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Giant Cell Arteritis-related Stroke: A Retrospective Multicenter Case-control Study.

Hubert de Boysson1,2, Eric Liozon3,4, Delphine Larivière3,4

  • 1From the Department of Internal Medicine, and Biostatistics and Clinical Research Unit, and Department of Neurology, Caen University Hospital; University of Caen, Basse Normandie; University of Caen-Normandie, Inserm U919, Caen; Department of Internal Medicine, Limoges University Hospital, Limoges; Department of Internal Medicine, Bichat University Hospital, Paris; Department of Internal Medicine, Dijon University Hospital, Dijon, France. deboysson-h@chu-caen.fr.

The Journal of Rheumatology
|January 17, 2017
PubMed
Summary

Giant cell arteritis (GCA) patients experiencing recent ophthalmic ischemic symptoms and low inflammatory markers are more prone to stroke, particularly in the vertebrobasilar territory. Early recognition of these risk factors is crucial for timely intervention.

Keywords:
CEREBROVASCULAR DISORDERSGIANT CELL ARTERITISNERVOUS SYSTEM DISEASESTEMPORAL ARTERITISVASCULITIS

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Area of Science:

  • Neurology
  • Rheumatology
  • Vascular Medicine

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis affecting large and medium-sized arteries.
  • Stroke is a serious complication of GCA, but risk factors are not fully elucidated.
  • Understanding GCA-related stroke can improve patient outcomes and preventative strategies.

Purpose of the Study:

  • To describe the characteristics of patients who experienced stroke secondary to GCA.
  • To compare patients with GCA-related stroke to a control group of GCA patients without stroke.
  • To identify predictors of stroke in GCA patients.

Main Methods:

  • Retrospective multicenter cohort study.
  • Inclusion criteria: GCA diagnosis (ACR criteria, 1995-2015) with or without stroke.
  • Comparison of stroke patients (n=40) with a control group (n=200).

Main Results:

  • Stroke occurred at diagnosis in 73% of patients, predominantly in the vertebrobasilar territory (73%).
  • GCA patients with stroke showed more ophthalmic ischemic symptoms (63% vs 25%) and lower inflammatory markers (CRP, anemia) compared to controls.
  • Predictors for stroke included ophthalmic ischemic symptoms (OR 5) and absence of anemia (OR 0.39).

Conclusions:

  • Stroke in GCA, especially in the vertebrobasilar territory, is associated with ophthalmic ischemic symptoms and low inflammatory markers.
  • Ophthalmic symptoms at diagnosis and lack of anemia are significant predictors of stroke in GCA.
  • These findings highlight the importance of recognizing specific clinical and laboratory features for stroke risk stratification in GCA patients.