1
|
Fedorinova EE, Bulanov NM, Meshkov AD, Borodin OO, Smitienko IO, Chachilo EV, Nartov AA, Filatova AL, Naumov AV, Novikov PI, Moiseev SV. Clinical Manifestations and Prognosis of Giant Cell Arteritis: A Retrospective Cohort Study. DOKL BIOCHEM BIOPHYS 2024; 517:250-258. [PMID: 39002010 DOI: 10.1134/s1607672924700984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 07/15/2024]
Abstract
The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA). MATERIALS AND METHODS . A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan-Meier method. RESULTS . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0-54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. CONCLUSIONS : Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.
Collapse
Affiliation(s)
- E E Fedorinova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia.
| | - N M Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A D Meshkov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - O O Borodin
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - I O Smitienko
- International Institute of Postgraduate Medical Education, Moscow, Russia
| | - E V Chachilo
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A A Nartov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A L Filatova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
| | - A V Naumov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - P I Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - S V Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
| |
Collapse
|
2
|
Stamatis P, Mohammad MA, Gisslander K, Merkel PA, Englund M, Turesson C, Erlinge D, Mohammad AJ. Myocardial infarction in a population-based cohort of patients with biopsy-confirmed giant cell arteritis in southern Sweden. RMD Open 2024; 10:e003960. [PMID: 38599652 PMCID: PMC11015192 DOI: 10.1136/rmdopen-2023-003960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To determine the incidence rate (IR) of myocardial infarction (MI), relative risk of MI, and impact of incident MI on mortality in individuals with biopsy-confirmed giant cell arteritis (GCA). METHODS MIs in individuals diagnosed with GCA 1998-2016 in Skåne, Sweden were identified by searching the SWEDEHEART register, a record of all patients receiving care for MI in a coronary care unit (CCU). The regional diagnosis database, with subsequent case review, identified GCA patients receiving care for MI outside of a CCU. A cohort of 10 reference subjects for each GCA case, matched for age, sex and area of residence, was used to calculate the incidence rate ratio (IRR) of MI in GCA to that in the general population. RESULTS The GCA cohort comprised 1134 individuals. During 7958 person-years of follow-up, 102 were diagnosed with incident MI, yielding an IR of 12.8 per 1000 person-years (95% CI 10.3 to 15.3). The IR was highest in the 30 days following GCA diagnosis and declined thereafter. The IRR of MI in GCA to that of the background population was 1.29 (95% CI 1.05 to 1.59). Mortality was higher in GCA patients who experienced incident MI than in those without MI (HR 2.8; 95% CI 2.2 to 3.6). CONCLUSIONS The highest incidence of MI occurs within the 30 days following diagnosis of GCA. Individuals with GCA have a moderately increased risk of MI compared with a reference population. Incident MI has a major impact on mortality in GCA.
Collapse
Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Sunderby Hospital, Luleå, Sweden
| | | | - Karl Gisslander
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund Universtiy, Malmö, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
3
|
Fernández-Lozano D, Hernández-Rodríguez I, Narvaez J, Domínguez-Álvaro M, De Miguel E, Silva-Díaz M, Belzunegui JM, Moriano Morales C, Sánchez J, Galíndez-Agirregoikoa E, Aldaroso V, Abasolo L, Loricera J, Garrido-Puñal N, Moya Alvarado P, Larena C, Navarro VA, Calvet J, Casafont-Solé I, Ortiz-Sanjuán F, Salman Monte TC, Castañeda S, Blanco R. Incidence and clinical manifestations of giant cell arteritis in Spain: results of the ARTESER register. RMD Open 2024; 10:e003824. [PMID: 38531620 DOI: 10.1136/rmdopen-2023-003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE This study aimed to estimate the incidence of giant cell arteritis (GCA) in Spain and to analyse its clinical manifestations, and distribution by age group, sex, geographical area and season. METHODS We included all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 at 26 hospitals of the National Health System. They had to be aged ≥50 years and have at least one positive results in an objective diagnostic test (biopsy or imaging techniques), meet 3/5 of the 1990 American College of Rheumatology classification criteria or have a clinical diagnosis based on the expert opinion of the physician in charge. We calculated incidence rate using Poisson regression and assessed the influence of age, sex, geographical area and season. RESULTS We identified 1675 cases of GCA with a mean age at diagnosis of 76.9±8.3 years. The annual incidence was estimated at 7.42 (95% CI 6.57 to 8.27) cases of GCA per 100 000 people ≥50 years with a peak for patients aged 80-84 years (23.06 (95% CI 20.89 to 25.4)). The incidence was greater in women (10.06 (95% CI 8.7 to 11.5)) than in men (4.83 (95% CI 3.8 to 5.9)). No significant differences were found between geographical distribution and incidence throughout the year (p=0.125). The phenotypes at diagnosis were cranial in 1091 patients, extracranial in 337 patients and mixed in 170 patients. CONCLUSIONS This is the first study to estimate the incidence of GCA in Spain at a national level. We found a predominance among women and during the ninth decade of life with no clear variability according to geographical area or seasons of the year.
Collapse
Affiliation(s)
| | | | - Javier Narvaez
- Rheumatology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | - Maite Silva-Díaz
- Rheumatology, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
| | | | | | - Julio Sánchez
- Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Lydia Abasolo
- Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Loricera
- Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Immunopathology Group-IDIVAL, Santander, Spain
| | | | | | - Carmen Larena
- Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Joan Calvet
- Rheumatology, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | | | | | - Santos Castañeda
- Rheumatology, Hospital Universitario de la Princesa. IIS-Princesa, Madrid, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Immunopathology Group-IDIVAL, Santander, Spain
| |
Collapse
|
4
|
Chehem Daoud Chehem F, de Mornac D, Feuillet F, Liozon E, Samson M, Bonnotte B, de Boysson H, Guffroy A, Balquet MH, Ledoult E, Lavigne C, Trefond L, Smets P, Bodard Q, Fenot M, Richez C, Duffau P, Guillaud C, Espitia O, Agard C. Giant cell arteritis associated with scalp, tongue or lip necrosis: A French multicenter case control study. Semin Arthritis Rheum 2024; 64:152348. [PMID: 38091870 DOI: 10.1016/j.semarthrit.2023.152348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/03/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Scalp, tongue and/or lip necrosis are rare complications of GCA. OBJECTIVES To describe characteristics and outcome of patients with giant cell arteritis (GCA) -related scalp, tongue and/or lip necrosis. METHODS A retrospective nationwide multicenter study included 20 GCA patients with scalp, tongue, and/or lip necrosis diagnosed between 1998 and 2021 and 80 GCA control patients matched for age, sex and management period. Logistic regression analyses were conducted to identify baseline characteristics associated with scalp, tongue and/or lip necrosis. RESULTS Compared to controls, patients with scalp, tongue and/or lip necrosis showed significantly more cranial manifestations (headache, p=0.045; scalp tenderness, p=0.006; jaw claudication, p=0.02). No differences were observed between both groups regarding the occurrence of visual symptoms or large vessel involvement. At diagnosis, GCA patients with necrosis more likely received IV methylprednisolone infusions and higher doses of oral prednisone. There were no differences regarding vascular complications during follow up. Compared to controls, survival was decreased in GCA patients with necrosis (p=0.003). In a multivariable logistic regression model, scalp tenderness [odds ratio (OR) 4.81(95 % CI: 1.57, 14.79), p = 0.006] and cognitive disorder [OR 6.42 (95 % CI: 1.01, 40.60), p=0.048] were identified as factors associated to scalp, tongue, and/or lip necrosis. CONCLUSION Our results suggest that scalp, tongue, and/or lip necrosis is associated to higher mortality in GCA patients. Scalp tenderness and cognitive disorder were significant factors associated to this very rare complication of GCA.
Collapse
Affiliation(s)
| | - Donatienne de Mornac
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France
| | - Fanny Feuillet
- Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Eric Liozon
- Internal Medicine Department, Limoges University Hospital, Limoges, France
| | - Maxime Samson
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Bernard Bonnotte
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Hubert de Boysson
- Internal Medicine Department, Caen University Hospital, Caen, France
| | - Aurélien Guffroy
- Internal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Emmanuel Ledoult
- Internal Medicine Department, Lille University Hospital, Lille, France
| | - Christian Lavigne
- Internal Medicine Department, Angers University Hospital, Angers, France
| | - Ludovic Trefond
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Perrine Smets
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Quentin Bodard
- Internal medicine and Infectious Diseases Department, Departmental Hospital Centre, Angoulême, France
| | - Marion Fenot
- Dermatology Department, Departmental Hospital Centre, La Roche Sur Yon, France
| | - Christophe Richez
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, and CHU of Bordeaux, Department of Rheumatology, F-33000 Bordeaux, France
| | - Pierre Duffau
- University Bordeaux, CHU Bordeaux, Department of internal medicine, Bordeaux, France
| | - Constance Guillaud
- Internal Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Olivier Espitia
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France; L'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, F-44000 Nantes, France
| | - Christian Agard
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France.
| |
Collapse
|
5
|
Pacoureau L, Barde F, Seror R, Nguyen Y. Association between infection and the onset of giant cell arteritis and polymyalgia rheumatica: a systematic review and meta-analysis. RMD Open 2023; 9:e003493. [PMID: 37949615 PMCID: PMC10649904 DOI: 10.1136/rmdopen-2023-003493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/18/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE We aimed to analyse the association between infections and the subsequent risk of giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR) by a systematic review and a meta-analysis of observational studies. METHODS Two databases (Medline and Embase) were systematically reviewed. Epidemiological studies studying the association between any prior infection and the onset of GCA/PMR were eligible. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale. Outcomes and pooled statistics were reported as OR and their 95% CI. RESULTS Eleven studies (10 case-control studies and one cohort study) were analysed, seven of them were included in the meta-analysis. Eight were at low risk of bias. A positive and significant association was found between prior overall infections and prior Herpes Zoster (HZ) infections with pooled OR (95% CI) of 1.27 (1.18 to 1.37) and 1.20 (1.08 to 1.21), respectively. When analysed separately, hospital-treated and community-treated infections, were still significantly associated with the risk of GCA, but only when infections occurring within the year prior to diagnosis were considered (pooled OR (95% CI) 1.92 (1.67 to 2.21); 1.67 (1.54 to 1.82), respectively). This association was no longer found when infections occurring within the year prior to diagnosis were excluded. CONCLUSION Our study showed a positive association between the risk of GCA and prior overall infections (occurring in the year before), and prior HZ infections. Infections might be the reflect of an altered immunity of GCA patients or trigger the disease. However, reverse causation cannot be excluded.CRD42023404089.
