Ab0743 the impact of giant cell arteritis and polymyalgia rheumatica on frailty, daily functioning and quality of life in a prospective longitudinal standard-of-care cohort

Background Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are often overlapping inflammatory diseases that occur in people older than 50 years. Both diseases can affect the quality of life, due to the burden of vascular inflammation and ischemia-related symptoms (GCA), joint symptoms (PMR) and systemic symptoms (GCA and PMR), in addition to the side-effects of long-term treatment with glucocorticoids. Objectives The goal of this study was to analyze patient reported outcome measures (PROMs), including the quality of life, in patients with GCA and PMR at the time of diagnosis and during 5 years of follow-up, in comparison with age- and sex-matched healthy controls (HCs). Methods We prospectively followed treatment-naïve GCA (n=56) and PMR (n=42) patients since diagnosis for up to five years in our observational GPS (GCA, PMR, SENEX) cohort. At each visit, frailty was assessed with the Groningen Frailty Indicator (GFI), daily functioning with the Health Assessment Questionnaire-Disability Index (HAQ-DI) and health-related quality of life with the Short Form (SF)-36. Data were compared to HCs (n=70) selected based on frequency matching of 10-year age cohorts stratified for gender, who were also followed for up to five years. Results At diagnosis, PROMs were substantially worse in GCA and PMR patients compared to HCs. GCA patients reported worse scores on the General Health domain than PMR patients, but better scores on the Physical Functioning domain, Pain domain and the HAQ. During the 5-year follow-up, we recorded a partial improvement in PROMs during the first year, which however never reached levels similar to that of HCs in most of the outcomes (Figure 1). Next, we aimed to identify the clinical factors that are most strongly associated with the PROMs at diagnosis and during follow-up. We found that weight loss at diagnosis was associated with particularly low PROM scores, whereas inflammatory markers did not (PMR) or only moderately (GCA) associate with PROMs. Surprisingly, the physician general disease assessment (GDA) score showed no association with PROMs at diagnosis or at the 2-year visit. PROMs at the 2-year visit did correlate with the Fatigue score and patient GDA. Equivalent to the baseline visit, laboratory markers such as CRP correlated with PROMs in GCA, but not PMR patients. Finally, at the 2-year visit the use of glucocorticoids in GCA patients associated with worse PROMs, but in PMR patients with better scores on the SF-36. MTX use was associated with better PROMs, but only in GCA patients. Conclusion GCA and PMR patients experience both short-term and long-term impact on their frailty, daily functioning and quality of life. Medication use appears to be important in determining the patient’s quality of life, although surprisingly, glucocorticoid and methotrexate use appear to affect GCA and PMR patients differently. Importantly, the physician GDA or inflammatory markers do not associate strongly with PROMs, particularly in PMR patients, indicating a need for better understanding of the disease and treatment impact on patient’s life. Figure 1. Scores of the eight domains of the SF-36 throughout the disease course in GCA and PMR patients. Data, expressed as median and interquartile range, are compared to age and sex-matched HCs. Scores range from 0-100; a score of 100 indicates the most healthy outcome. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests Yannick van Sleen: None declared, Suzanne Arends Consultant of: Argenx and Novartis, Kornelis van der Geest Speakers bureau: Roche, Grant/research support from: Abbvie, Maria Sandovici: None declared, Elisabeth Brouwer: None declared.