Related Experiment Video
Updated: May 16, 2025
An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Risk factors associated with disease relapse in healing/healed arterial injury and biopsy-proven giant cell arteritis
Wei Sim1, Jack Mouhanna2, Danah Albreiki1
1Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada.
Insights
Giant cell arteritis (GCA) relapse characteristics were compared to healing/healed (HH) arterial injury. Large-vessel vasculitis, like aortitis, independently predicts relapse in GCA patients, suggesting similar clinical management for both groups.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large arteries.
- Temporal artery biopsy (TAB) is crucial for diagnosis, distinguishing active GCA from healing/healed (HH) arterial injury.
- Understanding relapse patterns in both GCA and HH groups is essential for effective patient management.
Purpose of the Study:
- To compare relapse characteristics in patients with biopsy-proven GCA versus those with HH arterial injury on TAB.
- To identify risk factors associated with symptomatic or biochemical relapses in these patient cohorts.
Main Methods:
- Retrospective cohort study involving 135 patients with GCA-positive or HH arterial injury on TAB.
- Minimum 12-month follow-up period (January 2009 - December 2018).
- Evaluation of clinical characteristics and serological markers as potential relapse risk factors.
Main Results:
- Relapse rates were similar between HH (16.9%) and GCA-positive (25.7%) groups (p=0.21).
- Aortitis was significantly associated with relapse and earlier relapse rates in GCA-positive patients (p=0.007).
- Aortitis and jaw claudication were independent risk factors for relapse in GCA; aortitis and aortic aneurysm were associated with relapse in HH patients.
Conclusions:
- Large-vessel vasculitis, including aortitis, is linked to disease relapse in both GCA and HH biopsy groups.
- Similar relapse characteristics suggest clinicians can manage both patient groups similarly based on clinical history.
- Management decisions should not solely rely on TAB pathology findings but integrate clinical context.
Objective:
To compare characteristics of relapses in patients with biopsy-proven giant cell arteritis (GCA) and healing/healed (HH) arterial injury on temporal artery biopsy (TAB).
Design:
Single-centre, retrospective cohort study.
Participants:
One hundred thirty-five consecutive patients with GCA-positive or HH arterial injury on TAB and minimum 12-month follow-up from January 2009 to December 2018.
Methods:
Clinical characteristics and serological markers were evaluated for their potential as risk factors for symptomatic or biochemical relapses.
Results:
Relapse rates were 16.9% and 25.7% in the HH and GCA-positive groups, respectively (p = 0.21). Median length of follow-up was 34.8 months in the HH group and 36.6 months in the GCA-positive group. No statistically significant difference between groups with respect to time to relapse, steroid doses at relapse, and presence of symptoms and elevated biomarkers at relapse. In GCA-positive patients, aortitis was associated with relapse (p = 0.050) and with earlier relapse rates (p = 0.007). Aortitis (HR 7.96; p = 0.007) and jaw claudication (HR 5.08; p = 0.019) were found to be independent risk factors for relapse. In HH arterial injury patients, aortitis and aortic aneurysm were associated with earlier relapses (p = 0.044 and p = 0.047, respectively) and were associated with disease relapses on univariable analysis (p = 0.044 and p = 0.047, respectively) but not on multivariable analysis.
Conclusions:
The presence of large-vessel vasculitis is associated with disease relapse in both HH and GCA-positive biopsy patients. Similar relapse characteristics between both HH and biopsy-proven patients may suggest that clinicians manage these patients similarly in context of clinical history rather than modify management purely based on pathology findings.
Related Concept Videos
01:29Autoimmune Disorders
Concept and Mechanism of Autoimmune Diseases
The immune...
01:17Gastritis-II: Pathophysiology
In acute gastritis, the gastric mucosa becomes swollen and red and undergoes superficial erosion. Superficial ulceration may lead to bleeding.
In chronic gastritis, persistent or repeated insults lead to chronic inflammatory changes and, eventually, thinning or atrophy of the gastric tissue.
Gastritis can stem from various causes, each...