Ab1653 epidemiology and Clinical Presentation of Giant Cell Arteritis in a Referral Hospital of Northern Spain

Abstract

BackgroundTraditionally, giant cell arteritis (GCA) was described as a disease of the temporal arteries. It is now accepted that the clinical spectrum has become broader and different diagnostic tools such as PET and US have made possible to diagnose patients who have not been included in the last decades, especially in extracranial forms. Moreover, recently, new diagnosed criteria (2022 ACR/EULAR) have been proposed. This implies an evident change of the clinical epidemiology of GCA.ObjectivesTo assess the clinical epidemiology of GCA accordingly to new diagnostic tools and 2022 ACR/EULAR criteria.MethodsObservational study of patients diagnosed with GCA who underwent temporal artery biopsy (TAB) between January 2016 and December,2022. The patients were divided into 3 groups:a) only cranial (cGCA),b) only extracranial (ecGCA), andc) mixed affection (mixGCA). The diagnosis of GCA was made according toa) temporal artery biopsy, and/orb) EULAR/ACR2022 criteria, and/orc) imaging techniques. Demographic, clinical, analytical and imaging techniques characteristics were studied.ResultsWe included 191 patients (120 females/71 males), with a mean±SD age of 74.9±9.6 years. The main characteristics of the patients and the differences among phenotypes are shown inTable 1. Only a 27.2% of the patients had a positive TAB with a mean±SD length of 16.4±6.3mm.The GCA phenotype most frequent was the cranial GCA (cGCA). Headache (79.6%) was the most common ischemic manifestations, followed by the abnormal examination of temporal artery (46.6%) and visual symptoms (including 8.4% patients with blindness), jaw or lingual claudication (26.3%), and scalp tenderness (25.1%). Polymyalgia rheumatica (PmR) was the most frequent systemic manifestations, observing in 59.2% of the patients. The values of serum CRP and ESR are shown inTable 1.ConclusionGCA is a vasculitis which has increased its clinical spectrum with extracranial involvement, affecting people with a mean age of more than 70 years and with a female predilection. PmR appears to be present in more than half of the patients, mainly in extracranial phenotype.Table 1.Main features of the GCA patients.TOTAL (n=191)cGCA (n=128)ecGCA (n=28)mixGCA (n=36)p (cGCA vs ecGCA)Age (years), mean±SD75 ± 1075 ± 1074 ± 974 ± 90.55Sex, female (% females)120 (63)79 (62)16 (57)25 (69)0.62TAB+, n (%)52 (27)39 (31)2 (7)11 (31)0.010ACR1990 Criteria, n (%)128 (67)95 (75)6 (21)27 (75)<0.001EULAR/ACR2022 Criteria, n (%)155 (81)108 (85)14 (50)33 (92)<0.001Ischemic manifestations, n (%)-Headache-Scalp tenderness-Abnormal examination of TA-Visual impairment-Jaw/lingual claudication152(80)48(25)89(47)76(40)50(26)115(91)39(31)64(50)62(49)40(32)7(25)0(0)7(25)4(14)3(11)30 (83)9 (25)18 (50)10 (28)7 (19)<0.001<0.0010.0150.0010.034Systemic manifestations, n (%)-Fever-PmR27 (14)113 (59)16 (13)62 (49)5 (18)24 (86)6 (17)27 (75)0.54<0.001Laboratory-CPR, mg/dL, median [IQR]-ESR, mm 1ºh, mean±SD2.5 [0.5-7.7]56 ± 352.9 [0.4-7.7]54 ± 342.2 [0.6-8.0]63 ± 412.3[0.5-6.6]56 ± 300.920.26Predinsone therapy- Dose (mg/day), median [IQR]- Cumulative dose (mg), median [IQR]- Time (days) from GC onset and TAB, median [IQR]40 [20-45]569 [240-1875]9 [4-21]40 [30-50]625 [285-1925]9 [3-17]30 [10-40]330 [169-473]8 (5-30)40 [15-45]650 [200-1875]10 [5-25]0.150.820.45Abbreviations: ACR: American College of Rheumatology, cGCA: cranial giant cell arteritis, ecGCA: extracranial giant cell arteritis, EULAR: European League Against Rheumatism, GCA: giant cell arteritis, mixGCA: mixed giant cell arteritis, PmR: polymyalgia rheumatica, TA: temporal artery, TAB: temporal artery biopsy.Figure 1.Distribution of GCA phenotypes in different age groups. All data are in % (n).REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.