Characteristics and management of giant cell arteritis in France: a study based on national health insurance claims data

Abstract

Objective Few data are available on the epidemiology and management of GCA in real life. We aimed to address this situation by using health insurance claims data for France. Methods This retrospective study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1% representative sample of the French national health insurance system. The EGB contains anonymous data on long-term disease status, hospitalizations and reimbursement claims for 752 717 people. Data were collected between 2007 and 2015. The index date was defined as the date of the first occurrence of a GCA code. Demographics, comorbidities, diagnostic tests and therapies were analysed. Annual incidence rates were calculated, and incident and overall GCA cases were studied. Results We identified 241 patients with GCA. The annual incidence was 7–10/100 000 people ⩾50 years old. Among the 117 patients with incident GCA, 74.4% were females, with mean age 77.6 years and mean follow-up 2.2 years. After the index date, 51.3% underwent temporal artery biopsy and 29.1% high-resolution Doppler ultrasonography. Among the whole cohort, 84.3% used only glucocorticoids. The most-prescribed glucocorticoid-sparing agent was methotrexate (12.0%). Conclusion The incidence of GCA in France is 7–10/100 000 people ⩾ 50 years old. Adjunct agents, mainly methotrexate, are given to only a few patients. The use of temporal artery biopsy in only half of the patients might reflect a shift toward the use of imaging techniques to diagnose GCA.

Inflammatory Markers are Quickly Improved by Tocilizumab in Early Polymyalgia Rheumatica and Might Predict Early Response to Interleukin-6 Blockade

“…A main characteristic of PMR is an increase in acute-phase reactants (APRs), namely, C-reactive protein and the erythrocyte sedimentation rate. PMR may be associated with giant cell arteritis (GCA) but occur most often isolated [1]. Glucocorticoids remain the cornerstone of treatment for PMR.…”

Aortic involvement in giant cell arteritis

“…Giant cell arteritis (GCA) is the most frequent form of large vessel (LV) vasculitis affecting people over 50 years of age [1]. GCA affects the aorta and its branches (mostly subclavian and axillary arteries, internal, external carotid arteries and its branches, and vertebral arteries).…”

“…GCA pathophysiology is only partially understood. The current pathogenic model involves both innate immune cells (dendritic cells, monocytes and macrophages) as well as adaptive immune cells (interferon ␥ and IL-17 producing T cells) [2], and is largely based on studies in temporal artery biopsies. Availability of positron emission tomography coupled to computed tomography (PET-CT) has allowed extracranial forms of the disease to be investigated more precisely.…”

“…The prevalence of extracranial GCA LV involvement in imaging studies of biopsy-proven GCA patients varies between 30 to 80%, where the latter percentage of 80% matches findings in autopsy studies. Among the extracranial vessels affected in GCA, aorta is the main site of inflammation, followed by the common carotid arteries, the subclavian arteries and the limb arteries [1,3]. GCA patients with extracranial involvement are younger, have a longer diagnostic delay, and more commonly present with overlapping polymyalgia rheumatica (PMR) than patients with isolated cranial GCA [4].…”

Presentation characteristics and clinical outcome of patients with giant cell arteritis followed by a single center

“…GCA predominantly affects European populations especially those with Scandinavian origin (>20/100. 000 people older than 50 years) [3,4] in comparison with the Southern European and Mediterranean races (Turkey and Tunisia: ~1.13-7/100,000 people older than 50 years) [5][6][7][8].…”