Collapse
Affiliation(s)
- Lucas Pacoureau
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
| | - François Barde
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
| | - Raphaele Seror
- Auto-immunity team, IMVA, INSERM U1184, Le Kremlin Bicêtre, France
- Department of Rheumatology, Hôpital Bicêtre, AP-HP.Sud, Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Yann Nguyen
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
- Department of Rheumatology, Hôpital Bicêtre, AP-HP.Sud, Université Paris Saclay, Le Kremlin-Bicetre, France
| |
Collapse
|
6
|
Brekke LK, Assmus J, Fevang BTS. Factors predicting death and cancer in patients with giant cell arteritis in Western Norway 1972-2012: a retrospective observational cohort study. Front Med (Lausanne) 2023; 10:1243791. [PMID: 37746078 PMCID: PMC10514500 DOI: 10.3389/fmed.2023.1243791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Evidence as to whether or not giant cell arteritis (GCA) confers added risk of cancer or death is conflicting. Our aim was to identify factors predicting death or cancer in a large Norwegian GCA-cohort. Methods This is a retrospective observational cohort study including patients diagnosed with GCA in Western Norway during 1972-2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding. Medical records were reviewed and data about registered deaths and cancer occurrences were extracted from the Norwegian Cause of Death Registry and the Cancer Registry of Norway. We investigated predicting factors using Cox proportional hazards regression. Results We identified 881 cases with a validated diagnosis of GCA (60% biopsy-verified). 490 patients (56%) died during the study period. Among 767 patients with no registered cancer prior to GCA diagnosis, 120 (16%) were diagnosed with cancer during the study period. Traditional risk factors were the main predictors of death; age at time of GCA-diagnosis [hazard ratio (HR) 2.81], smoking (HR 1.61), hypertension (HR 1.48) and previous cardiovascular disease (HR 1.26). Hemoglobin (Hb) level was also associated with risk of death with increasing Hb-levels at time of GCA-diagnosis indicating decreased risk of death (HR 0.91). Other GCA-related factors were not predictive of death. We did not identify any predictors of cancer risk. Conclusion In our cohort of GCA-patients, the risk of death was predominantly predicted by age and traditional risk factors. We found no significant associations with regards to the risk of incident cancer.
Collapse
Affiliation(s)
- Lene Kristin Brekke
- Department of Rheumatology, Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway
- Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Bjørg-Tilde Svanes Fevang
- Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
7
|
Awisat A, Keret S, Silawy A, Kaly L, Rosner I, Rozenbaum M, Boulman N, Shouval A, Rimar D, Slobodin G. Giant Cell Arteritis: State of the Art in Diagnosis, Monitoring, and Treatment. Rambam Maimonides Med J 2023; 14:RMMJ.10496. [PMID: 37116064 PMCID: PMC10147399 DOI: 10.5041/rmmj.10496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Giant cell arteritis (GCA) is the most prevalent subtype of vasculitis in adults. In recent years, there has been substantial improvement in the diagnosis and treatment of GCA, mainly attributed to the introduction of highly sensitive diagnostic tools, incorporation of modern imaging modalities for diagnosis and monitoring of large-vessel vasculitis, and introduction of highly effective novel biological therapies that have revolutionized the field of GCA. This article reviews state-of-the-art approaches for the diagnosis, monitoring, and treatment options of GCA.
Collapse
Affiliation(s)
- Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Shiri Keret
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Amal Silawy
- Rheumatology Clinic, Maccabi Health Services, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | | | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Aniela Shouval
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| |
Collapse
|
8
|
Stamatis P, Turesson C, Michailidou D, Mohammad AJ. Pathogenesis of giant cell arteritis with focus on cellular populations. Front Med (Lausanne) 2022; 9:1058600. [PMID: 36465919 PMCID: PMC9714577 DOI: 10.3389/fmed.2022.1058600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 08/27/2023] Open
Abstract
Giant cell arteritis (GCA), the most common non-infectious vasculitis, mainly affects elderly individuals. The disease usually affects the aorta and its main supra-aortic branches causing both general symptoms of inflammation and specific ischemic symptoms because of the limited blood flow due to arterial structural changes in the inflamed arteries. The pathogenesis of the GCA is complex and includes a dysregulated immune response that affects both the innate and the adaptive immunity. During the last two decades several studies have investigated interactions among antigen-presenting cells and lymphocytes, which contribute to the formation of the inflammatory infiltrate in the affected arteries. Toll-like receptor signaling and interactions through the VEGF-Notch-Jagged1 pathway are emerging as crucial events of the aberrant inflammatory response, facilitating among others the migration of inflammatory cells to the inflamed arteries and their interactions with the local stromal milieu. The increased use of checkpoint inhibitors in cancer immunotherapy and their immune-related adverse events has fed interest in the role of checkpoint dysfunction in GCA, and recent studies suggest a dysregulated check point system which is unable to suppress the inflammation in the previously immune-privileged arteries, leading to vasculitis. The role of B-cells is currently reevaluated because of new reports of considerable numbers of plasma cells in inflamed arteries as well as the formation of artery tertiary lymphoid organs. There is emerging evidence on previously less studied cell populations, such as the neutrophils, CD8+ T-cells, T regulatory cells and tissue residing memory cells as well as for stromal cells which were previously considered as innocent bystanders. The aim of this review is to summarize the evidence in the literature regarding the cell populations involved in the pathogenesis of GCA and especially in the context of an aged, immune system.
Collapse
Affiliation(s)
- Pavlos Stamatis
- Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Rheumatology, Sunderby Hospital, Luleå, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Despina Michailidou
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Aladdin J. Mohammad
- Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
9
|
Gonzalez Chiappe S, Lechtman S, Maldini CS, Mekinian A, Papo T, Sené T, Mahr AD. Incidence of giant cell arteritis in six districts of Paris, France (2015-2017). Rheumatol Int 2022; 42:1721-1728. [PMID: 35819504 DOI: 10.1007/s00296-022-05167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
This prospective population-based study estimated the incidence of giant cell arteritis (GCA) in northeastern Paris. GCA cases diagnosed between 2015 and 2017 were obtained from local hospital and community-based physicians and the national health insurance system database. Criteria for inclusion were living in the study area at that time and fulfilling the 1990 American College of Rheumatology classification criteria and/or its expanded version. Cranial and large-vessel GCA cases were defined by the presence or absence of cranial signs and/or symptoms, respectively. Annual incidence was calculated by dividing the number of incident cases by the size of the study population ≥ 50 years old. Completeness of case ascertainment was assessed by a three-source capture-recapture analysis. Among the 62 included cases, 42 (68%) were women, mean (± SD) age 77.3 ± 9.1 years. The annual incidence of GCA in northeastern Paris and completeness of case ascertainment were estimated at 7.6 (95% CI 5.9-9.8) per 100,000 inhabitants ≥ 50 years old and 66% (95% CI 52-92%), respectively. Incidence increased with age, peaked at age 80-89 years, and was almost twice as high in women versus men. Large-vessel GCA cases, mean (± SD) age 68.6 ± 11.5 years, accounted for 8% of all GCA cases. In this study, GCA epidemiology was mainly driven by cases with cranial GCA signs or symptoms and incidence results were consistent with recent European and past French studies.
Collapse
Affiliation(s)
- Solange Gonzalez Chiappe
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France. .,Rheumatology Department, Saint Gallen Kantonsspital, Saint Gallen, Switzerland.
| | - Sarah Lechtman
- Internal Medicine, AP-HP, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - Carla Soledad Maldini
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France
| | - Arsène Mekinian
- Internal Medicine and Inflammation-Immunopathology-Biotherapy Department (DMU i3), AP-HP, Saint Antoine Hospital, Sorbonne Université, Paris, France.,French-Armenian Clinical Research Center, National Institute of Health, 0051, Yerevan, Armenia
| | - Thomas Papo
- Internal Medicine, AP-HP, Bichat Hospital, Paris Diderot University, Paris, France
| | - Thomas Sené
- Internal Medicine, Croix Saint-Simon Hospital, University Paris 6, Paris, France
| | - Alfred Daniel Mahr
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France.,ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, UMR 1153 Inserm, Paris, France.,Rheumatology Department, Saint Gallen Kantonsspital, Saint Gallen, Switzerland
| |
Collapse
|
10
|
Yu E, Chang JR. Giant Cell Arteritis: Updates and Controversies. FRONTIERS IN OPHTHALMOLOGY 2022; 2:848861. [PMID: 38983551 PMCID: PMC11182101 DOI: 10.3389/fopht.2022.848861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 07/11/2024]
Abstract
Abstract Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting the medium and large-size arteries, and may present with a range of ophthalmic findings. This review will cover GCA epidemiology, pathophysiology, clinical presentation, diagnostic workup, and treatment. Epidemiology and Pathophysiology GCA is commonly found in elderly patients and individuals of Scandinavian descent. Recent publications suggest it may be more common in African Americans and Hispanics than previously thought. It is very rare in Asian and Middle-Eastern populations, and there is little data regarding African populations. Genetic studies have identified increased risk associated with HLA-DRB1*04. Rather than a response to a specific antigen such as varicella zoster virus, current immunology research suggests that GCA results from changes associated with the aging immune system. Clinical presentation to Ophthalmology Arteritic anterior ischemic optic neuropathy is the most common ophthalmic manifestation of GCA, but central or branch retinal artery occlusion, ophthalmic artery occlusion, cranial neuropathies causing diplopia, and more rarely anterior segment ischemia and anisocoria may also occur. Clinical testing including visual field testing, OCT, OCT-A, ICG and fluorescein angiography can be helpful in suggesting a diagnosis in addition to the clinical exam. Diagnostic Workup GCA is ultimately a clinical diagnosis, but it is usually supported with lab results, pathology, and/or imaging. Temporal artery biopsy (TAB) remains the gold standard diagnostic test although its sensitivity is debated and practice patterns still vary with respect to sample length and whether unilateral or simultaneous bilateral biopsies are performed. Some studies have reported higher sensitivity of ultrasounds over TAB, with added benefits of time efficiency and cost effectiveness, promoting the diagnostic use of ultrasounds. MRI and even PET CT protocols offer additional options for less invasive diagnostic testing. Treatment Vision-threatening GCA is treated acutely with emergent admission for intravenous methylprednisolone, and long-term high dose oral corticosteroids remain the standard of care, despite common and sometimes serious side effects. The use of steroid-sparing alternatives such as tocilizumab is becoming more common and additional agents are being investigated.
