Objectives Recent advances in imaging revealed that giant cell arteritis (GCA) is frequently associated with large vessel involvement (LVI), but they may also contribute to earlier diagnosis and treatment of LV-GCA. We aimed to compare clinical characteristics of GCA with or without LVI and evaluate its association with clinical outcomes. Method We retrospectively reviewed the medical records of 36 patients with GCA in Kyoto University Hospital. Results Eighteen patients each were assigned to the LVI(+) and LVI(-) groups. Five-year survival rates in the LVI(+) group was better than in the LVI(-) group (P = 0.034), while five-year relapse-free survival rates were similar between the groups (P = 0.75). The LVI(+) group required lower doses of glucocorticoid at month 6 (P = 0.036). Disease activity evaluated with the Birmingham Vasculitis Activity Score at disease onset was higher in the LVI(-) group (P = 0.014), and the Vasculitis Damage Index score examined at the last visit was higher in the LVI(-) group (P = 0.011). Conclusion GCA without LVI had more active disease, severer vascular damage, and worse survival, possibly because of ophthalmic complications and their greater glucocorticoid requirement. Our results revisit the impact of cranial manifestations on disease severity and morbidity.

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