8. Dysregulated glucose and lipid metabolism in glucocorticoid naïve GCA patients at diagnosis
Creators: name: Idil Esen
name: Therkildsen, Philip
name: Nielsen, Berit Dalsgaard
name: Hansen, Ib Tønder
name: Van T'Ende, Anna
name: Boots, Annemieke M.H.
name: Heeringa, Peter
name: Ellen-Margrethe Hauge
name: Brouwer, Elisabeth
name: Van Sleen, Yannick
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background:</strong> Giant cell arteritis (GCA) is an autoinflammatory disorder that affects the large and medium arteries in elderly people. Approximately 40-60% of patients with GCA also have overlapping polymyalgia rheumatica (PMR). PMR is a common rheumatological disease that affects the proximal large joints in the shoulders and hips. Long-term glucocorticoids (GCs) administration is still the mainstay of therapy for GCA and PMR patients. However, GCs can cause GC-related adverse events including hypercholesterolemia, hypertension, diabetes mellitus, cataract, and infections. Therefore, novel GC-sparing treatment options are needed. Previous studies reported a negative association between metabolic features such as cholesterol, fasting blood glucose and BMI in the development of GCA. However, data are limited. Here, we aimed to explore the metabolic features in two independent GC-naïve GCA/PMR patient cohorts and to elaborate on the prevalence of comorbidities in patients at the time of diagnosis and during treatment. <strong>Methods</strong>: This study included two cohorts from Aarhus (Denmark) and Groningen (The Netherlands, GCA/PMR/SENEX (GPS) cohort). The GPS cohort consisted of 50 GCA and 44 PMR patients. From the Aarhus cohort, 52 GCA and 25 PMR patients were included (Aarhus cohort). As a representation of the general population, we also included data of participants of the Lifelines cohort study (n=591), which includes participants from the northern population of the Netherlands. Patients in the GPS cohort were also prospectively followed with visits at 3 months, 1, 2, 3, 4 and 5 years. Laboratory measurements and comorbidities (diabetes mellitus, hypercholesterolemia, hypertension, obesity and cataract) were assessed at each visit. <strong>Results:</strong> In GCA patients (GPS cohort), we observed higher HbA1c and glucose levels before treatment compared to the general population. In contrast, LDL, HDL and cholesterol levels as well as BMI were lower in GCA patients suggesting a disturbed lipid and glucose metabolism in newly diagnosed GCA patients. Similar findings were seen in the Aarhus cohort, thereby validating our findings in the GPS cohort. Next, we investigated whether comorbidities were associated with levels of acute-phase markers (CRP, ESR) at the time of diagnosis. Except for cataract, none of the comorbidities were associated with CRP or ESR. In the early phase of GC treatment, the prevalence of diabetes increased in GCA patients, but not in PMR patients. The prevalence of cataract and obesity was increased in GCA patients upon long-term (5 year) treatment. <strong>Conclusions:</strong> Here, we show a dysregulated lipid and glucose metabolism in newly diagnosed GCA patients. GC treatment resulted in the development of comorbidities in GCA patients, emphasizing the high need for improved GC-sparing treatment options. <strong>Disclosures:</strong> None.