All-cause and cause-specific mortality in patients with giant cell arteritis: a nationwide, population-based cohort study

Therkildsen, Philip; Nielsen, Berit Dalsgaard; Thurah, Annette de; Hansen, Ib Tønder; Nørgaard, Mette; Hauge, Ellen‐Margrethe

doi:10.1093/rheumatology/keab507

Cited by 14 publications

(9 citation statements)

References 33 publications

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“…Thus, the higher risk of aortic dilation in GCA patients is unanimously admitted today. Other cohort studies confirmed that patients with aortic dilation have an increased mortality, especially secondary to aortic dissections [11][12][13]68,69].…”

Section: Aortic Complications In Gcamentioning

confidence: 89%

“…As an inflammatory vascular disease, GCA can be directly and indirectly responsible for cardiovascular (CV) events. Thanks to large-registry studies, it is nowadays wellestablished that GCA is associated with an increased risk of CV events [8][9][10], increasing the mortality from CV origin [11][12][13]. By definition, GCA patients are over 50 and they are even more frequently between 70 and 80 years old, an age at which usual cardiovascular risk factors and atherosclerosis are also common [14].…”

Section: Introductionmentioning

confidence: 99%

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An Updated Review of Cardiovascular Events in Giant Cell Arteritis

Boysson

Aouba

2022

JCM

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Giant cell arteritis (GCA) is a systemic vasculitis with a direct and indirect increased risk of acute and chronic vascular events, affecting large and medium vessels, and responsible for most of the morbidity and mortality of this disease. We aimed in this review to provide an updated synthesis of knowledge regarding cardiovascular events observed in GCA. By definition, GCA patients are over 50 and often over 70 years old, and subsequently also present age-related cardiovascular risk factors. In addition, the systemic and vascular inflammation as well as glucocorticoids (GC) probably contribute to an accelerated atherosclerosis and to vascular changes leading to arterial stenoses and aortic dilations and/or dissections. GCA-related ischemic complications, especially ophthalmologic events, stroke or myocardial infarcts are mostly observed within the first months after the diagnosis, being mainly linked to the vasculitic process. Conversely, aortic complications, including dilations or dissections, generally occur several months or years after the diagnosis, mainly in patients with large-vessel vasculitis. In these patients, other factors such as atherosclerosis, GC-related endothelial damage and vascular wall remodeling/healing probably contribute to the vascular events. GCA management includes the detection and treatment of these previous and newly induced cardiovascular risk factors. Hence, the use of cardiovascular treatments (e.g., aspirin, anticoagulation, statins, anti-hypertensive treatments) should be evaluated individually. Aortic structural changes require regular morphologic evaluations, especially in patients with previous aortitis. The initial or secondary addition of immunosuppressants, especially tocilizumab, an anti-IL-6 receptor antibody, is discussed in patients with GCA-related cardiovascular complications and, more consensually, to limit GC-mediated comorbidities.

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Section: Aortic Complications In Gcamentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

An Updated Review of Cardiovascular Events in Giant Cell Arteritis

Boysson

Aouba

2022

JCM

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“…The GiACTA trial demonstrated the superiority of the combination of tocilizumab and corticosteroids versus placebo and corticosteroids in terms of sustained corticosteroid-free remission but did not report changes in disease-related mortality [3]. Given that GCA mortality is primarily due to glucocorticoid-related complications (e.g., infections, cardiovascular disease, endocrinopathies), it is still reasonable to hypothesize that tocilizumab may reduce GCA mortality by decreased glucocorticoid use over time [26]. In addition, not all patients with GCA receive tocilizumab due to contraindications, physician judgment or patient preference.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Trends of Hospitalizations for Giant Cell Arteritis: A 21-Year Longitudinal National Population-Based Study

Hino¹,

Edigin²,

Aihie³

et al. 2023

Cureus

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BackgroundLong-term longitudinal studies on giant cell arteritis (GCA) hospitalizations are limited. Here we aim to fill gaps in knowledge by analyzing longitudinal trends of GCA hospitalizations over the last two decades in the United States (U.S.). Materials and methodsWe performed a 21-year longitudinal trend analysis of GCA hospitalizations using data obtained from the National Inpatient Sample (NIS) database between 1998 and 2018. Using the NIS database, we searched for hospitalizations for patients aged ≥ 50 years with a principal diagnosis of GCA using ICD billing codes. The principal diagnosis was the main reason for hospitalization. We used all hospitalizations in patients without GCA aged ≥50 years as the control population. Multivariable logistic and linear regression analysis was utilized to calculate the adjusted p-trend for outcomes of interest. ResultsThe incidence of GCA hospitalization remained stable at about one per 100,000 U.S. persons throughout the study period. There was no statistically significant change in the inpatient mortality for the GCA group during the study period (adjusted p-trend=0.111). In comparison, inpatient mortality reduced from 4.4% to 3.1% from 1998 to 2018 (adjusted p-trend <0.0001) in the control group. The proportion of whites reduced, while the proportion of racial minorities increased over time in both the GCA and control groups. ConclusionThe non-GCA control population saw significant reductions in mortality over time, but unfortunately, the GCA group did not see such improvements. More research into additional treatment modalities for inpatient GCA management may help improve mortality.

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“…[13][14][15] Mortality is not increased in PMR, 56 57 whereas in GCA, patients have higher mortality, particularly at disease onset, most likely as a consequence of disease manifestations and adverse effects of intensive treatment. 58 Among disease-related symptoms, patients pay particular attention to pain, stiffness, disability and fatigue. 48 59 In GCA, preservation of sight and integrity of other tissues potentially affected by vascular compromise are other fundamental aspects of maintaining a high quality of life.…”

Section: Recommendationmentioning

confidence: 99%

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

et al. 2023

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ObjectivesTo develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).MethodsA systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously.ResultsFive overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment.ConclusionThese are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.

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All-cause and cause-specific mortality in patients with giant cell arteritis: a nationwide, population-based cohort study

Cited by 14 publications

References 33 publications

An Updated Review of Cardiovascular Events in Giant Cell Arteritis

An Updated Review of Cardiovascular Events in Giant Cell Arteritis

Longitudinal Trends of Hospitalizations for Giant Cell Arteritis: A 21-Year Longitudinal National Population-Based Study

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica

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