Association of Giant Cell Arteritis With Race

Abstract

IMPORTANCE Giant cell arteritis (GCA) is the most common vasculitis in adults and is associated with significant morbidity and mortality. Its incidence has been carefully studied in white populations, yet its relevance among other racial and ethnic groups is less well known. OBJECTIVE To examine the incidence of biopsy-proven GCA (BP-GCA) in a tertiary care center-based population with a sizeable proportion of black patients. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study identified all patients who underwent temporal artery biopsy (TAB) from July 1, 2007, through September 30, 2017, using the electronic medical record system at the Johns Hopkins Wilmer Eye Institute. Associations between self-reported race, sex, and age were explored and compared with all other patients attending the hospital over the same period. Data were analyzed from November 1, 2017, through July 31, 2018. MAIN OUTCOMES AND MEASURES Estimated incidence rates of BP-GCA in black and white patients. RESULTS Among 586 patients who underwent TAB (mean [SD] age, 70.5 [11.1] years; age range, 32-103 years; 423 [72.2%] women), 167 (28.5%) were black, 382 (65.2%) were white, and 37 (6.3%) were other or unknown. Of 573 individuals 50 years and older, 92 (16.1%) had BP-GCA; 14 were black (8.4% of all black patients undergoing testing) and 75 were white (19.6% of all white patients undergoing testing). Crude annual incidence rates for BP-GCA were 2.9 (95% CI, 1.3-5.5) per 100 000 for black and 4.2 (95% CI, 3.0-5.6) per 100 000 for white patients within the study population. Population-adjusted age-and sex-standardized incidence rates were 3.1 (95% CI, 1.0-5.2) and 3.6 (95% CI, 2.5-4.7) per 100 000 for black and white patients, respectively (difference, 0.5; 95% CI, −1.7 to 2.7; P = .70). The incidence rate ratio was 1.9 in women compared with men (95% CI, 1.1-3.4; P = .03) but was not significant in white compared with black patients (1.2; 95% CI, 0.6-2.4; P = .66). CONCLUSIONS AND RELEVANCE In our cohort, BP-GCA occurred more commonly in women, but rates were similar between races. These findings do not appear to support the conclusion that GCA occurs more frequently in white compared with black patients.

Bibliometric Analysis of Publication Activity in the Field of GIANT Cell Arteritis: A SCOPUS-based Study

“…One of the most recently published epidemiologic studies did not show a difference in the incidence of GCA based on race. 17 This contradicts previous studies, which reported higher incidences in white and particularly Scandinavian-origin ethnicities. 18 Temporal arteritis is relatively a 'confined' topic as compared with hypertension and diabetes.…”

Giant Cell Arteritis Presenting as Bilateral Cotton Wool Spots

“…In a recent retrospective cohort study comprising 586 patients who underwent temporal artery biopsy (TAB), there was no significant difference in biopsy-positive GCA cases between Caucasian and Afro-Caribbean patients. However, the proportion of Afro-Caribbean patients in the study was only 28.5% [9]. Similarly, in two other retrospective studies, the proportion of non-Caucasian patients was small [10][11].…”

A Critical Look at Race‐Based Practices in Rheumatology Guidelines

“…This study led to the common teaching that GCA is largely a disease affecting White individuals. However, more recent and racially representative studies have demonstrated similar prevalence of GCA between Black and White patients (24). Despite this, ethnicity was still included as an important clinical factor in diagnosis of GCA in the ACR rheumatology guideline (17).…”