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Background Giant cell arteritis (GCA) typically affects cranial vessels, but it can also affect large vessels in a high percentage of patients. Vascular inflammation of the aorta and/or its main branches can cause complications of high morbidity and mortality such as aneurysms, dissection, thrombosis and/or require aortic surgery. The analysis of the different clinical and imaging patterns in patients with GCA and aortitis and their relationship with the prognosis needs more investigation. Early identification of patients with the highest risk of mortality could help predict deaths and vascular complications.
Objectives To evaluate the clinical characteristics of patients with giant cell arteritis (GCA) who present vascular complications.
To evaluate prognostic factors associated with vascular complications in patients with GCA.
Methods A retrospective cohort study was carried out including patients diagnosed of GCA by a multidisciplinary expert committee in aortic pathologies. A total of 71 patients followed between the years 2011-2021 who had a PET-CT at onset before receiving treatment were included. Other causes of aortitis were excluded. Vascular complication was defined as the presence of aneurysm, dissection, thrombosis, or aortic surgery during the disease.
Demographic, clinical, analytical and imaging variables were collected. A descriptive study of the sample and a groups comparison, according to the presence of vascular complication, was carried out. The Shapiro-Wilk test was used to study the normality of the variables. Univariate logistic regression was performed to assess predictive factors.
Results A total of 71 patients were included, 73.2% were female and the mean age was 79.3 (±6.7) years.
During the disease, 13 patients presented aortic vascular complication. Jaw claudication (p<0.0001), fever of unknown origin (p<0.0001), anemia (p=0.001), constitutional syndrome (p<0.0001) and use of pulses of glucocorticoids (p=0.014) were associated with a higher occurrence of vascular complications. On the contrary, ischemic stroke prior to or at onset of disease (p=0.035) was the only variable associated with fewer complications with statistical significance. Cardiovascular risk factors and acute phase reactants were not associated with the appearance of complication, and either the delay of diagnosis and start of therapy. The details of the sample characteristics are described in Table 1.
| Complication (n=13) | No complication (n=58) | p | |
|---|---|---|---|
| GCA Classification (%) | 18.9 | 0.944 | |
| - Cranial | 15.3 | 24.1 | |
| - Extracranial | 23.1 | 56.9 | |
| - Both | 61.5 | ||
| Clinical presentation (%) | |||
| Headache | 30.77 | 31.58 | 0.945 |
| Jaw claudication | 84.6 | 61.4 | <0.000 |
| Ophtalmological signs | 53.8 | 73.6 | 0.159 |
| Scalp tenderness | 61.5 | 80.7 | 0.138 |
| Fever of unknown origin | 76.9 | 71.9 | <0.000 |
| Polymyalgia rheumatica | 53.8 | 59.6 | 0.702 |
| Anemia | 23 | 71.9 | 0.001 |
| Constitutional syndrome | 61.5 | 60.5 | <0.000 |
| Complications at onset (%) | |||
| Aortic surgery | 0 0 | 6.8 | 0.049 |
| Ischemic stroke | 1 7.6 | 5.1 | 0.035 |
| Vascular complication | 0 | 13.7 | 0.383 |
| IV pulse GC mg/kg/d (%) | 46.1 | 15.5 | 0.014 |
The univariate analysis to identify predictive factors showed that anemia (OR: 0.11 [0.02-0.48], p=0.003) was a protective factor against the occurrence of vascular complication.
Conclusion Occurrence of new vascular complications was observed in 18.3% of patients with GCA included in our study.
Jaw claudication, fever of unknown origin, anemia and constitutional syndrome, and the use of pulses glucocorticoids as treatment were associated with a greater appearance of complications, while ischemic stroke with fewer complications.
Anemia proved to be a protective factor against the occurrence of vascular complications.
REFERENCES:
NIL.
Acknowledgements: NIL.
Disclosure of Interests None Declared.
Keywords: Vasculitis, Real-world evidence, Imaging
DOI: 10.1136/annrheumdis-2023-eular.1823