Collapse
Affiliation(s)
| | - Jessica R. Chang
- University of Southern California Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, United States
| |
Collapse
|
11
|
Ughi N, Padoan R, Crotti C, Sciascia S, Carrara G, Zanetti A, Rozza D, Monti S, Camellino D, Muratore F, Emmi G, Quartuccio L, Morbelli S, El Aoufy K, Tonolo S, Caporali R, De Vita S, Salvarani C, Cimmino M. The Italian Society of Rheumatology clinical practice guidelines for the management of large vessel vasculitis. Reumatismo 2022; 73. [DOI: 10.4081/reumatismo.2021.1470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: Since of the last publication of last recommendations on primary large-vessel vasculitis (LVV) endorsed by the Italian Society of Rheumatology (SIR) in 2012, new evidence emerged regarding the diagnosis and the treatment with conventional and biologic immunosuppressive drugs. The associated potential change of clinical care supported the need to update the original recommendations. Methods: Using the grading of recommendations assessment, development and evaluation (GRADE)-ADOLOPMENT framework, a systematic literature review was performed to update the evidence supporting the European Alliance of Associations for Rheumatology (EULAR) guidelines on LVV as reference. A multidisciplinary panel of 12 expert clinicians, a trained nurse, and a patients’ representative discussed the recommendation in cooperation with an Evidence Review Team. Sixty-one stakeholders were consulted to externally review and rate the recommendations. Results: Twelve recommendations were formulated. A suspected diagnosis of LVV should be confirmed by imaging or histology. In active GCA or TAK, the prompt commencement of high dose of oral glucocorticoids (40-60 mg prednisone-equivalent per day) is strongly recommended to induce clinical remission. In selected patients with GCA (e.g., refractory or relapsing disease or patients at risk of glucocorticoid related adverse effects) the use of an adjunctive therapy (tocilizumab or methotrexate) is recommended. In all patients diagnosed with TAK, adjunctive therapies, such as conventional synthetic or biological immunosuppressants, should be given in combination with glucocorticoids. Conclusions: The new set of SIR recommendations was formulated in order to provide a guidance on both diagnosis and treatment of patients suspected of or with a definite diagnosis of LVV.
Collapse
|
12
|
Pugh D, Karabayas M, Basu N, Cid MC, Goel R, Goodyear CS, Grayson PC, McAdoo SP, Mason JC, Owen C, Weyand CM, Youngstein T, Dhaun N. Large-vessel vasculitis. Nat Rev Dis Primers 2022; 7:93. [PMID: 34992251 PMCID: PMC9115766 DOI: 10.1038/s41572-021-00327-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 02/08/2023]
Abstract
Large-vessel vasculitis (LVV) manifests as inflammation of the aorta and its major branches and is the most common primary vasculitis in adults. LVV comprises two distinct conditions, giant cell arteritis and Takayasu arteritis, although the phenotypic spectrum of primary LVV is complex. Non-specific symptoms often predominate and so patients with LVV present to a range of health-care providers and settings. Rapid diagnosis, specialist referral and early treatment are key to good patient outcomes. Unfortunately, disease relapse remains common and chronic vascular complications are a source of considerable morbidity. Although accurate monitoring of disease activity is challenging, progress in vascular imaging techniques and the measurement of laboratory biomarkers may facilitate better matching of treatment intensity with disease activity. Further, advances in our understanding of disease pathophysiology have paved the way for novel biologic treatments that target important mediators of disease in both giant cell arteritis and Takayasu arteritis. This work has highlighted the substantial heterogeneity present within LVV and the importance of an individualized therapeutic approach. Future work will focus on understanding the mechanisms of persisting vascular inflammation, which will inform the development of increasingly sophisticated imaging technologies. Together, these will enable better disease prognostication, limit treatment-associated adverse effects, and facilitate targeted development and use of novel therapies.
Collapse
Affiliation(s)
- Dan Pugh
- British Hearth Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Maira Karabayas
- Centre for Arthritis & Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Maria C Cid
- Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ruchika Goel
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Carl S Goodyear
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Peter C Grayson
- National Institute of Arthritis & Musculoskeletal & Skin Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Stephen P McAdoo
- Department of Immunology & Inflammation, Imperial College London, London, UK
| | - Justin C Mason
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Cornelia M Weyand
- Centre for Translational Medicine, Stanford University, Stanford, California, USA
| | - Taryn Youngstein
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Neeraj Dhaun
- British Hearth Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
13
|
Antonini L, Dumont A, Lavergne A, Castan P, Barakat C, Gallou S, Sultan A, Deshayes S, Aouba A, de Boysson H. Real-life analysis of the causes of death in patients consecutively followed for giant cell arteritis in a French centre of expertise. Rheumatology (Oxford) 2021; 60:5080-5088. [PMID: 33693495 DOI: 10.1093/rheumatology/keab222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe, in a real-life setting, the direct causes of death in a cohort of consecutive patients with GCA. METHODS We retrospectively analysed the deaths that occurred in a cohort of 470 consecutive GCA patients from a centre of expertise between January 2000 and December 2019. Among the 120 patients who died, we retrieved data from the medical files of 101 patients. RESULTS Cardiovascular events were the dominant cause of death (n = 41, 41%) followed by infections (n = 22, 22%), geriatric situations (i.e. falls or senile deterioration; n = 17, 17%) and cancers (n = 15, 15%). Patients in each of these four groups were compared with the other deceased patients pooled together. Patients who died from cardiovascular events were more frequently male (46 vs 27%; P = 0.04) with a past history of coronary artery disease (29 vs 8%; P = 0.006). Patients who died from infections mostly had ongoing glucocorticoid treatment (82 vs 53%; P = 0.02) with higher cumulative doses (13 994 vs 9150 mg; P = 0.03). Patients who died from geriatric causes more frequently had osteoporosis (56 vs 17%; P = 0.0009) and had mostly discontinued glucocorticoid treatment (76 vs 33%; P = 0.001). The predictive factors of death in multivariate analysis were a history of coronary disease [hazard ratio (HR) 2.39; 95% CI 1.27, 4.21; P = 0.008], strokes at GCA diagnosis (HR 2.54; 95% CI 1.05, 5.24; P = 0.04), any infection during follow-up (HR 1.93; 95% CI 1.24, 2.98; P = 0.004) and fever at GCA diagnosis (HR 1.99; 95% CI 1.16, 3.28; P = 0.01). CONCLUSION Our study provides real-life insight on the cause-specific mortality in GCA patients.
Collapse
Affiliation(s)
- Luca Antonini
- Department of Internal Medicine, Caen University Hospital
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
| | | | - Paul Castan
- Department of Internal Medicine, Caen University Hospital
| | - Clivia Barakat
- Department of Internal Medicine, Caen University Hospital
| | - Sophie Gallou
- Department of Internal Medicine, Caen University Hospital
| | - Audrey Sultan
- Department of Internal Medicine, Caen University Hospital
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital.,Caen University-Normandie, Caen, France
| |
Collapse
|
14
|
Garvey TD, Koster MJ, Crowson CS, Warrington KJ. Incidence, survival, and diagnostic trends in GCA across seven decades in a North American population-based cohort. Semin Arthritis Rheum 2021; 51:1193-1199. [PMID: 34644662 DOI: 10.1016/j.semarthrit.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To analyze trends in the incidence and use of diagnostic modalities for GCA in a population-based cohort over the past seven decades. To explore survival trends in patients with GCA compared with the general population. METHODS A population-based cohort of patients diagnosed with GCA was extended with new incident cases from 2010 to 2019. Three time periods were compared: Period One (1950-1979), Period Two (1980-1999), and Period Three (2000-2019). Cases were classified as: Diagnostic Group One, temporal artery biopsy (TAB) positive; Diagnostic Group Two, TAB-negative or not done with positive large-vessel imaging; or Diagnostic Group Three, clinical diagnosis of GCA. Survival was evaluated by comparing Kaplan-Meier estimated mortality rates for cases of GCA against expected mortality rates from Minnesota life tables RESULTS: Age- and sex-adjusted incident rates per 100,000 ≥ 50 years of age (95% CI) were 13.5 (10.1, 16.9) in Period One, 21.0 (17.1, 25.0) in Period Two, and 15.0 (12.4, 17.5) in Period Three. The percent of patients in Diagnostic Group One decreased over the three time periods (89%, 86%, and 72%) while the patients in Diagnostic Group Three increased (11%, 14%, and 17%). Standardized mortality ratios (95% CI) were 1.03 (0.79, 1.32), 1.11 (0.91, 1.34), and 0.82 (0.64, 1.04) across Periods 1-3, respectively. CONCLUSIONS Incidence of GCA in females in the population declined, resulting in a decreasing overall incidence. More patients have been identified by large-vessel imaging and fewer by positive TABs. No significant difference in survival between patients with GCA and the general population was observed.
Collapse
Affiliation(s)
- Thomas D Garvey
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America.
| | - Matthew J Koster
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America
| | - Cynthia S Crowson
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kenneth J Warrington
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America
| |
Collapse
|
15
|
Kønig EB, Stormly Hansen M, Foldager J, Siersma V, Loft A, Terslev L, Møller Døhn U, Radmer Jensen M, Wiencke AK, Faber C, Hamann S, Heegaard S. Seasonal variation in biopsy-proven giant cell arteritis in Eastern Denmark from 1990-2018. Acta Ophthalmol 2021; 99:527-532. [PMID: 33211398 DOI: 10.1111/aos.14675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to investigate seasonal variation in cases of biopsy-proven GCA in eastern Denmark in a 29-year period. METHODS Pathology records of all temporal artery biopsies in eastern Denmark between 1990 and 2018 were reviewed. For each patient, data were collected which included age, sex, date of birth and biopsy result. Seasonality was evaluated using logistic regression and Poisson regression analysis. Lastly, an explorative pilot study was conducted to investigate a possible association between three weather parameters (average temperature, amount of rain and hours of sunshine) and the biopsy outcome. RESULTS One thousand three hundred twenty-three biopsies were included of which 336 fulfilled objective criteria for GCA diagnosis. Mean age at diagnosis was 75.6 years (range 52-94 years). Among the biopsy-proven cases of GCA, there were 223 women (66.3%, mean age 76.2 years) and 113 men (33.7%, mean age 74.4 years) giving a female to male ratio of 1.97:1. The peak occurrence of GCA was in the 70-79 years age group. Statistical analysis of seasonal variation showed an increased risk of a positive biopsy during summer compared to autumn (p = 0.037). No association between the three weather parameters and the biopsy outcome was found. CONCLUSION In this study of biopsy-proven GCA in a large Danish patient cohort, the occurrence of GCA showed seasonal variation with higher occurrence in the summer months when compared to autumn. Future studies pooling all cases of GCA worldwide are needed to determine seasonality in the occurrence of GCA.
