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Large-vessel giant cell arteritis: a cohort study.

Francesco Muratore1, Tanaz A Kermani1, Cynthia S Crowson2

  • 1Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.

Rheumatology (Oxford, England)
|September 7, 2014
PubMed
Summary

Patients with large-vessel GCA (LV-GCA) of the extremities were younger and had more relapses than those with cranial GCA (C-GCA). LV-GCA patients required higher corticosteroid doses and longer treatment, indicating limitations in current GCA classification criteria.

Keywords:
giant cell arteritisimaginglarge-vessel vasculitisprognosistreatment

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Area of Science:

  • Rheumatology
  • Vascular Medicine
  • Immunology

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis.
  • GCA predominantly affects the aorta and its branches.
  • Distinguishing large-vessel GCA (LV-GCA) from cranial GCA (C-GCA) is crucial for management.

Purpose of the Study:

  • To compare baseline characteristics, treatment strategies, and outcomes in patients with LV-GCA (primarily upper extremities) versus C-GCA.
  • To evaluate the efficacy of existing classification criteria for LV-GCA.

Main Methods:

  • Retrospective comparison of patients diagnosed with LV-GCA (subclavian involvement) and C-GCA between 1999 and 2008.
  • Inclusion criteria: age >50 years, radiographic evidence for LV-GCA, biopsy-proven C-GCA.
  • Data collected included demographics, symptoms, American College of Rheumatology (ACR) criteria, treatment, and outcomes.

Main Results:

  • The study included 120 LV-GCA and 212 C-GCA patients.
  • LV-GCA patients were younger (68.2 vs 75.7 years), had longer symptom duration, and more polymyalgia rheumatica (PMR).
  • LV-GCA patients experienced higher relapse rates (4.9 vs 3.0/10 person-years), required higher cumulative corticosteroid (CS) doses (11.4g vs 9.1g at 1 year), and longer treatment duration (4.5 vs 2.2 years).

Conclusions:

  • Despite a lower rate of vision loss, LV-GCA is associated with increased relapses and higher corticosteroid requirements compared to C-GCA.
  • The current ACR classification criteria are insufficient for accurately classifying patients with LV-GCA.
  • Further research is needed to refine diagnostic and classification criteria for LV-GCA.