COVID-19 among patients with giant cell arteritis: a single-centre observational study from Slovenia

Abstract

Objectives Patients with giant cell arteritis (GCA) represent a fragile population with an increased infection risk. In a recent study, older age, a higher number of comorbidities, higher disease activity and prednisolone ≥ 10 mg/day were associated with worse COVID-19 outcome. We aimed to evaluate the frequency and severity of COVID-19 in a well-defined GCA cohort. Methods We reviewed medical records of histologically and/or by imaging-proven GCA patients diagnosed between September 2011 and February 2020 at our secondary/tertiary centre and followed during the COVID-19 pandemic between March 2020 and February 2022 (24 months). Descriptive statistics were used to explore the studied population. Results Of 314 patients with GCA diagnosed for the first time during a 102-month period, 49 patients died before March 2020. Of the remaining 265 patients, 55 (20.8%) patients suffered from a total of 57 SARS-CoV-2 infections. We observed 44 (77.2%) mild and 13 (22.8%) severe COVID-19 episodes (the latter defined as needing hospitalization, death or thrombotic complication). Patients with severe COVID-19 were more likely to have arterial hypertension (12 [92.3%] vs. 25 [56.8%]; p = 0.022), cardiovascular disease (7 [53.8%] vs. 10 [22.7%]; p = 0.043) or obesity (5 [38.5%] vs. 5 [11.4%]; p = 0.038). Neither prednisolone dose 1–5 mg/day ( p = 0.483) nor leflunomide use ( p = 1.000) was associated with COVID-19 course. There were no significant differences in sex, age, GCA type, GCA disease duration and other comorbidities in patients with mild and severe COVID-19 in our cohort. Conclusion More than a fifth of our GCA patients had severe COVID-19. Treatment with leflunomide or low doses of glucocorticoids were not associated with severe course in our cohort. Key Points • Treatment with leflunomide or low doses of glucocorticoids were not associated with worse COVID-19 outcome . • Outcomes of COVID-19 improved as the COVID-19 pandemic, prevention and treatment options evolved . • Arterial hypertension, cardiovascular disease or obesity were associated with severe COVID-19 .

SARS-CoV-2 infection among patients with autoimmune rheumatic diseases; comparison between the Delta and Omicron waves in Israel

“…ARD patients are generally at higher risk for COVID-19-related worse outcomes, probably due to lessened vaccine efficacy and weaker anti-viral immune response of ARD patients receiving these therapies. [ 7 , 15 , [18] , [19] , [20] ] For instance, a review by Grainger et al concluded that there is an increased risk of COVID-19-related hospitalization and mortality among ARD patients. [3] Of note, an existing ARD of RA or SLE was associated with a higher risk for hospitalization and death.…”

Overlapping Symptoms of COVID-19 and Giant Cell Arteritis: The Need for a Higher Degree of Suspicion for Diagnostic Differentiation

“…These symptoms include GCA-like symptoms, such as scalp tenderness, temporal artery tenderness, difficulty chewing, transient visual loss, weight loss, dysphagia, and trismus, and COVID-19 features such as dry cough, sore throat, dyspnea, confusion, anosmia or alteration in sense of taste lymphopenia, thrombocytopenia, elevation in lactate dehydrogenase, and elevation in creatine kinase [ 4 , 5 ]. Further studies are required to know if GCA patients with short symptom duration (days to weeks) differ from patients presenting with long symptom duration (months to years) [ 1 , 3 ]. Most new-onset headaches in the current clinical scenario are attributed to COVID-19 infection.…”

“…On a similar note, an infection with the SARS-CoV-2 virus leading to a COVID-19 infection can involve multiple systems, especially the vascular system, due to the intense surge of inflammatory cytokines associated with the disease [ 1 , 2 ]. Despite the similar inflammatory damage induced by both GCA and the COVID-19 virus, very few cases have been reported regarding a potential association between GCA and COVID-19 [ 1 - 3 ]. There has been an increasingly elevated rate of COVID-19 cases diagnosed in concordance with other primary systemic vasculitis or cases of polymyalgia rheumatica; however, there are few cases of GCA being seen in the context of an ongoing COVID-19 infection [ 3 , 4 ].…”

“…Despite the similar inflammatory damage induced by both GCA and the COVID-19 virus, very few cases have been reported regarding a potential association between GCA and COVID-19 [ 1 - 3 ]. There has been an increasingly elevated rate of COVID-19 cases diagnosed in concordance with other primary systemic vasculitis or cases of polymyalgia rheumatica; however, there are few cases of GCA being seen in the context of an ongoing COVID-19 infection [ 3 , 4 ]. During the period of the COVID-19 pandemic, clinicians expressed significant diagnostic challenges since a COVID-19 infection can present with incredibly similar symptoms to GCA, including headache, fever, and myalgia [ 1 , 3 , 4 ], thus making the clinical distinction between these highly different diseases increasingly difficult.…”

“…There has been an increasingly elevated rate of COVID-19 cases diagnosed in concordance with other primary systemic vasculitis or cases of polymyalgia rheumatica; however, there are few cases of GCA being seen in the context of an ongoing COVID-19 infection [ 3 , 4 ]. During the period of the COVID-19 pandemic, clinicians expressed significant diagnostic challenges since a COVID-19 infection can present with incredibly similar symptoms to GCA, including headache, fever, and myalgia [ 1 , 3 , 4 ], thus making the clinical distinction between these highly different diseases increasingly difficult. Herein, we present a case of a patient who developed intractable left-sided headache strongly suggestive of GCA following COVID-19 infection with high erythrocyte sedimentation rate (ESR) but negative temporal biopsy.…”