Collapse
Affiliation(s)
- Elisabeth Bay Kønig
- Eye Pathology Section Department of Pathology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | | | - Jonathan Foldager
- Department of Applied Mathematics and Computer Science Technical University of Denmark Copenhagen Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Lene Terslev
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Uffe Møller Døhn
- Center for Rheumatology and Spine Diseases Rigshospitalet Copenhagen Denmark
| | - Mads Radmer Jensen
- Department of Clinical Physiology and Nuclear Medicine Bispebjerg Hospital Copenhagen Denmark
| | | | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Steffen Heegaard
- Eye Pathology Section Department of Pathology, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Ophthalmology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| |
Collapse
|
16
|
Stamatis P, Turkiewicz A, Englund M, Turesson C, Mohammad AJ. Comment on: EPIDEMIOLOGY OF BIOPSY-CONFIRMED GIANT CELL ARTERITIS IN SOUTHERN SWEDEN-AN UPDATE ON INCIDENCE AND FIRST PREVALENCE ESTIMATE: Reply. Rheumatology (Oxford) 2021; 60:e423-e424. [PMID: 34270676 PMCID: PMC8566306 DOI: 10.1093/rheumatology/keab559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Martin Englund
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Sweden, Lund
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.,Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
17
|
Therkildsen P, Nielsen BD, de Thurah A, Hansen IT, Nørgaard M, Hauge EM. All-cause and cause-specific mortality in patients with giant cell arteritis: a nationwide, population-based cohort study. Rheumatology (Oxford) 2021; 61:1195-1203. [PMID: 34164660 DOI: 10.1093/rheumatology/keab507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate whether giant cell arteritis (GCA) is associated with increased all-cause and cause-specific mortality. METHODS A nationwide, population-based cohort study in Denmark using medical and administrative registries. GCA cases were defined as patients aged ≥50 years from 1996-2018 with a first-time discharge diagnosis of GCA and ≥3 prescriptions for prednisolone within 6 months following diagnosis. Each GCA patient was matched based on age, sex and calendar time to 10 persons without a history of GCA. Index date was the date for the third prednisolone prescription. We used a pseudo-observation approach to calculate all-cause and cause-specific mortality, adjusted risk differences (RDs) and relative risks (RRs). RESULTS We included 9908 GCA patients and 98204 persons from the general population. The median time for GCA patients to redeem the third prednisolone prescription was 74 days (IQR: 49-106). Among GCA patients, the overall mortality was 6.4% (95% CI: 5.9-6.9) 1 year after index date and 45% (95% CI: 44-47) after 10 years. Compared to the reference cohort, adjusted RDs and RRs of deaths in the GCA cohort were 2.2% (95% CI: 1.7-2.7) and 1.49 (95% CI: 1.36-1.64) after 1 year, and 2.1% (95% CI: 1.0-3.3) and 1.03 (95% CI: 1.00-1.05) 10 years after index date. GCA patients had a higher risk of death due to infectious, endocrine, cardiovascular, and gastrointestinal diseases. CONCLUSIONS GCA is associated with increased all-cause mortality, particularly within the first year following the diagnosis. Cause-specific mortality indicates that mortality in GCA may in part be due to glucocorticoid-related complications.
Collapse
Affiliation(s)
- Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Dalsgaard Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
18
|
Muratore F, Boiardi L, Mancuso P, Restuccia G, Galli E, Marvisi C, Macchioni P, Rossi PG, Salvarani C. Incidence and prevalence of large vessel vasculitis (giant cell arteritis and Takayasu arteritis) in northern Italy: A population-based study. Semin Arthritis Rheum 2021; 51:786-792. [PMID: 34148007 DOI: 10.1016/j.semarthrit.2021.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate the epidemiology of the entire spectrum of large vessel vasculitis (LVV) in a well-defined population from a Northern Italian area. METHODS All patients with incident giant cell arteritis (GCA) diagnosed from 2005 to 2016 and all patients with incident Takayasu arteritis (TAK) diagnosed from 1998 to 2016 living in the Reggio Emilia area were identified. Only patients satisfying the modified inclusion criteria of the GiACTA trial, and the 1990 ACR classification criteria for TAK were included. The epidemiology of cranial- and LV-GCA was separately evaluated. RESULTS 207 patients were diagnosed with GCA and 5 with TAK. 123 patients had cranial-GCA, 53 patients had LV-GCA, and the remaining 31 patients had overlapping features. The standardized annual incidence rate of GCA was 8.3 (95% CI 7.1, 9.4) per 100,000 population ages ≥50 years. The standardized annual incidence rate of cranial-GCA (6.1 [95% CI 5.1, 7.1] per 100,000 population ages ≥50 years) was double the rate of LV-GCA (3.4 [95% CI 2.7, 4.2]). The age-specific incidence rates were similar in the <70 and >90 years age groups, but they were higher in cranial-GCA than in LV-GCA in the age groups 70-79 and 80-89 years. The age- and sex-adjusted annual incidence rate of TAK was 0.5 (95% CI 0.1, 1.2) per 1,000,000 population. CONCLUSION Incidence of GCA is higher than previously reported by study evaluating only biopsy-proven or ACR classification criteria confirmed cases. Cranial-GCA and LV-GCA have epidemiological differences. TAK is an extremely rare disease also in Italy.
Collapse
Affiliation(s)
- Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Boiardi
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanna Restuccia
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Galli
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Università di Modena e Reggio Emilia, Modena, Italy
| | - Chiara Marvisi
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Università di Modena e Reggio Emilia, Modena, Italy
| | - Pierluigi Macchioni
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Università di Modena e Reggio Emilia, Modena, Italy.
| |
Collapse
|
19
|
Garvey TD, Koster MJ, Warrington KJ. My Treatment Approach to Giant Cell Arteritis. Mayo Clin Proc 2021; 96:1530-1545. [PMID: 34088416 DOI: 10.1016/j.mayocp.2021.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults 50 years or older. Expanded use of advanced arterial imaging has assisted both in the diagnosis of GCA and recognition of disease subsets. Although glucocorticoids have been the mainstay of treatment for almost 7 decades, new therapeutic options have emerged. This review aims to provide the clinician with a pragmatic approach to evaluating and managing patients with GCA while also addressing recent diagnostic and therapeutic developments.
Collapse
Affiliation(s)
- Thomas D Garvey
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Matthew J Koster
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
20
|
de Mornac D, Espitia O, Néel A, Connault J, Masseau A, Espitia-Thibault A, Artifoni M, Achille A, Wahbi A, Lacou M, Durant C, Pottier P, Perrin F, Graveleau J, Hamidou M, Hardouin JB, Agard C. Large-vessel involvement is predictive of multiple relapses in giant cell arteritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211009029. [PMID: 34046092 PMCID: PMC8135215 DOI: 10.1177/1759720x211009029] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Giant cell arteritis (GCA) is the most common systemic vasculitis. Relapses are frequent. The aim of this study was to identify relapse risk factors in patients with GCA with complete large-vessel imaging at diagnosis. Methods: Patients with GCA followed in our institution between April 1998 and April 2018 were included retrospectively. We included only patients who had undergone large vascular imaging investigations at diagnosis by computed tomography (CT)-scan and/or positron emission tomography (PET)-scan and/or angio-magnetic resonance imaging (MRI). Clinical, biological, and radiological data were collected. Relapse was defined as the reappearance of GCA symptoms, with concomitant increase in inflammatory markers, requiring treatment adjustment. Relapsing patients (R) and non-relapsing patients (NR) were compared. Relapse and multiple relapses (>2) risk factors were identified in multivariable Cox analyses. Results: This study included 254 patients (73.2% women), with a median age of 72 years at diagnosis and a median follow up of 32.5 months. At diagnosis, 160 patients (63%) had an inflammatory large-vessel involvement on imaging, 46.1% (117 patients) relapsed at least once, and 21.3% (54 patients) had multiple relapses. The median delay of first relapse after diagnosis was 9 months. The second relapse delay was 21.5 months. NR patients had more stroke at diagnosis than R (p = 0.03) and the brachiocephalic trunk was involved more frequently on CT-scan (p = 0.046), as carotids (p = 0.02) in R patients. Multivariate Cox model identified male gender [hazard ratio (HR): 0.51, confidence interval (CI) (0.27–0.96), p = 0.04] as a relapse protective factor, and peripheral musculoskeletal manifestations [HR: 1.74 (1.03–2.94), p = 0.004] as a relapse risk factor. Peripheral musculoskeletal manifestations [HR: 2.78 (1.23–6.28), p = 0.014], negative temporal artery biopsy [HR: 2.29 (1.18–4.45), p = 0.015], large-vessel involvement like upper limb ischemia [HR: 8.84 (2.48–31.56), p = 0.001] and inflammation of arm arteries on CT-scan [HR: 2.39 (1.02–5.58), p = 0.04] at diagnosis were risk factors of multiple relapses. Conclusion: Male gender was a protective factor for GCA relapse and peripheral musculoskeletal manifestations appeared as a relapsing risk factor. Moreover, this study identified a particular clinical phenotype of multi-relapsing patients with GCA, characterized by peripheral musculoskeletal manifestations, negative temporal artery biopsy, and large-vessel involvement with upper limb ischemia or inflammation of arm arteries. Plain language Summary At giant cell arteritis diagnosis, large-vessel inflammatory involvement is predictive of multiple relapses
Collapse
Affiliation(s)
| | - Olivier Espitia
- Department of Internal Medicine, CHU Nantes, 1 Place Alexis Ricordeau, Nantes, 44093, France
| | - Antoine Néel
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Jérôme Connault
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Agathe Masseau
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Mathieu Artifoni
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Aurélie Achille
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Anaïs Wahbi
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Mathieu Lacou
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Cécile Durant
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Pierre Pottier
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - François Perrin
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Julie Graveleau
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| |
Collapse
|
21
|
Stamatis P, Turkiewicz A, Englund M, Turesson C, Mohammad AJ. Epidemiology of biopsy-confirmed giant cell arteritis in southern Sweden - an update on incidence and first prevalence estimate. Rheumatology (Oxford) 2021; 61:146-153. [PMID: 33742665 PMCID: PMC8742826 DOI: 10.1093/rheumatology/keab269] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To characterize the epidemiology of temporal artery biopsy-positive (TAB+) GCA, including trends in incidence, seasonal variation and prevalence in Skåne, the southernmost region of Sweden. Methods All histopathology reports of TABs from 1997 through 2019 were reviewed to identify patients diagnosed with TAB+ GCA. Incidence rates based on the 23-year period and the point-prevalence at 31 December 2014 were determined. An alternative prevalence calculation included only TAB+ GCA patients living in the study area and receiving immunosuppressant therapy on the point-prevalence date. Results One thousand three hundred and sixty patients were diagnosed with TAB+ GCA (71% female). The average annual incidence 1997–2019 was 13.3 (95% CI: 12.6, 14.0) per 100 000 inhabitants aged ≥50 years and was higher in females (17.8; 95% CI: 16.7, 18.9) than in males (8.2; 95% CI: 7.4, 9.0). The age- and sex-standardized incidence declined from 17.3 in 1997 to 8.7 in 2019, with incidence ratio (IR) of 0.98 per year (95% CI: 0.98, 0.99). A seasonal variation was observed with higher incidence during spring than winter [IR = 1.19 (95% CI: 1.03, 1.39)]. The overall point-prevalence of TAB+ GCA was 127.1/100 000 (95% CI: 117, 137.3) and was 75.5 (95% CI: 67.7, 83.3) when including only patients receiving immunosuppressants. Conclusion Over the past 2 decades, the incidence of biopsy-confirmed GCA has decreased by ∼2% per year. Still, a high prevalence of GCA on current treatment was observed. More cases are diagnosed during spring and summer than in the winter.
