Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years

Abstract

Background. Age at onset of large-vessel vasculitis (LVV) is commonly used to distinguish giant cell arteritis (GCA) and Takayasu arteritis (TA). However, LVV between age 50 and 60 years may be difficult to classify. Methods.We conducted a retrospective study including LVV aged between 50 and 60 years at onset (LVV50-60, cases) and compared them to LVV aged over 60 years (LVV>60, controls).LVV was defined histologically and/or morphologically. Controls fulfilled ACR 1990 criteria for GCA or presented isolated aortitis.Results. We included 183 LVV50-60 and 183 gender-matched LVV>60. LVV50-60 had more frequent peripheral limb manifestations (23 vs. 5%), and less frequent cephalic (73 vs. 90%) and ocular signs (17 vs. 27%) than LVV>60. Compared to LVV>60, CT angiography and PET/CT scan were more frequently abnormal in LVV50-60 (74 vs. 38%, and 90 vs. 72%, respectively), with aorta being more frequently involved (78 vs. 47%). By multivariate analysis, absence of cephalic symptoms, presence of peripheral limb ischemia and aorta involvement, and increased CRP level were significantly associated with LVV50-60 presentation compared to LVV>60. At last follow-up, compared to LVV>60, LVV50-60 received significantly more lines of treatment (2 vs. 1), more frequent biologics (12 vs. 3%), had more surgery (10 vs. 0%), and had higher prednisone dose (8.8 vs. 6.5 mg/d) at last follow-up, Conclusion. LVV onset between 50 and 60 years identifies a subset of patients with more frequent aorta and peripheral vascular involvement and more refractory disease compared to patients with LVV onset after 60.

A French cohort of patients with giant cell arteritis: glucocorticoid treatment and its associated side effects

“…In our study, we evidenced that sustained GC-withdrawal was more frequent in patients with headaches. In addition, we observed a trend toward a prolonged treatment and a less curable disease in patients with aortitis, as was previously reported (27,28). Overall, these data suggest that subgroups with different outcomes might be identified in GCA, although additional data are required to support this hypothesis and better identify prognostic factors.…”

Impact of age at diagnosis in polymyalgia rheumatica: A retrospective cohort study of 218 patients

“…Primarily, we examined a relatively large sample of patients with isolated PMR (218 in total). The exclusion of patients with associated GCA at diagnosis precludes age-dependent presentations of GCA [9] confounding the data. In addition, multiple outcomes pertaining to disease severity (relapse likelihood and timing, maximal and cumulative doses of glucocorticoids, need for glucocorticoid-sparing agents, and total duration of glucocorticoid treatment) were recorded, to allow for the possibility that more aggressive treatment of younger patients masked a more severe presentation of the disease.…”

“…A minority of patients with isolated PMR subsequently develops GCA, which may occur years later and despite glucocorticoid therapy [22,23]. Patients diagnosed with GCA at a younger age appear to have a more severe clinical course, with a phenotype that includes predominantly large vessel involvement, a higher risk of aortic complications and more frequent need for intensification of immunosuppression, as compared to older patients who more often develop cranial disease [9]. Interestingly however, presence of PMR symptoms in patients with GCA does not differ based on age.…”

“…In other rheumatic diseases, including ANCA-associated vasculitis and rheumatoid arthritis, age may have a significant impact on the clinical phenotype, prognosis, or response to treatment [6][7][8]. Delaval et al recently conducted a retrospective study in GCA patients aged between 50 and 60 years at onset and compared them to GCA patients aged over 60 years [9], finding differences in presentation (predominantly large-vessel involvement versus cranial disease) and more refractory disease in younger patients.…”

Treatment of Giant Cell Arteritis (GCA)

“…It differs from the most recent recommendations established by US practitioners who advise a GCs-sparing agent in most patients and favour TCZ over MTX and other IS agents [ 14 ]. The youngest patients and those with large-vessel involvement may frequently experience relapse [ 4 , 8 , 59 , 60 ]. These patients who have clinical features overlapping with Takayasu arteritis may have some benefit from the initial prescription of GCs-sparing therapy at the time of diagnosis.…”