Large‐Vessel Dilatation in Giant Cell Arteritis: A Different Subset of Disease?

Muratore, Francesco; Kermani, Tanaz A.; Crowson, Cynthia S.; Koster, Matthew J.; Matteson, Eric L.; Salvarani, Carlo; Warrington, Kenneth J.

doi:10.1002/acr.23498

Cited by 29 publications

(18 citation statements)

References 17 publications

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“…Differential treatment response and discrepancy of the results in each cohort may be influenced by the definition of clinical remission and relapse, prevalence of LVLs, and severity of LVLs at baseline. CRP elevation without clinical signs and symptoms was not a reliable indicator of relapse of cranial lesions and PMR [42], while clinical signs and symptoms of active GCA were not necessarily observed in patients with progression of LVLs [22,36,[43][44][45][46]. Active LVLs of GCA without clinical signs and symptoms were demonstrated by PET-CT [47,48].…”

Section: Discussionmentioning

confidence: 99%

Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions

et al. 2020

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Background: Relapses frequently occur in giant cell arteritis (GCA), and long-term glucocorticoid therapy is required. The identification of associated factors with poor treatment outcomes is important to decide the treatment algorithm of GCA. Methods: We enrolled 139 newly diagnosed GCA patients treated with glucocorticoids between 2007 and 2014 in a retrospective, multi-center registry. Patients were diagnosed with temporal artery biopsy, 1990 American College of Rheumatology classification criteria, or large vessel lesions (LVLs) detected by imaging based on the modified classification criteria. Poor treatment outcomes (non-achievement of clinical remission by week 24 or relapse during 52 weeks) were evaluated. Clinical remission was defined as the absence of clinical signs and symptoms in cranial and large vessel areas, polymyalgia rheumatica (PMR), and elevation of C-reactive protein (CRP) levels. A patient was determined to have a relapse if he/she had either one of the signs and symptoms that newly appeared or worsened after achieving clinical remission. Re-elevation of CRP without clinical manifestations was considered as a relapse if other causes such as infection were excluded and the treatment was intensified. Associated factors with poor treatment outcomes were analyzed by using the Cox proportional hazard model.

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Section: Discussionmentioning

confidence: 99%

Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions

et al. 2020

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“…Aortic inflammation may eventually lead to the development of aortic aneurysms and dissection in patients with GCA . Little is known about the factors predictive of these late complications in GCA, although a recent study indicated that subclavian artery dilatation at diagnosis is associated with a higher risk of aortic aneurysms in GCA patients .…”

Section: Evidence For Distinct Gca Subsets Based On Clinical Featuresmentioning

confidence: 99%

Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?

Geest

Sandovici

Sleen

et al. 2018

Arthritis & Rheumatology

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Giant cell arteritis (GCA) is an autoimmune vasculitis affecting large and medium‐sized arteries. Ample evidence indicates that GCA is a heterogeneous disease in terms of symptoms, immune pathology, and response to treatment. In the current review, we discuss the evidence for disease subsets in GCA. We describe clinical and immunologic characteristics that may impact the risk of cranial ischemic symptoms, relapse rates, and long‐term glucocorticoid requirements in patients with GCA. In addition, we discuss both proven and putative immunologic targets for therapy in patients with GCA who have an unfavorable prognosis. Finally, we provide recommendations for further research on disease subsets in GCA.

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“…Previous studies demonstrated that aneurysm formation slowly developed in LVLs detected at baseline by imaging (19,35,41). However, clinical signs and symptoms of active GCA were not necessarily observed in patients with progression of LVLs (19,34,(41)(42)(43)(44). Active LVLs of GCA without clinical signs and symptoms were demonstrated by PET-CT (45,46).…”

Section: Discussionmentioning

confidence: 99%

Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions

Sugihara

Hasegawa

Uchida

et al. 2020

Preprint

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Background: Relapses frequently occur in giant cell arteritis (GCA) patients treated with conventional immunosuppressive therapy, and identification of associated factors with poor treatment outcomes is relevant to adjust treatment appropriately. Methods: We enrolled 139 newly-diagnosed GCA patients treated with glucocorticoids between 2007 and 2014 in a retrospective, multi-center registry. Patients were diagnosed as having GCA with temporal artery biopsy, large-vessel lesions (LVLs) detected by imaging, 1990 American College of Rheumatology classification criteria, or combination of these. Poor treatment outcomes (non-achievement of clinical remission by week 24 or relapse during 52 weeks) were evaluated. Clinical remission was defined as absence of clinical signs and symptoms in cranial and large-vessel areas, polymyalgia rheumatica (PMR), and elevation of C-reactive protein (CRP) levels. A patient was determined to have relapse if he/she had either one of the signs and symptoms that newly appeared or worsened after achieving clinical remission. Re-elevation of CRP without clinical manifestations was considered as relapse if other causes such as infection were excluded and the treatment was intensified. Associated factors with poor treatment outcomes were analyzed by using the Cox proportional hazard model.Results: Cranial lesions, PMR, and LVLs were detected in 77.7%, 41.7%, and 52.5% of the enrolled patients, respectively. Treatment outcomes were evaluated in 119 newly-diagnosed patients who were observed for 24 weeks or longer. The mean initial dose of prednisolone was 0.76 mg/kg/day, and 29.4% received any concomitant immunosuppressive drugs at baseline. Overall, 41 (34.5%) of the 119 patients had poor treatment outcomes; 13 did not achieve clinical remission by week 24, and 28 had relapse after achieving clinical remission. Cumulative rates of the events of poor treatment outcomes in patients with and without LVLs were 47.5 % and 17.7%, respectively. A multivariable model showed the presence of LVLs at baseline was significantly associated with poor treatment outcomes (adjusted hazard ratio [HR] 3.54, 95% CI 1.52-8.24, p=0.003). Cranial lesions and PMR did not increase the risk of poor treatment outcomes. Conclusion: Presence of LVLs detected by imaging at baseline was an associated factor for poor treatment outcomes in patients given conventional immunosuppressive therapy without biologics.

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Large‐Vessel Dilatation in Giant Cell Arteritis: A Different Subset of Disease?

Abstract: Two different subsets of LV-GCA were identified. Given the strong association between subclavian artery dilatation and aortic aneurysm, such patients should be evaluated and monitored carefully for aortic dilatation.

Cited by 29 publications

References 17 publications

Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions

Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions

Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?

Associated factors of poor treatment outcomes in patients with giant cell arteritis: clinical implication of large vessel lesions

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