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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Prevalence, characteristics, and outcomes of patients with low baseline C-reactive protein in giant cell arteritis
Samuel Pichon1, Vincent Koether2, Amélie Leurs2,3
1Service de Médecine Interne, Centre de référence des Maladies Auto- Immunes et Auto-inflammatoires Systémiques rares de l'Adulte du Nord, Méditerranée et Guadeloupe (CeRAINOM), Univ. Lille, CHU Lille, Nord-Ouest, Lille, F-59000, France. samuel.pichon0@gmail.com.
Insights
Giant cell arteritis (GCA) can occur with low C-reactive protein (CRP). Patients with low CRP GCA show more ocular and limb issues, but similar relapse rates to those with high CRP.
Area of Science:
- Rheumatology
- Vascular Inflammation
- Diagnostic Markers
Background:
- Elevated inflammatory markers like C-reactive protein (CRP) are vital for diagnosing and monitoring giant cell arteritis (GCA).
- However, a subset of GCA patients presents with low baseline CRP levels, posing diagnostic challenges.
Purpose of the Study:
- To investigate the prevalence, clinical characteristics, and outcomes of GCA patients with low baseline CRP (<10 mg/L).
- To compare these features against GCA patients with elevated CRP (≥10 mg/L).
Main Methods:
- A retrospective observational study analyzed 380 GCA patients diagnosed between 2000 and 2023.
- Patients were stratified into low CRP (<10 mg/L) and high CRP (≥10 mg/L) groups.
- Baseline characteristics, clinical presentations, laboratory results, imaging findings, and outcomes were compared.
Main Results:
- 7.6% of GCA patients had low baseline CRP.
- The low CRP group showed less fever but higher rates of ocular involvement (anterior ischemic optic neuropathy) and limb claudication.
- Elevated plasma fibrinogen (>4 g/L) was observed in 77% of the low CRP group, indicating ongoing inflammation.
Conclusions:
- Giant cell arteritis with low CRP is not uncommon and is associated with distinct clinical features, including increased ocular and peripheral vascular manifestations.
- Elevated fibrinogen levels in low CRP GCA patients suggest active inflammation, necessitating clinical vigilance.
- GCA should be considered even with CRP <10 mg/L due to the risk of severe complications.
Objective:
Elevated inflammatory markers play a crucial role in the diagnosis and follow-up of patients with giant cell arteritis (GCA). This study aimed to describe the prevalence, characteristics, and outcomes of patients with low baseline (< 10 mg/L) C-reactive protein (CRP) in GCA.
Methods:
A retrospective observational study was conducted at Lille University Hospital, involving all patients diagnosed with GCA between January 2000 and April 2023. Patients were categorized based on their CRP level at diagnosis. Baseline characteristics, clinical manifestations, laboratory findings, imaging results, and outcomes were compared between patients with baseline CRP < 10 mg/L ("low CRP") and those with CRP ≥ 10 mg/L ("high CRP").
Results:
Of the 380 patients, 7.6% (n = 29) had baseline CRP < 10 mg/L at diagnosis. When compared to the high CRP group, the low CRP group exhibited a lower incidence of fever, and had a higher incidence of ocular involvement, particularly anterior ischemic optic neuropathy (28% vs. 13%, p = 0.04), and limb claudication (24% vs. 8%, p < 0.01). Plasma fibrinogen levels were elevated (> 4 g/L) in 77% of patients with low CRP. Despite differences in clinical presentation, relapse rates were equilibrated between the two groups.
Conclusion:
GCA patients with low CRP are not rare and present with more ocular and peripheral vascular involvement and less constitutional symptoms in our study. Elevated fibrinogen in these patients suggests active inflammation despite low CRP. Clinicians should consider GCA even with a CRP < 10 mg/L, as these patients may present with severe complications.
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