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Symptomatic lower-limb giant-cell arteritis: Characteristics, management and long-term outcome
C Le Hello1, L Auboire1, L Berger2
1Vascular Medicine Department, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
Journal De Medecine Vasculaire
|July 15, 2017
Summary
Symptomatic lower-limb giant-cell arteritis (LL-GCA) is rare but can cause significant symptoms. Long-term mortality appears low despite frequent relapses and steroid dependence in patients with LL-GCA.
Area of Science:
- Rheumatology
- Vascular Medicine
- Immunology
Background:
- Giant-cell arteritis (GCA) is a systemic vasculitis typically affecting large arteries, often involving the cranial arteries.
- Lower-limb involvement in GCA (LL-GCA) is rare and less understood, presenting unique diagnostic and management challenges.
Purpose of the Study:
- To characterize the clinical presentation, vascular risk factors, and long-term outcomes of patients with symptomatic lower-limb giant-cell arteritis (LL-GCA).
Main Methods:
- Retrospective analysis of 8 patients diagnosed with symptomatic LL-GCA.
- Evaluation of clinical characteristics, diagnostic criteria (ACR), imaging findings, treatment strategies, and patient outcomes over a mean follow-up of 137.3 months.
Main Results:
- Patients presented with bilateral, rapidly progressive arterial claudication; 2 experienced rest ischemia. Common sites of inflammation included superficial femoral and popliteal arteries.
- Corticosteroids were the primary treatment (mean 132 months), with 2 patients requiring immunosuppressants. Bypass surgery was successful for limb salvage, unlike endovascular procedures.
- Relapses were frequent (100% of patients), and corticosteroid dependence was common. Long-term mortality was low, with LL-GCA contributing to only one death.
Conclusions:
- Symptomatic LL-GCA, though rare, is manageable with a low long-term mortality rate.
- Despite frequent relapses and corticosteroid dependence, effective management strategies can lead to favorable long-term outcomes.
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