Sex differences among patients with giant cell arteritis: insights from the Spanish ARTESER Registry

To evaluate sex-based differences in clinical presentation, vascular phenotype, diagnostic approaches, treatment, adverse events and outcomes among patients with giant cell arteritis (GCA).

We analysed data from all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 across 26 hospitals in Spain. Eligibility criteria included age ≥50 years and diagnosis confirmed by imaging, the 1990 American College of Rheumatology classification criteria, or expert clinical judgment.

A total of 1675 patients were included. The extracranial phenotype was more prevalent in women (14.8% vs 9.9%; P = 0.039), while the mixed phenotype was more common in men (17.7% vs 11.7%; P = 0.002). Temporal artery ultrasound was more frequently positive in men (73.5% vs 65.1%; P = 0.025). Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) were prescribed more often in women (35.3% vs 28.2%; P = 0.005), while glucocorticoid and tocilizumab use did not differ by sex. Fractures (22.4% vs 10.9%; P = 0.010) and cataracts (6.0% vs 2.8%; P = 0.010) were significantly more frequent in women and men, respectively. Remission rates (23.1% vs 23.8%) and relapse frequencies (19.7% vs 19.3%) were similar between sexes. Mortality was higher in men (13.8% vs 6.6%; P < 0.001).

Women more frequently exhibited the extracranial phenotype, required more csDMARDs, and experienced a higher incidence of fractures. In contrast, men more commonly presented with the mixed phenotype, had more cataracts, and showed a higher mortality rate. These findings highlight the importance of integrating sex as a key biological variable in GCA research and clinical management to support more tailored and effective therapeutic strategies.