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Published on: February 8, 2019
Fever in biopsy-proven giant cell arteritis: clinical implications in a defined population
Miguel A Gonzalez-Gay1, Carlos Garcia-Porrua, Juan C Amor-Dorado
1Hospital Xeral-Calde, Lugo, Spain. miguelaggay@hotmail.com
Insights
Fever in giant cell arteritis (GCA) patients indicates a more severe inflammatory response and a lower risk of ischemic complications. This finding highlights fever as a key clinical feature in GCA diagnosis and management.
Area of Science:
- Rheumatology
- Internal Medicine
- Vasculitis Research
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis affecting large arteries.
- Fever is a recognized but not fully characterized symptom in GCA.
- Understanding fever's role is crucial for GCA diagnosis and prognosis.
Purpose of the Study:
- To determine the frequency and clinical characteristics of fever in biopsy-proven GCA patients at diagnosis.
- To investigate the relationship between fever, ischemic complications, and systemic inflammation in GCA.
Main Methods:
- Retrospective analysis of biopsy-proven GCA patients diagnosed between 1981 and 2001.
- Definition of fever: axillary temperature >= 38°C at admission or prior to corticosteroid therapy.
- Statistical analysis including logistic regression to assess associations.
Main Results:
- Fever was present in 10% (21/210) of biopsy-proven GCA patients.
- Fever patients showed a lower frequency of severe ischemic manifestations (OR 0.41).
- Fever was associated with a more severe inflammatory response, including elevated erythrocyte sedimentation rate, anemia (OR 12.24), and increased alkaline phosphatase.
Conclusions:
- Fever in biopsy-proven GCA patients identifies a subgroup with a more pronounced systemic inflammatory response.
- This subgroup exhibits a reduced risk of severe ischemic complications compared to afebrile GCA patients.
- Fever is an important clinical indicator of disease severity and inflammatory activity in GCA.
Objective:
To assess the frequency and clinical features of biopsy-proven giant cell arteritis (GCA) patients who had fever at the time of diagnosis of the disease, and the relationship between fever, ischemic complications, and the systemic inflammatory response in GCA.
Methods:
A retrospective study of biopsy-proven GCA patients diagnosed between 1981 and 2001 was performed at the single referral hospital for a well-defined population in the Lugo region of northwest Spain. Patients were considered as having fever if the axillary temperature at the time of admission or during the followup prior to the onset of corticosteroid therapy was > or =38 degrees C.
Results:
During the period of study, 21 (10%) of the 210 biopsy-proven GCA patients had fever. Two of them fulfilled criteria for fever of unknown origin. Patients with fever had a lower frequency of severe ischemic manifestations than the rest of biopsy-proven GCA patients. They also exhibited a more severe inflammatory disease, with significant abnormality in most laboratory variables, including higher elevation of erythrocyte sedimentation rate, lower values of hemoglobin, and higher proportion of patients with increased alkaline phosphatase. By logistic regression analysis, we observed that patients with fever had an increased risk of developing anemia (odds ratio [OR] 12.24). In contrast, a negative association between severe ischemic manifestations and fever was found (OR 0.41).
Conclusion:
Biopsy-proven GCA patients with fever constitute a subgroup of patients with more severe inflammatory response and less ischemic disease.
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