Collapse
Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden.,Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Thessaly, Greece
| | - Aleksandra Turkiewicz
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Sweden
| | - Martin Englund
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden.,Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
22
|
Andersen JB, Myklebust G, Haugeberg G, Pripp AH, Diamantopoulos AP. Incidence Trends and Mortality of Giant Cell Arteritis in Southern Norway. Arthritis Care Res (Hoboken) 2021; 73:409-414. [DOI: 10.1002/acr.24133] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/31/2019] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Are H. Pripp
- Oslo Centre of Biostatistics and Epidemiology Oslo University Hospital Oslo Norway
| | | |
Collapse
|
23
|
Therkildsen P, de Thurah A, Hansen IT, Nørgaard M, Nielsen BD, Hauge EM. Giant cell arteritis: A nationwide, population-based cohort study on incidence, diagnostic imaging, and glucocorticoid treatment. Semin Arthritis Rheum 2021; 51:360-366. [PMID: 33601192 DOI: 10.1016/j.semarthrit.2021.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
AIM The study investigated the development over time of the incidence, diagnostic imaging, and treatment of giant cell arteritis (GCA). METHOD This nationwide, population-based cohort study was conducted in Denmark using medical and administrative registries. Incident GCA cases from 1996-2018 were defined as patients aged ≥50 years registered with a first-time GCA diagnosis and ≥3 prescriptions for glucocorticoids (GCs) within 6 months after diagnosis. We determined incidence rates of GCA, the proportion of patients still receiving GCs >2 years after diagnosis, the proportion of patients receiving temporal artery biopsies (TAB) and diagnostic imaging including ultrasound, positron emission tomography, magnetic resonance, and/or computed tomography angiography at the time of diagnosis. RESULTS We identified 9908 incident GCA cases. The incidence rates of GCA remained stable at 19-25 per 100,000 people aged >50 years from 1996-2018. The proportion of GCA patients receiving a TAB remained constant until 2016, after which it promptly declined from 70-80% to 29-39%. In contrast, the proportion of patients receiving diagnostic imaging increased from 2% to 66% from 2000-2018. The proportion of GCA patients remaining in GC treatment has steadily decreased from 1996-2016, but remains high at 64%, 40%, and 34% after 2, 5, and 10 years following the diagnosis, respectively. The cumulative GC dose has remained relatively stable. CONCLUSION Incidence rates of GCA have remained stable since 1996 despite increasing use of diagnostic imaging. There is a clear discrepancy between current international GCA treatment guidelines and the clinical practice up to 2018.
Collapse
Affiliation(s)
- Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
24
|
Barra L, Pope JE, Pequeno P, Saxena FE, Bell M, Haaland D, Widdifield J. Incidence and prevalence of giant cell arteritis in Ontario, Canada. Rheumatology (Oxford) 2021; 59:3250-3258. [PMID: 32249899 DOI: 10.1093/rheumatology/keaa095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To estimate trends in the incidence and prevalence of GCA over time in Canada. METHODS We performed a population-based study of Ontario health administrative data using validated case definitions for GCA. Among Ontario residents ≥50 years of age we estimated the annual incidence and prevalence rates between 2000 and 2018. We performed sensitivity analyses using alternative validated case definitions to provide comparative estimates. RESULTS Between 2000 and 2018 there was a relatively stable incidence over time with 25 new cases per 100 000 people >50 years of age. Age-standardized incidence rates were significantly higher among females than males [31 cases (95% CI: 29, 34) vs 15 cases (95% CI: 13, 18) per 100 000 in 2000]. Trends in age-standardized incidence rates were stable among females but increased among males over time. Incidence rates were highest among those ≥70 years of age. Standardized prevalence rates increased from 125 (95% CI 121, 129) to 235 (95% CI 231, 239) cases per 100 000 from 2000 to 2018. The age-standardized rates among males rose from 76 (95% CI 72, 81) cases in 2000 to 156 (95% CI 151, 161) cases per 100 000 population in 2018. Between 2000 and 2018, the age-standardized rates among females similarly increased over time, from 167 (95% CI 161, 173) to 304 (95% CI 297, 310) cases per 100 000 population. CONCLUSION The incidence and prevalence of GCA in Ontario is similar to that reported in the USA and northern Europe and considerably higher than that reported for southern Europe and non-European populations.
Collapse
Affiliation(s)
- Lillian Barra
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Medicine, St. Joseph's Health Care London, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Medicine, St. Joseph's Health Care London, Ontario, Canada
| | | | | | - Mary Bell
- Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Derek Haaland
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Northern Ontario School of Medicine, Laurentian University Campus, Sudbury, Ontario, Canada
| | - Jessica Widdifield
- ICES, Toronto, Ontario, Canada.,Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Hng M, Zhao SS, Moots RJ. An update on the general management approach to common vasculitides. Clin Med (Lond) 2020; 20:572-579. [PMID: 33199323 DOI: 10.7861/clinmed.2020-0747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary systemic vasculitides (PSV) are multisystem diseases associated with high morbidity and mortality, particularly if not treated in a timely manner. In recent decades, clinical trials have delivered considerable evidence to underpin optimal diagnostic and therapeutic approaches. This article provides a brief overview of PSV in adults, focusing on the latest updates and recommendations for the management of antineutrophil cytoplasmic antibody-associated vasculitis and giant cell arteritis.
Collapse
Affiliation(s)
| | - Sizheng S Zhao
- Aintree University Hospital, Liverpool, UK and University of Liverpool, Liverpool, UK
| | - Robert J Moots
- Aintree University Hospital, Liverpool, UK and Edge Hill University, Liverpool, UK
| |
Collapse
|
26
|
Long-term follow-up of 89 patients with giant cell arteritis: a retrospective observational study on disease characteristics, flares and organ damage. Rheumatol Int 2020; 41:439-448. [PMID: 33113000 DOI: 10.1007/s00296-020-04730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
The objective of the study is to investigate the clinical characteristics and long-term prognosis including flares and organ damage in patients with giant cell arteritis (GCA) from a tertiary referral centre and compare these features in different subgroups. In this retrospective observational study, patients with GCA who were followed up in our vasculitis clinic between 1998 and 2018 were evaluated by a predefined protocol. Patients with and without cranial symptoms were compared for clinical and laboratory features, flares and permanent damage findings. Vasculitis Damage Index and Large Vessel Vasculitis Index of Damage were used for damage assessment. Records of 89 patients (median follow-up time 46 months) were analysed; mean time to diagnosis after initial symptom was longer in patients with acute vision loss (11 ± 4 vs. 4.8 ± 1.1 months p = 0.002). EGG (n = 19) was younger (63 ± 2 vs. 69 ± 1 years old p = 0.01); had higher mean CRP (141.8 ± 107.3 vs. 76.6 ± 67.9 mg/dL p = 0.023) and ESR (120.8 ± 25.1 vs. 99.3 ± 24.3 mm/h p = 0.004) at diagnosis. PET-CT detected large vessel vasculitis in 42/48 (87.5%) cases of the entire cohort. Thirty-one patients had flares and proportion of flared patients was significantly higher in patients with cranial symptoms. At least one damage item (DI) was present in 54 (60.7%) patients. The development of damage was found to be associated with flares. Evaluation of our cohort revealed the importance of early diagnosis for prevention of vision loss in GCA. Patients without cranial symptoms were younger, present with higher inflammatory response and for these, PET-CT was the main diagnostic tool. Relapse rate was higher in patients with cranial symptoms. Flares and accompanying corticosteroid treatment may contribute to organ damage in GCA.
Collapse
|
27
|
Deshayes S, de Boysson H, Dumont A, Vivien D, Manrique A, Aouba A. An overview of the perspectives on experimental models and new therapeutic targets in giant cell arteritis. Autoimmun Rev 2020; 19:102636. [DOI: 10.1016/j.autrev.2020.102636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022]
|
28
|
Incidence and prevalence of giant cell arteritis and polymyalgia rheumatica: A systematic literature review. Semin Arthritis Rheum 2020; 50:1040-1048. [DOI: 10.1016/j.semarthrit.2020.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022]
|
29
|
Stamatis P. Giant Cell Arteritis versus Takayasu Arteritis: An Update. Mediterr J Rheumatol 2020; 31:174-182. [PMID: 32676554 PMCID: PMC7362112 DOI: 10.31138/mjr.31.2.174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
Giant cell arteritis (GCA) and Takayasu Arteritis (TAK) are two systemic granulomatous vasculitides affecting medium- and large-sized arteries. Similarities in GCA and TAK regarding the clinical presentation, the systemic inflammatory response and the distribution of the arterial lesions, have triggered a debate over the last decade about whether GCA and TAK represent two different diseases, or are age-associated different clinical phenotypes of the same disease. On the other hand, there are differences regarding epidemiology, several clinical features (eg, polymyalgia rheumatica in GCA) and treatment. The aim of this review is to present the latest data regarding this question and to shed some light on the differences and similarities between GCA and TAK regarding epidemiology, genetics, pathogenesis, histopathology, clinical presentation, imaging and treatment. The existing data in literature support the opinion that GCA and TAK are different clinical entities.
