Large-vessel giant cell arteritis

A cohort study

Francesco Muratore, Tanaz A. Kermani, Cynthia Crowson, Abigail B. Green, Carlo Salvarani, Eric Lawrence Matteson, Kenneth J Warrington

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Objective. The aim of this study was to compare baseline variables, treatment and outcomes in patients with large-vessel GCA (LV-GCA), primarily of the upper extremities, with those with cranial disease (C-GCA). Methods. All patients > 50 years of age with radiographic evidence of subclavian LV-GCA diagnosed between 1 January 1999 and 31 December 2008 were identified and compared with those with biopsypositive C-GCA diagnosed in the same period. Results. The study included 120 LV-GCA patients and 212 C-GCA patients. Compared with C-GCA, patients with LV-GCA were younger [68.2 years (S.D. 7.5) vs 75.7 (7.4), P < 0.001] and had longer duration of symptoms at GCA diagnosis (median 3.5 vs 2.2 months, P < 0.001). A history of PMR was more common in LV-GCA patients (26% vs 15%, P = 0.012), but a smaller proportion had cranial symptoms (41% vs 83%, P < 0.001) and vision loss (4% vs 11%, P = 0.035). ACR classification criteria for GCA were satisfied in 39% of LV-GCA patients and 95% of C-GCA patients (P < 0.001). Compared with C-GCA, patients with LV-GCA had more relapses (4.9 vs 3.0/10 person-years, P < 0.001), higher cumulative corticosteroid (CS) doses at 1 year [11.4 g (S.D. 5.9) vs 9.1 (S.D. 3.7), P < 0.001] and required longer treatment (median 4.5 vs 2.2 years, P < 0.001). Conclusion. Although patients with LV-GCA had a lower rate of vision loss, they had a higher relapse rate and greater CS requirements. The ACR criteria for GCA are inadequate for the classification of patients with LV-GCA.

Original languageEnglish (US)
Pages (from-to)463-470
Number of pages8
JournalRheumatology (United Kingdom)
Volume54
Issue number3
DOIs
StatePublished - 2015

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Giant Cell Arteritis
Cohort Studies
Adrenal Cortex Hormones
Recurrence
Upper Extremity

Keywords

  • Giant cell arteritis
  • Imaging
  • Large-vessel vasculitis
  • Prognosis
  • Treatment

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

Cite this

Large-vessel giant cell arteritis : A cohort study. / Muratore, Francesco; Kermani, Tanaz A.; Crowson, Cynthia; Green, Abigail B.; Salvarani, Carlo; Matteson, Eric Lawrence; Warrington, Kenneth J.

In: Rheumatology (United Kingdom), Vol. 54, No. 3, 2015, p. 463-470.

Research output: Contribution to journalArticle

Muratore, Francesco ; Kermani, Tanaz A. ; Crowson, Cynthia ; Green, Abigail B. ; Salvarani, Carlo ; Matteson, Eric Lawrence ; Warrington, Kenneth J. / Large-vessel giant cell arteritis : A cohort study. In: Rheumatology (United Kingdom). 2015 ; Vol. 54, No. 3. pp. 463-470.
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abstract = "Objective. The aim of this study was to compare baseline variables, treatment and outcomes in patients with large-vessel GCA (LV-GCA), primarily of the upper extremities, with those with cranial disease (C-GCA). Methods. All patients > 50 years of age with radiographic evidence of subclavian LV-GCA diagnosed between 1 January 1999 and 31 December 2008 were identified and compared with those with biopsypositive C-GCA diagnosed in the same period. Results. The study included 120 LV-GCA patients and 212 C-GCA patients. Compared with C-GCA, patients with LV-GCA were younger [68.2 years (S.D. 7.5) vs 75.7 (7.4), P < 0.001] and had longer duration of symptoms at GCA diagnosis (median 3.5 vs 2.2 months, P < 0.001). A history of PMR was more common in LV-GCA patients (26{\%} vs 15{\%}, P = 0.012), but a smaller proportion had cranial symptoms (41{\%} vs 83{\%}, P < 0.001) and vision loss (4{\%} vs 11{\%}, P = 0.035). ACR classification criteria for GCA were satisfied in 39{\%} of LV-GCA patients and 95{\%} of C-GCA patients (P < 0.001). Compared with C-GCA, patients with LV-GCA had more relapses (4.9 vs 3.0/10 person-years, P < 0.001), higher cumulative corticosteroid (CS) doses at 1 year [11.4 g (S.D. 5.9) vs 9.1 (S.D. 3.7), P < 0.001] and required longer treatment (median 4.5 vs 2.2 years, P < 0.001). Conclusion. Although patients with LV-GCA had a lower rate of vision loss, they had a higher relapse rate and greater CS requirements. The ACR criteria for GCA are inadequate for the classification of patients with LV-GCA.",
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T1 - Large-vessel giant cell arteritis

