POS0811 EULAR RECOMMENDATIONS ON GIANT CELL ARTERITIS IN REAL LIFE
Authors: F. Regola, F. Franceschini, G. Bosio, P. Toniati
Journal: Annals of the Rheumatic Diseases (2021)

Background: GCA is the most frequent systemic vasculitis in patients older than 50 years involving medium-sized and large arteries. On July 2019 EULAR published its updated recommendations for the management of large vessel vasculitis, including GCA. Objectives: To analyze how the application of the updated EULAR recommendations changed clinical practice in GCA patients in our Hospital. Methods: All patients with a new diagnosis of GCA between January 1 st , 2018 and December 31 st , 2020 were enrolled in this study. Two cohorts were analyzed: patients who received GCA diagnosis in the eighteen months before EULAR recommendations publication (between January 1 st , 2018 and June 30 th , 2019: cohort A) and patients who received GCA diagnosis in the following eighteen months (between July 1 st , 2019 and December 31 st , 2020: cohort B). Data are expressed as median (IQR). Results: 70 patients were enrolled in the study (F: 47, M: 23, age: 76 (69-79) years): 39 patients in cohort A, 31 in cohort B. Table 1 summarize main clinical features and treatment of patients. Sixteen patients of cohort A (41%) and eleven patients of cohort B (35%) presented large vessel involvement demonstrated by FDG-PET/CT. Thirty-one patients in cohort A (79%) and twenty-seven in cohort B (87%) presented cranial symptoms and were studied with temporal arteries ultrasound (US) and/or biopsy (TAB). More specifically, in cohort A US was performed in 42% of patients with cranial symptoms and TAB in 58% of them. After EULAR recommendations publication (cohort B) the percentage of patients with cranial symptoms who performed US increased to 56% and the percentage of TAB decreased to 52%. After EULAR recommendations publication, time between symptoms onset and first rheumatologic evaluation was reduced by 30% (from 61 (23-131) to 43 (22-92) days). No difference in treatment regiments were found between groups, whether in glucocorticoid initial dose or DMARDs adjunctive therapy. Conclusion: After EULAR recommendations publication, two major improvement were achieved in our cohort. EULAR suggests GCA patients should be urgently referred to a specialist team. Consistently with this recommendation, time between symptoms onset and first rheumatologic evaluation was markedly reduced. Moreover, EULAR suggests always confirming GCA diagnosis by imaging or TAB, with US as first choice. In line with these recommendations, in our cohort US became more and more frequently performed and progressively preferred over TAB. On the other hand, no differences in treatment regiments were found over time, with EULAR recommendations satisfied both before and after their publication. References: [1]Hellmich B, et al. Ann Rheum Dis 2019. ALL GCA (n: 70) Before EULAR recommendations (n: 39) After EULAR recommendations (n: 31) Time between symptoms onset and first rheumatologic evaluation (days) 53 (22-110) 61 (23-131) 43 (22-92) Temporal artery US 28/58 (48%) 13/31 (42%) 15/27 (56%) Temporal artery biopsy 32/58 (55%) 18/31 (58%) 14/27 (52%) Large vessel involvement (FDG-PET/CT) 27 (39%) 16 (41%) 11 (35%) Glucocorticoid initial dose (mg/die prednisone equivalent) 50 (47-50) 50 (50-50) 50 (38-50) DMARDs 43 (61%) 24 (61%) 19 (61%) Disclosure of Interests: None declared