Collapse
Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences, Rheumatology, Lund University, Sweden
| |
Collapse
|
30
|
Mainbourg S, Addario A, Samson M, Puéchal X, François M, Durupt S, Gueyffier F, Cucherat M, Durieu I, Reynaud Q, Lega J. Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta‐Analysis. Arthritis Care Res (Hoboken) 2020; 72:838-849. [DOI: 10.1002/acr.23901] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Sabine Mainbourg
- University of Lyon and Claude Bernard University Lyon, Centre Hospitalier Lyon Sud, and Hospices Civils de Lyon, Pierre‐Bénite Lyon France
| | | | - Maxime Samson
- CHU Dijon Bourgogne and Hôpital François Mitterrand Dijon France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic and Autoimmune DiseasesHôpital CochinAP‐HPParis Descartes University Paris France
| | - Mathilde François
- University of Lyon and Claude Bernard University Lyon, Centre Hospitalier Lyon Sud, and Hospices Civils de Lyon, Pierre‐Bénite Lyon France
| | - Stéphane Durupt
- University of Lyon and Claude Bernard University Lyon Lyon France
| | | | - Michel Cucherat
- University of Lyon and Claude Bernard University Lyon Lyon France
| | - Isabelle Durieu
- University of Lyon and Claude Bernard University Lyon, Centre Hospitalier Lyon Sud, and Hospices Civils de Lyon, Pierre‐Bénite Lyon France
| | - Quitterie Reynaud
- University of Lyon and Claude Bernard University Lyon, Centre Hospitalier Lyon Sud, and Hospices Civils de Lyon, Pierre‐Bénite Lyon France
| | - Jean‐Christophe Lega
- University of Lyon and Claude Bernard University Lyon, Centre Hospitalier Lyon Sud, and Hospices Civils de Lyon, Pierre‐Bénite Lyon France
| |
Collapse
|
31
|
Stamatis P, Turkiewicz A, Englund M, Jönsson G, Nilsson JÅ, Turesson C, Mohammad AJ. Infections Are Associated With Increased Risk of Giant Cell Arteritis: A Population-based Case-control Study from Southern Sweden. J Rheumatol 2020; 48:251-257. [PMID: 32414956 DOI: 10.3899/jrheum.200211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the association between infections and the subsequent development of giant cell arteritis (GCA) in a large population-based cohort from a defined geographic area in Sweden. METHODS Patients diagnosed with biopsy-confirmed GCA between 2000 and 2016 were identified through the database of the Department of Pathology in Skåne, the southernmost region of Sweden. For each GCA case, 10 controls matched for age, sex, and area of residence were randomly selected from the general population. Using the Skåne Healthcare Register, we identified all infection events prior to patients' date of GCA diagnosis and controls' index date. With infection as exposure, a conditional logistic regression model was employed to estimate the OR for developing GCA. The types of infections contracted nearest in time to the GCA diagnosis/index date were identified. RESULTS A total of 1005 patients with biopsy-confirmed GCA (71% female) and 10,050 controls were included in the analysis. Infections were more common among patients subsequently diagnosed with GCA compared to controls (51% vs 41%, OR 1.78, 95% CI 1.53-2.07). Acute upper respiratory tract infection (OR 1.77, 95% CI 1.47-2.14), influenza and pneumonia (OR 1.72, 95 % CI 1.35-2.19), and unspecified infections (OR 5.35, 95 % CI 3.46-8.28) were associated with GCA. Neither skin nor gastrointestinal infections showed a correlation. CONCLUSION Infections, especially those of the respiratory tract, were associated with subsequent development of biopsy-confirmed GCA. Our findings support the hypothesis that a range of infections may trigger GCA.
Collapse
Affiliation(s)
- Pavlos Stamatis
- P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences, Rheumatology, Lund University, Lund;
| | - Aleksandra Turkiewicz
- A. Turkiewicz, MSc, PhD, CStat, M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Clinical Epidemiology Unit, Lund University, Lund
| | - Martin Englund
- A. Turkiewicz, MSc, PhD, CStat, M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Clinical Epidemiology Unit, Lund University, Lund
| | - Göran Jönsson
- G. Jönsson, MD, PhD, Associate Professor of Infection Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund
| | - Jan-Åke Nilsson
- J.Å.Nilsson, BS, Statistician, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö
| | - Carl Turesson
- C. Turesson, MD, PhD, Professor of Rheumatology, Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö
| | - Aladdin J Mohammad
- A.J. Mohammad, MD, MPH, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden, Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
32
|
Ben-Shabat N, Tiosano S, Shovman O, Comaneshter D, Shoenfeld Y, Cohen AD, Amital H. Mortality among Patients with Giant Cell Arteritis: A Large-scale Population-based Cohort Study. J Rheumatol 2019; 47:1385-1391. [DOI: 10.3899/jrheum.190927] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 12/13/2022]
Abstract
Objective.Studies regarding mortality among patients with giant cell arteritis (GCA) have yielded conflicting results. Thus in this large population-based study we aimed to examine whether GCA is associated with increased mortality, and if so, the effect of age at diagnosis and sex on the association.Methods.We used the medical database of Clalit Health Services for this retrospective cohort study. Followup was from January 1, 2002, and continued until death or end of followup on September 1, 2018. Incident GCA patients were compared with age- and sex-matched controls. Estimated median survival times were calculated using the Kaplan-Meier method. HR for all-cause mortality were obtained by the Cox proportional hazard model, adjusted for sociodemographic variables and cardiovascular risk factors.Results.The study included 7294 patients with GCA and 33,688 controls. The mean age at start of followup was 72.1 ± 9.9 years with 69.2% females. Estimated median survival time was 13.1 years (95% CI 12.6–13.5) in patients with GCA compared with 14.4 years (95% CI 14.1–14.6) in controls (p < 0.001). The multivariate analysis demonstrated increased mortality risk in the first 2 years after diagnosis (HR 1.14, 95% CI 1.04–1.25) and > 10 years after diagnosis (HR 1.14, 95% CI 1.02–1.3). The mortality risk was higher in patients diagnosed at ≤ 70 years of age [HR 1.5 (95% CI 1.14–1.99) 0–2 yrs; HR 1.38 (95% CI 1.1–1.7) > 10 yrs].Conclusion.Patients with GCA have a minor decrease in longterm survival compared to age- and sex-matched controls. The seen difference is due to excess mortality in the first 2 years, and > 10 years after diagnosis. Patients diagnosed ≤ 70 years of age are at greater risk.
Collapse
|
33
|
Nesher G, Poltorak V, Hindi I, Nesher R, Dror Y, Orbach H, Breuer GS. Survival of patient with giant cell arteritis: Impact of vision loss and treatment with aspirin. Autoimmun Rev 2019; 18:831-834. [DOI: 10.1016/j.autrev.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
|
34
|
González-Gay MÁ, Ortego-Jurado M, Ercole L, Ortego-Centeno N. Giant cell arteritis: is the clinical spectrum of the disease changing? BMC Geriatr 2019; 19:200. [PMID: 31357946 PMCID: PMC6664782 DOI: 10.1186/s12877-019-1225-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 07/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Giant cell arteritis is a vasculitis of large and middle-sized arteries that affects patients aged over 50 years. It can show a typical clinical picture consisting of cranial manifestations but sometimes nonspecific symptoms and large-vessel involvement prevail. Prompt diagnosis and treatment is essential to avoid irreversible damage. DISCUSSION There has been an increasing knowledge on the occurrence of the disease without the typical cranial symptoms and its close relationship and overlap with polymyalgia rheumatica, and this may contribute to reduce the number of underdiagnosed patients. Although temporal artery biopsy is still the gold-standard and temporal artery ultrasonography is being widely used, newer imaging techniques (FDG-PET/TAC, MRI, CT) can be of valuable help to identify giant cell arteritis, in particular in those cases with a predominance of extracranial large-vessel manifestations. CONCLUSIONS Giant cell arteritis is a more heterogeneous condition than previously thought. Awareness of all the potential clinical manifestations and judicious use of diagnostic tests may be an aid to avoid delayed detection and consequently ominous complications.
Collapse
Affiliation(s)
- Miguel Á. González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, 39011 Santander, Spain
- University of Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Norberto Ortego-Centeno
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (IBS. GRANADA), Department of Internal Medicine, Professor of Medicine of the University of Granada, Granada, Spain
| |
Collapse
|
35
|
Brekke LK, Fevang BTS, Diamantopoulos AP, Assmus J, Esperø E, Gjesdal CG. Risk of Cancer in 767 Patients with Giant Cell Arteritis in Western Norway: A Retrospective Cohort with Matched Controls. J Rheumatol 2019; 47:722-729. [PMID: 31308209 DOI: 10.3899/jrheum.190147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the risk of cancer in a large Norwegian cohort of patients with giant cell arteritis (GCA). METHODS This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in the Bergen Health Area during 1972-2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding system. Medical records were reviewed. Each patient was randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway. Data on the occurrence of cancer were obtained from the Cancer Registry of Norway. The cumulative risk of malignancy was estimated using Kaplan-Meier methods and potential differences were analyzed using the Gehan-Breslow and log-rank tests. RESULTS We identified 881 cases with a clinical diagnosis of GCA, of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria and 528 were biopsy-verified. Cases with no registered cancer prior to GCA diagnosis were included in a time-to-event analysis, with first cancer as the event (n = 767 with clinical GCA diagnosis, 686 fulfilling ACR criteria for GCA, 463 biopsy-verified). These cases were matched with previously cancer-free population controls (n = 1437, 1284, 895, respectively). We found no significant difference in the risk of malignancy after time of diagnosis/matching for GCA patients compared to population controls (p > 0.05). CONCLUSION In this study of a large and well-characterized cohort of patients with GCA, there was no difference in the risk of malignancy in patients with GCA compared to matched population controls.
Collapse
Affiliation(s)
- Lene Kristin Brekke
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway. .,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital.
| | - Bjørg-Tilde Svanes Fevang
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Andreas P Diamantopoulos
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Jörg Assmus
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Elisabet Esperø
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| | - Clara Gram Gjesdal
- From the Hospital for Rheumatic Diseases, Haugesund; Department of Clinical Science, University of Bergen, Bergen; Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, and Centre for Clinical Research, Haukeland University Hospital, Bergen; Martina Hansens Hospital, Bærum, Norway.,L.K. Brekke, MD, Hospital for Rheumatic Diseases, and Department of Clinical Science, University of Bergen; B.T. Fevang, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital; A.P. Diamantopoulos, MD, PhD, MPH, Martina Hansens Hospital; J. Assmus, PhD, Centre for Clinical Research, Haukeland University Hospital; E. Esperø, MD, Hospital for Rheumatic Diseases; C. Gram Gjesdal, MD, PhD, Department of Clinical Science, University of Bergen, and BEaBIRD, Department of Rheumatology, Haukeland University Hospital
| |
Collapse
|
36
|
Brekke LK, Fevang BTS, Diamantopoulos AP, Assmus J, Esperø E, Gjesdal CG. Survival and death causes of patients with giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther 2019; 21:154. [PMID: 31238961 PMCID: PMC6593490 DOI: 10.1186/s13075-019-1945-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022] Open
Abstract
Background Our objective was to determine the survival and causes of death in a large and well-characterized cohort of patients with giant cell arteritis (GCA). Methods This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in Western Norway during 1972–2012. Patients were identified through computerized hospital records using the International Classification of Diseases (ICD)-coding system. Medical records were reviewed. Patients were randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway (CPRN). Date and cause of death were obtained from the Norwegian Cause of Death Registry (NCoDR). The survival was analyzed using Kaplan-Meier methods with the Gehan-Breslow test and the causes of death using cumulative incidence and Cox models for competing risks. Results We identified 881 cases with a clinical diagnosis of GCA of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria. Among those fulfilling the ACR criteria, 528 were also biopsy-verified. Cases were matched with 2577 population controls. A total of 490 (56%) GCA patients and 1517 (59%) controls died during the study period. We found no difference in the overall survival of GCA patients compared to controls, p = 0.413. The most frequent underlying causes of death in both groups were diseases of the circulatory system followed by cancer. GCA patients had increased risk of dying of circulatory disease (HR 1.31, 95% CI 1.13–1.51, p < 0.001) but lower risk of dying of cancer (HR 0.56, 95% CI 0.42–0.73, p < 0.001) compared to population controls. Conclusions We found no difference in the overall survival of GCA patients compared to matched controls, but there were differences in the distribution of underlying death causes.