T2 - A cohort study

AU - Muratore, Francesco

AU - Kermani, Tanaz A.

AU - Crowson, Cynthia

AU - Green, Abigail B.

AU - Salvarani, Carlo

AU - Matteson, Eric Lawrence

AU - Warrington, Kenneth J

PY - 2015

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N2 - Objective. The aim of this study was to compare baseline variables, treatment and outcomes in patients with large-vessel GCA (LV-GCA), primarily of the upper extremities, with those with cranial disease (C-GCA). Methods. All patients > 50 years of age with radiographic evidence of subclavian LV-GCA diagnosed between 1 January 1999 and 31 December 2008 were identified and compared with those with biopsypositive C-GCA diagnosed in the same period. Results. The study included 120 LV-GCA patients and 212 C-GCA patients. Compared with C-GCA, patients with LV-GCA were younger [68.2 years (S.D. 7.5) vs 75.7 (7.4), P < 0.001] and had longer duration of symptoms at GCA diagnosis (median 3.5 vs 2.2 months, P < 0.001). A history of PMR was more common in LV-GCA patients (26% vs 15%, P = 0.012), but a smaller proportion had cranial symptoms (41% vs 83%, P < 0.001) and vision loss (4% vs 11%, P = 0.035). ACR classification criteria for GCA were satisfied in 39% of LV-GCA patients and 95% of C-GCA patients (P < 0.001). Compared with C-GCA, patients with LV-GCA had more relapses (4.9 vs 3.0/10 person-years, P < 0.001), higher cumulative corticosteroid (CS) doses at 1 year [11.4 g (S.D. 5.9) vs 9.1 (S.D. 3.7), P < 0.001] and required longer treatment (median 4.5 vs 2.2 years, P < 0.001). Conclusion. Although patients with LV-GCA had a lower rate of vision loss, they had a higher relapse rate and greater CS requirements. The ACR criteria for GCA are inadequate for the classification of patients with LV-GCA.

AB - Objective. The aim of this study was to compare baseline variables, treatment and outcomes in patients with large-vessel GCA (LV-GCA), primarily of the upper extremities, with those with cranial disease (C-GCA). Methods. All patients > 50 years of age with radiographic evidence of subclavian LV-GCA diagnosed between 1 January 1999 and 31 December 2008 were identified and compared with those with biopsypositive C-GCA diagnosed in the same period. Results. The study included 120 LV-GCA patients and 212 C-GCA patients. Compared with C-GCA, patients with LV-GCA were younger [68.2 years (S.D. 7.5) vs 75.7 (7.4), P < 0.001] and had longer duration of symptoms at GCA diagnosis (median 3.5 vs 2.2 months, P < 0.001). A history of PMR was more common in LV-GCA patients (26% vs 15%, P = 0.012), but a smaller proportion had cranial symptoms (41% vs 83%, P < 0.001) and vision loss (4% vs 11%, P = 0.035). ACR classification criteria for GCA were satisfied in 39% of LV-GCA patients and 95% of C-GCA patients (P < 0.001). Compared with C-GCA, patients with LV-GCA had more relapses (4.9 vs 3.0/10 person-years, P < 0.001), higher cumulative corticosteroid (CS) doses at 1 year [11.4 g (S.D. 5.9) vs 9.1 (S.D. 3.7), P < 0.001] and required longer treatment (median 4.5 vs 2.2 years, P < 0.001). Conclusion. Although patients with LV-GCA had a lower rate of vision loss, they had a higher relapse rate and greater CS requirements. The ACR criteria for GCA are inadequate for the classification of patients with LV-GCA.

KW - Giant cell arteritis

KW - Imaging

KW - Large-vessel vasculitis

KW - Prognosis

KW - Treatment

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