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Large-Vessel Dilatation in Giant Cell Arteritis: A Different Subset of Disease?
Francesco Muratore1, Tanaz A Kermani2, Cynthia S Crowson3
1Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia and University of Modena and Reggio Emilia, Modena, Italy.
Insights
Patients with large-vessel giant cell arteritis (LV-GCA) and subclavian artery dilatation, unlike those with stenosis, show a higher risk of aortic aneurysm. Careful monitoring for aortic dilatation is crucial in these patients.
Area of Science:
- Vascular Medicine
- Rheumatology
- Cardiology
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis that can affect large arteries.
- Large-vessel GCA (LV-GCA) involving the subclavian arteries presents with diverse vascular manifestations.
- Understanding these presentations is key for appropriate patient management and risk stratification.
Purpose of the Study:
- To compare patients with LV-GCA exhibiting subclavian artery wall thickening, stenosis, or occlusion.
- To compare patients with LV-GCA characterized by subclavian artery dilatation without stenotic changes.
- To identify distinct clinical features and outcomes between these two LV-GCA subsets.
Main Methods:
- Retrospective study of patients with radiographic evidence of subclavian artery vasculitis secondary to GCA.
- Group 1: LV-GCA with subclavian artery wall thickening, stenosis, and/or occlusion.
- Group 2: LV-GCA with subclavian artery dilatation without wall thickening or stenotic changes.
Main Results:
- LV-GCA with subclavian dilatation (Group 2) was diagnosed later than LV-GCA with stenosis (Group 1).
- Group 2 patients were more frequently male, ever smokers, and had a history of coronary artery disease.
- A significantly higher prevalence of aortic dilatation at diagnosis and aortic aneurysm during follow-up was observed in Group 2 compared to Group 1.
Conclusions:
- Two distinct subsets of LV-GCA based on subclavian artery involvement were identified.
- Subclavian artery dilatation in LV-GCA is strongly associated with aortic aneurysm.
- Patients with LV-GCA and subclavian artery dilatation require careful evaluation and monitoring for aortic dilatation.
Objective:
To compare patients with large-vessel giant cell arteritis (LV-GCA) characterized by wall thickening, stenosis, and/or occlusion of subclavian arteries to those with subclavian dilatation.
Methods:
For the purposes of the present retrospective study, 2 different subsets of LV-GCA were identified and compared from an established cohort of patients with radiographic evidence of subclavian artery vasculitis secondary to GCA: LV-GCA with wall thickening, stenosis, and/or occlusion of subclavian arteries (Group 1), and LV-GCA with dilatation of subclavian arteries without wall thickening or stenotic changes (Group 2).
Results:
The study included 109 patients in Group 1 and 11 in Group 2. Large-vessel involvement secondary to GCA was diagnosed significantly later in patients from Group 2 compared to those from Group 1 (median 15.3 versus 0.0 months; P = 0.010). Compared to patients from Group 1, those from Group 2 were more frequently male (17% versus 45%; P = 0.027), ever smokers (42% versus 73%; P = 0.048), and more frequently had a history of coronary artery disease (11% versus 36%; P = 0.018). At LV-GCA diagnosis, 10 of the 11 patients (91%) from Group 2 had aortic dilatation compared to 13 of 109 patients (12%) from Group 1 (P < 0.001). During the followup period, the prevalence of aortic aneurysm was significantly higher in patients from Group 2 compared with those from Group 1 (64% versus 7% at 5 years; P < 0.001).
Conclusion:
Two different subsets of LV-GCA were identified. Given the strong association between subclavian artery dilatation and aortic aneurysm, such patients should be evaluated and monitored carefully for aortic dilatation.
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