Collapse
Affiliation(s)
- L K Brekke
- Hospital for Rheumatic Diseases, Haugesund, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway. .,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.
| | - B-T S Fevang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - J Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - E Esperø
- Hospital for Rheumatic Diseases, Haugesund, Norway
| | - C G Gjesdal
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
37
|
Al-Mousawi AZ, Gurney SP, Lorenzi AR, Pohl U, Dayan M, Mollan SP. Reviewing the Pathophysiology Behind the Advances in the Management of Giant Cell Arteritis. Ophthalmol Ther 2019; 8:177-193. [PMID: 30820767 PMCID: PMC6513947 DOI: 10.1007/s40123-019-0171-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Improving understanding of the underlying pathophysiology of giant cell arteritis (GCA) is transforming clinical management by identifying novel avenues for targeted therapies. One key area of concern for both clinicians and patients with GCA is glucocorticoid (GC) morbidity. The first randomised controlled trials of targeted treatment to reduce cumulative GC use in GCA have been published, with tocilizumab, an interleukin (IL)-6 receptor inhibitor, now the first ever licensed treatment for GCA. Further potential therapies are emerging owing to our enhanced understanding of the pathophysiology of the disease. Other improvements in the care of our patients are rapid access pathways and imaging techniques, such as ultrasound, which are becoming part of modern rheumatology practice in the UK, Europe and beyond. These have been highlighted in the literature to reduce delay in diagnosis and improve long-term outcomes for those investigated for GCA.
Collapse
Affiliation(s)
- Alia Z Al-Mousawi
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
| | - Sam P Gurney
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
| | - Alice R Lorenzi
- The Department of Rheumatology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Ute Pohl
- Department of Cellular Pathology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2GW, UK
| | - Margaret Dayan
- Ophthalmology Department, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK.
| |
Collapse
|
38
|
Stamatis P, Turesson C, Willim M, Nilsson JÅ, Englund M, Mohammad AJ. Malignancies in Giant Cell Arteritis: A Population-based Cohort Study. J Rheumatol 2019; 47:400-406. [PMID: 31154410 DOI: 10.3899/jrheum.190236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the risk of cancer in patients with biopsy-proven giant cell arteritis (GCA) from a defined population in southern Sweden. METHODS The study cohort consisted of 830 patients (mean age at GCA diagnosis was 75.3 yrs, 74% women) diagnosed with biopsy-proven GCA between 1997 and 2010. Temporal artery biopsy results were retrieved from a regional database and reviewed to ascertain GCA diagnosis. The cohort was linked to the Swedish Cancer Registry. The patients were followed from GCA diagnosis until death or December 31, 2013. Incident malignancies registered after GCA diagnosis were studied. Based on data on the first malignancy in each organ system, age- and sex-standardized incidence ratios (SIR) with 95% CI were calculated compared to the background population. RESULTS One hundred seven patients (13%) were diagnosed with a total of 118 new malignancies after the onset of GCA. The overall risk for cancer after the GCA diagnosis was not increased (SIR 0.98, 95% CI 0.81-1.17). However, there was an increased risk for myeloid leukemia (2.31, 95% CI 1.06-4.39) and a reduced risk for breast cancer (0.33, 95% CI 0.12-0.72) and upper gastrointestinal tract cancer (0.16, 95% 0.004-0.91). Rates of other site-specific cancers were not different from expected. CONCLUSION In this Swedish population-based cohort of GCA, the overall risk for cancer was not increased compared to the background population. However, there was an increased risk for leukemia and a decreased risk for breast and upper gastrointestinal tract cancer.
Collapse
Affiliation(s)
- Pavlos Stamatis
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK. .,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge.
| | - Carl Turesson
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Minna Willim
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Jan-Åke Nilsson
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Martin Englund
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Aladdin J Mohammad
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| |
Collapse
|
39
|
Strand V, Dimonaco S, Tuckwell K, Klearman M, Collinson N, Stone JH. Health-related quality of life in patients with giant cell arteritis treated with tocilizumab in a phase 3 randomised controlled trial. Arthritis Res Ther 2019; 21:64. [PMID: 30786937 PMCID: PMC6381622 DOI: 10.1186/s13075-019-1837-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/30/2019] [Indexed: 02/04/2023] Open
Abstract
Background Patients with giant cell arteritis (GCA) treated with tocilizumab (TCZ) every week or every other week and prednisone tapering achieved superior rates of sustained remission to patients treated with placebo and prednisone tapering in a randomised controlled trial. Health-related quality of life (HRQOL) in patients from this trial is now reported. Methods Exploratory analyses of SF-36 PCS and MCS and domain scores, PtGA and FACIT-Fatigue were performed in patients treated with weekly subcutaneous TCZ 162 mg plus 26-week prednisone taper (TCZ-QW + Pred-26) or placebo plus 26-week or 52-week prednisone tapers (PBO + Pred-26 or PBO + Pred-52). These analyses were performed on responder and non-responder patients, including those who achieved the primary outcome and those who experienced flare and received escape prednisone doses. Results Baseline SF-36 PCS, MCS and domain scores were low, indicating impaired HRQOL related to GCA. At week 52, least squares mean (LSM) changes in PCS scores improved with TCZ-QW + Pred-26 but worsened in both PBO + Pred groups (p < 0.001). LSM changes in MCS scores increased with TCZ-QW + Pred-26 versus PBO + Pred-52 (p < 0.001). Treatment with TCZ-QW + Pred-26 resulted in significantly greater improvement in four of eight SF-36 domains compared with PBO + Pred-26 and six of eight domains compared with PBO + Pred-52 (p < 0.01). Improvement with TCZ-QW + Pred-26 met or exceeded minimum clinically important differences (MCID) in all eight domains compared with five domains with PBO + Pred-26 and none with PBO + Pred-52. Domain scores in the TCZ-QW + Pred-26 group at week 52 met or exceeded age- and gender-matched normative values (A/G norms). LSM changes from baseline in FACIT-Fatigue scores increased significantly with TCZ-QW + Pred-26, exceeding MCID and A/G norms (p < 0.001). Conclusions Patients with GCA receiving TCZ-QW + Pred-26 reported statistically significant and clinically meaningful improvement in SF-36 and FACIT-Fatigue scores compared with those receiving prednisone only. Improvements in the TCZ-QW + Pred-26 group led to recovery of HRQOL to levels at least comparable to those of A/G-matched normative values at week 52 and exceeded normative values in five of eight domains. Trial registration ClinicalTrials.gov, NCT01791153. Date of registration: February 13, 2013.
Collapse
Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | | | | | | | | | - John H Stone
- Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Yawkey 2, 55 Fruit Street, Boston, MA, 02114, USA.
| |
Collapse
|
40
|
Ing EB, Lahaie Luna G, Pagnoux C, Baer PA, Wang D, Benard-Seguin E, Godra I, Godra A, Munoz DG, McReelis K, ten Hove M. The incidence of giant cell arteritis in Ontario, Canada. Can J Ophthalmol 2019; 54:119-124. [DOI: 10.1016/j.jcjo.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 01/29/2023]
|
41
|
Macchioni P, Boiardi L, Muratore F, Restuccia G, Cavazza A, Pipitone N, Catanoso M, Mancuso P, Luberto F, Giorgi Rossi P, Salvarani C. Survival predictors in biopsy-proven giant cell arteritis: a northern Italian population-based study. Rheumatology (Oxford) 2018; 58:609-616. [DOI: 10.1093/rheumatology/key325] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/19/2018] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To evaluate the influence of disease-related findings and treatment outcomes on survival in a population-based cohort of Northern Italian patients with GCA.
Methods
A total of 281 patients with incident temporal artery biopsy (TAB)-proven GCA, diagnosed over a 26-year period (1986–2012) and living in the Reggio Emilia area, were retrospectively evaluated. We analysed clinical, imaging and laboratory findings at diagnosis, pathological patterns of TAB, CS treatment and therapeutic outcomes, and traditional cardiovascular risk factors as factors predictive of survival.
Results
Univariate analysis showed that increased mortality was associated with large vessel involvement at diagnosis [hazard ratio (HR) 5.84], while reduced mortality was associated with female sex (HR 0.66), PMR (HR 0.54), higher haemoglobin levels (HR 0.84) at diagnosis, long-term remission (HR 0.47) and inflammation limited to adventitia or to the adventitial vasa vasorum (HR 0.48) at TAB examination. Multivariate analysis confirmed the association between increased mortality and large vessel involvement (HR 5.14) at diagnosis, between reduced mortality and PMR (HR 0.57) at diagnosis and adventitial inflammation (HR 0.31) at TAB.
Conclusion
PMR at diagnosis and inflammation limited to the adventitia at TAB appear to identify subsets of patients with more benign disease, while large vessel involvement at diagnosis is associated with reduced survival.
