumatology (Oxford, England) 54(3):463–470. https://doi.org/10.1093/rheumatology/keu329. (PMID: 10.1093/rheumatology/keu32925193809)
Guarda M, Hanson AC, Langenfeld HE, Crowson CS, Rakholiya J, Labarca C, Weyand CM, Warrington KJ, Koster MJ (2025) Concordance of relapse symptoms in patients with giant cell arteritis. Semin Arthritis Rheum 74:152814. https://doi.org/10.1016/j.semarthrit.2025.152814. (PMID: 10.1016/j.semarthrit.2025.15281440876384)
*Further Information*
*Objectives: The objective was to identify predictive factors for major relapses (MR) in patients with giant cell arteritis (GCA) and to compare clinical characteristics between MR phenotypes.
Method: This multicenter retrospective case-control study included patients fulfilling GiaCTA criteria for GCA. Cases were patients experiencing MR according to 2018 EULAR definitions. Controls were GCA patients without MR with a 1:3 ratio. Data were collected and analyzed using univariate and multivariate logistic regression to determine factors independently associated with MR. MR was subclassified into cranial-MR and large-vessel-MR which were compared using appropriate statistical tests.
Results: 258 patients were included, 70 cases and 188 controls (48.4% minor relapse, and 24.4% without relapse). The mean age at diagnosis was 72.5 ± 8.6 years, 70,9% were females. Younger age at diagnosis was associated with an increased risk of MR (OR = 0.93 per 10 years, 95% CI [0.87; 0.999], p = 0.043). No other clinically significant risk factors were identified. Among the 70 cases, 48.6% had a cranial-MR and 51.4% a large-vessel-MR. Patients with a cranial-MR were older (74.3 ± 6.3 years vs. 67.3 ± 7.0 years, p < 0.001) and were more likely to have cranial symptoms at diagnosis of GCA (91.2% vs. 69.4%, p = 0.023) compared to those with a large-vessel-MR. Compared with cranial-MR, large-vessel MR was more frequent in women (80.5% vs. 52.9%, p < 0.01) and tended to be associated with aortitis at diagnosis (70.0% vs. 43.5%, p = 0.052).
Conclusions: Younger age at diagnosis was the only independent predictor of MR. Relapse patterns mirrored initial disease phenotype, supporting the existence of cranial and large-vessel GCA subtypes. Key Points •Younger age at diagnosis is associated with a higher risk of major relapse in giant cell arteritis. •Cranial and large-vessel major relapses display distinct clinical patterns, often mirroring the initial disease phenotype. •No strong laboratory or imaging predictor of major relapse was identified in this multicentre case-control study.
(© 2025. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)*
*Declarations. Ethics approval and consent to participate: This study was approved by the Ethics and Scientific Committee of the Hospices Civils de Lyon on June 1, 2023 (approval n°22–5109). An information notice was provided to all participants in accordance with applicable regulations; written informed consent was therefore not required. All procedures involving human participants complied with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication: Not applicable. Related congress abstract publication: A related abstract was accepted as an e-poster presentation at the 91st National French Internal Medicine Society (SNFMI) Congress held in Tours from December 10 to 12, 2025. Editing support and AI use: We declare no editing support. Artificial intelligence (ChatGPT, OpenAI) was used to improve the clarity and fluency of the English language in the manuscript. The authors reviewed and take full responsibility for the final content. Competing interests: AR, SP, LP, SM, AH and JCL declare that they have no competing interests. LS has received personal fees or benefits from Abbvie, Novartis, Roche, and Chugai. HB reports receiving fees for serving on advisory boards from Roche-Chugai and Novartis and lecture fees from Roche-Chugai, Novartis, Fresenius Kabi, GlaxoSmithKline, Amicus therapeutics, and Sanofi. OE received fees for serving on advisory boards for Roche-Chugai and Novartis regarding biotherapy. PS has received institutional support from GSK and Novartis, and personal fees or benefits from Abbvie, GSK, Novartis, CHUGAI, UCB Pharma, Lilly, Fresenius Kabi, and Boehringer Ingelheim.*