Collapse
Affiliation(s)
- Pierluigi Macchioni
- Rheumatology Unit, Department of Specialistic Medicine, and Pathology Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Luigi Boiardi
- Rheumatology Unit, Department of Specialistic Medicine, and Pathology Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Italy
| | - Giovanna Restuccia
- Rheumatology Unit, Department of Specialistic Medicine, and Pathology Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Alberto Cavazza
- Rheumatology Unit, Department of Specialistic Medicine, and Pathology Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Nicolò Pipitone
- Rheumatology Unit, Department of Specialistic Medicine, and Pathology Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Mariagrazia Catanoso
- Rheumatology Unit, Department of Specialistic Medicine, and Pathology Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Italy
| | - Pamela Mancuso
- Interinstitutional Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia (Local Health Authority), Reggio Emilia, Italy
| | - Ferdinando Luberto
- Interinstitutional Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia (Local Health Authority), Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia (Local Health Authority), Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Italy
| |
Collapse
|
42
|
Giant-cell arteritis-related mortality in France: A multiple-cause-of-death analysis. Autoimmun Rev 2018; 17:1219-1224. [PMID: 30316993 DOI: 10.1016/j.autrev.2018.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Giant-cell arteritis (GCA) is a large vessel vasculitis. Data regarding mortality are controversial. We describe the mortality data of the French death certificates for the period of 2005 to 2014. METHODS Using multiple-cause-of-death (MCOD) analysis, we calculated age-adjusted mortality rates for GCA, examined differences in mortality rates according to age and gender and analyzed the underlying causes of death (UCD). RESULTS We analyzed 4628 death certificates listing a diagnosis of GCA as UCD or non-underlying cause of death (NUCD). The mean age of death was 86 (±6.8) years. The overall age-standardized mortality rate among GCA patients was 7.2 per million population. Throughout the study period, the mean age of death was significantly increased (r = 0.17, p < .0001) in both genders. There was no significant difference with age repartition of death in the general population (p = .26). When GCA was listed as the UCD, most frequent associated diseases were cardiovascular (79%) and infectious diseases (35%). When GCA was reported as the NUCD, the listed UCD was a cardiovascular event in 40% of cases, neoplasm in 13%, neurodegenerative disorder in 11% and infectious disease in 10%. When GCA was the UCD or NUCD, an age-adjusted observed/expected ratio > 1 in GCA-associated mortality compared with the general population mortality was observed for tuberculosis, pneumonia and cardiovascular diseases. CONCLUSION In this analysis of French death certificates mentioning GCA, we observed a stable standardized mortality rate between 2005 and 2014. The most frequent associated diseases were cardiovascular diseases and infections.
Collapse
|
43
|
The incidence of giant cell arteritis in Slovenia. Clin Rheumatol 2018; 38:285-290. [DOI: 10.1007/s10067-018-4236-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
|
44
|
Aouba A, Gonzalez Chiappe S, Eb M, Delmas C, de Boysson H, Bienvenu B, Rey G, Mahr A. Mortality causes and trends associated with giant cell arteritis: analysis of the French national death certificate database (1980-2011). Rheumatology (Oxford) 2018; 57:1047-1055. [PMID: 29554340 DOI: 10.1093/rheumatology/key028] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives Comprehensive analyses of cause-specific death patterns in GCA are sparse. We studied the patterns and time trends in GCA-related mortality using a large death certificate database. Methods We obtained multiple-cause-of-death data from the French national death certificate database for 1980-2011. GCA-associated deaths were defined as decedents ⩾55 years old with GCA listed as an underlying or non-underlying cause of death. Time trends of death rates were analysed and the mean age at death with GCA and in the general population ⩾55 years old were calculated. Standardized mortality odds ratios (SMORs) were calculated for 17 selected causes of death (based on 2000-11 data). Results The analyses pertained to approximately 15 000 death certificates listing GCA (including approximately 6300 for 2000-11). Annual standardized death rates for GCA increased to a peak in 1997 and then decreased (Spearman's correlation test, both P < 0.0001). Mean age at death was higher for GCA than for general population decedents (Student's t-test, P < 0.0001). GCA deaths were frequently or strongly associated with aortic aneurysm and dissection (1.85% of death certificates, SMOR: 3.09, 95% CI: 2.48, 3.82), hypertensive disease (20.78%, SMOR: 2.22, 95% CI: 1.97, 2.50), diabetes mellitus (11.27%, SMOR: 1.96, 95% CI: 1.72, 2.23), certain infectious and parasitic diseases (12.12%, SMOR: 1.76, 95% CI: 1.55, 2.00) and ischaemic heart disease (16.54%, SMOR: 1.45, 95% CI: 1.35, 1.64). Conclusion GCA is associated with increased risk of dying from large-vessel disease, other cardiovascular diseases and potentially treatment-related co-morbidities. These findings help provide better insights into the outcomes of GCA.
Collapse
Affiliation(s)
- Achille Aouba
- Department of Internal Medicine, University Hospital Caen, Normandy University, Caen, France
| | | | - Mireille Eb
- Inserm-CépiDc, Hospital Bicêtre, Le Kremlin-Bicêtre, France
| | - Claire Delmas
- Department of Internal Medicine, University Hospital Caen, Normandy University, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, University Hospital Caen, Normandy University, Caen, France
| | - Boris Bienvenu
- Department of Internal Medicine, University Hospital Caen, Normandy University, Caen, France
| | - Grégoire Rey
- Inserm-CépiDc, Hospital Bicêtre, Le Kremlin-Bicêtre, France
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France.,ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France
| |
Collapse
|
45
|
Li L, Neogi T, Jick S. Mortality in Patients With Giant Cell Arteritis: A Cohort Study in UK Primary Care. Arthritis Care Res (Hoboken) 2018; 70:1251-1256. [DOI: 10.1002/acr.23538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Lin Li
- University of Massachusetts Medical School, Worcester, and Boston Collaborative Drug Surveillance Program, Boston University School of Public Health; Lexington Massachusetts
| | - Tuhina Neogi
- Boston University School of Medicine; Boston Massachusetts
| | - Susan Jick
- Boston University School of Public Health; Lexington Massachusetts
| |
Collapse
|
46
|
Update on the epidemiology, risk factors, and outcomes of systemic vasculitides. Best Pract Res Clin Rheumatol 2018; 32:271-294. [DOI: 10.1016/j.berh.2018.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 02/07/2023]
|
47
|
Ing EB, Ing R, Liu X, Zhang A, Torun N, Sey M, Pagnoux C. Does herpes zoster predispose to giant cell arteritis: a geo-epidemiologic study. Clin Ophthalmol 2018; 12:113-118. [PMID: 29391771 PMCID: PMC5769597 DOI: 10.2147/opth.s151893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly and can cause irreversible blindness and aortitis. Varicella zoster (VZ), which is potentially preventable by vaccination, has been proposed as a possible immune trigger for GCA, but this is controversial. The incidence of GCA varies widely by country. If VZ virus contributes to the immunopathogenesis of GCA we hypothesized that nations with increased incidence of GCA would also have increased incidence of herpes zoster (HZ). We conducted an ecologic analysis to determine the relationship between the incidence of HZ and GCA in different countries. Methods A literature search for the incidence rates (IRs) of GCA and HZ from different countries was conducted. Correlation and linear regression was performed comparing the disease IR of each country for subjects 50 years of age or older. Results We found the IR for GCA and HZ from 14 countries. Comparing the IRs for GCA and HZ in 50-year-olds, the Pearson product-moment correlation (r) was −0.51, with linear regression coefficient (β) −2.92 (95% CI −5.41, −0.43; p=0.025) using robust standard errors. Comparing the IRs for GCA and HZ in 70-year-olds, r was −0.40, with β −1.78, which was not statistically significant (95% CI −4.10, 0.53; p=0.12). Conclusion Although this geo-epidemiologic study has potential for aggregation and selection biases, there was no positive biologic gradient between the incidence of clinically evident HZ and GCA.
Collapse
Affiliation(s)
- Edsel B Ing
- Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.,Toronto Eyelid Strabismus & Orbit Surgery Clinic, Toronto, ON, Canada
| | - Royce Ing
- Toronto Eyelid Strabismus & Orbit Surgery Clinic, Toronto, ON, Canada
| | - Xinyang Liu
- Department of Medicine, Internal Medicine, Fudan University, Shanghai, China
| | - Angela Zhang
- Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Nurhan Torun
- Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Michael Sey
- Department of Medicine, Western University Schulich School of Medicine, London, ON
| | - Christian Pagnoux
- Vasculitis Clinic, Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
48
|
Brekke LK, Diamantopoulos AP, Fevang BT, Aβmus J, Esperø E, Gjesdal CG. Incidence of giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther 2017; 19:278. [PMID: 29246164 PMCID: PMC5732381 DOI: 10.1186/s13075-017-1479-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022] Open
Abstract
Background Giant cell arteritis (GCA) is the most common systemic vasculitis in persons older than 50 years. The highest incidence rates of the disease have been reported in Scandinavian countries. Our objective was to determine the epidemiology of GCA in an expected high-incidence region during a 41-year period. Methods This is a hospital-based, retrospective, cohort study. Patients diagnosed with GCA in Bergen health area during 1972–2012 were identified through computerized hospital records (n = 1341). Clinical information was extracted from patients’ medical journals, which were reviewed by a standardized method. We excluded patients if data were unavailable (n = 253), if the reviewing rheumatologist found GCA to be an implausible diagnosis (n = 207) or if the American College of Rheumatology (ACR) 1990 classification criteria for GCA were not fulfilled (n = 89). Descriptive methods were used to characterize the sample. Incidence was analyzed by graphical methods and Poisson regression. Results A total of 792 patients were included. The average annual cumulative incidence of GCA was 16.7 (95% CI 15.5-18.0) per 100,000 of the population ≥ 50 years old. The corresponding incidence for biopsy-verified GCA was 11.2 (95% CI 10.2–12.3). The annual cumulative incidence increased with time in the period 1972–1992 (relative risk (RR) 1.1, p < 0.001) but not in 1993–2012 (RR 1.0, p = 0.543). The incidence was higher in women compared to men (average annual incidence 37.7 (95% CI 35.8–39.6) vs. 14.3 (95% CI 13.2–15.5), p < 0.001) with women having a twofold to threefold higher incidence rate throughout the study period. Average annual incidence increased with age until the 7th decade of life in both sexes throughout the study period (2.8 (95% CI 2.3–3.3) for age <60, 15.5 (95% CI 14.4–16.8) for age 60–69, 34.5 (95% CI 32.8–36.4) for age 70–79 and 26.8 (95% CI 25.3-28.4) for age ≥80 years, p < 0.001 for all age adjustments). Conclusions Our study confirms an incidence of GCA comparable to previous reports on Scandinavian populations. Our results show increasing incidence from 1972 through 1992, after which the incidence has levelled out. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1479-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- L K Brekke
- Hospital for Rheumatic Diseases, Haugesund, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway. .,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway. .,Hospital for Rheumatic Diseases (HSR AS), PB 2175, 5504, Haugesund, Norway.
| | | | - B-T Fevang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - J Aβmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - E Esperø
- Hospital for Rheumatic Diseases, Haugesund, Norway
| | - C G Gjesdal
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
49
|
Épidémiologie et histoire naturelle de l’artérite à cellules géantes (Horton). Rev Med Interne 2017; 38:663-669. [DOI: 10.1016/j.revmed.2017.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/11/2017] [Indexed: 02/02/2023]
|
50
|
Chasset F, Francès C. Cutaneous Manifestations of Medium- and Large-Vessel Vasculitis. Clin Rev Allergy Immunol 2017; 53:452-468. [DOI: 10.1007/s12016-017-8612-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|