Symptomatic Aortitis at Giant Cell Arteritis Diagnosis: A Prognostic Factor of Aortic Event.

Espitia, O.; Blonz, Gautier; Urbanski, G.; Landron, C.; Connault, J.; Lavigne, Christian; Roblot, P.; Maillot, F.; Audemard, A.; Artifoni, Mathieu; Durant, C.; Guyomarch, Béatrice; Hamidou, M.; Magnant, Julie; Agard, C.

doi:10.21203/rs.3.rs-88107/v1

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…Median time to first relapse after diagnosis was 9 months, 4–17 with a mean dose of prednisone at first relapse of 10.9 (±11.7) mg/day. Median time to second relapse after diagnosis was 21.5 months [10–32.3] with a mean prednisone dose at second relapse of 5.8 (±5.6) mg/day.…”

Section: Resultsmentioning

confidence: 99%

“…3,4 In around 50% of cases in some series, and sometimes even higher, patients develop extracranial large vessel involvement (LV-GCA), leading to limb claudication, stroke, aortic aneurysm, dissection/rupture, or aortic insufficiency. 5–9 In GCA, relapses are frequent, occurring in at least 40% of cases, mostly during progressive steroids tapering, and at low doses (prednisone 5–15 mg/day). Thus, this leads to increased duration and cumulative doses of steroids, and to discuss steroid sparing treatments like tocilizumab and methotrexate.…”

Section: Introductionmentioning

confidence: 99%

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Large-vessel involvement is predictive of multiple relapses in giant cell arteritis

Mornac

Espitia

Néel

et al. 2021

Therapeutic Advances in Musculoskeletal

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Background: Giant cell arteritis (GCA) is the most common systemic vasculitis. Relapses are frequent. The aim of this study was to identify relapse risk factors in patients with GCA with complete large-vessel imaging at diagnosis. Methods: Patients with GCA followed in our institution between April 1998 and April 2018 were included retrospectively. We included only patients who had undergone large vascular imaging investigations at diagnosis by computed tomography (CT)-scan and/or positron emission tomography (PET)-scan and/or angio-magnetic resonance imaging (MRI). Clinical, biological, and radiological data were collected. Relapse was defined as the reappearance of GCA symptoms, with concomitant increase in inflammatory markers, requiring treatment adjustment. Relapsing patients (R) and non-relapsing patients (NR) were compared. Relapse and multiple relapses (>2) risk factors were identified in multivariable Cox analyses. Results: This study included 254 patients (73.2% women), with a median age of 72 years at diagnosis and a median follow up of 32.5 months. At diagnosis, 160 patients (63%) had an inflammatory large-vessel involvement on imaging, 46.1% (117 patients) relapsed at least once, and 21.3% (54 patients) had multiple relapses. The median delay of first relapse after diagnosis was 9 months. The second relapse delay was 21.5 months. NR patients had more stroke at diagnosis than R ( p = 0.03) and the brachiocephalic trunk was involved more frequently on CT-scan ( p = 0.046), as carotids ( p = 0.02) in R patients. Multivariate Cox model identified male gender [hazard ratio (HR): 0.51, confidence interval (CI) (0.27–0.96), p = 0.04] as a relapse protective factor, and peripheral musculoskeletal manifestations [HR: 1.74 (1.03–2.94), p = 0.004] as a relapse risk factor. Peripheral musculoskeletal manifestations [HR: 2.78 (1.23–6.28), p = 0.014], negative temporal artery biopsy [HR: 2.29 (1.18–4.45), p = 0.015], large-vessel involvement like upper limb ischemia [HR: 8.84 (2.48–31.56), p = 0.001] and inflammation of arm arteries on CT-scan [HR: 2.39 (1.02–5.58), p = 0.04] at diagnosis were risk factors of multiple relapses. Conclusion: Male gender was a protective factor for GCA relapse and peripheral musculoskeletal manifestations appeared as a relapsing risk factor. Moreover, this study identified a particular clinical phenotype of multi-relapsing patients with GCA, characterized by peripheral musculoskeletal manifestations, negative temporal artery biopsy, and large-vessel involvement with upper limb ischemia or inflammation of arm arteries. Plain language Summary At giant cell arteritis diagnosis, large-vessel inflammatory involvement is predictive of multiple relapses 46.1% of patients with GCA relapse, and 21.3% undergo multiple relapses; Male gender appears as a protective factor for relapsing in GCA; Peripheral musculoskeletal manifestations are a relapse and multiple relapses risk factor; A negative temporal artery biopsy is predictive of multiple relapses; Large-vessel involvement is predictive of multiple relapses.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Large-vessel involvement is predictive of multiple relapses in giant cell arteritis

Mornac

Espitia

Néel

et al. 2021

Therapeutic Advances in Musculoskeletal

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“…Moreover, aortic dissection, which is one complication of these aneurysms, is associated with an increased mortality. 7 , 8 Very few and controversial studies have been conducted so far trying to identify predictive factors of large-artery complications in GCA patients. 7 , 9 – 11 …”

Section: Introductionmentioning

confidence: 99%

“…7,8 Very few and controversial studies have been conducted so far trying to identify predictive factors of large-artery complications in GCA patients. 7,9–11…”

Section: Introductionmentioning

confidence: 99%

Risk factors for symptomatic vascular events in giant cell arteritis: a study of 254 patients with large-vessel imaging at diagnosis

Mornac

Agard

Hardouin

et al. 2021

Therapeutic Advances in Musculoskeletal

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Aims: To identify factors associated with vascular events in patients with giant cell arteritis (GCA). Methods: We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Symptomatic vascular events were defined as the occurrence of any aortic event (aortic dissection or symptomatic aortic aneurysm), stroke, myocardial infarction, limb or mesenteric ischemia and de novo lower limbs arteritis stage 3 or 4. Patients with symptomatic vascular event (VE+) and without were compared, and risk factors were identified in a multivariable analysis. Results: Thirty-nine (15.4%) of the 254 included patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were more frequent in VE+ patients ( p < 0.05), as an abnormal computed tomography (CT)-scan at diagnosis ( p = 0.04), aortitis ( p = 0.01), particularly of the descending thoracic aorta ( p = 0.03) and atheroma ( p = 0.03). Deaths were more frequent in the VE+ group (37.1 versus 10.3%, p = 0.0003). In multivariable analysis, aortic surgery [hazard ratio (HR): 10.46 (1.41–77.80), p = 0.02], stroke [HR: 22.32 (3.69–135.05), p < 0.001], upper limb ischemia [HR: 20.27 (2.05–200.12), p = 0.01], lower limb ischemia [HR: 76.57 (2.89–2027.69), p = 0.009], aortic atheroma [HR: 3.06 (1.06–8.82), p = 0.04] and aortitis of the descending thoracic aorta on CT-scan at diagnosis [HR: 4.64 (1.56–13.75), p = 0.006] were independent predictive factors of a vascular event. Conclusion: In this study on GCA cases with large vessels imaging at diagnosis, aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event. Plain language summary Risk factors for symptomatic vascular events in giant cell arteritis This study was performed to identify the risk factors for developing symptomatic vascular event during giant cell arteritis (GCA) because these are poorly known. We performed a retrospective study of GCA patients diagnosed over a 20-year-period, who all underwent vascular imaging evaluation at diagnosis. Patients with symptomatic vascular event (VE+) and without (VE-) were compared, and risk factors were identified in a multivariable analysis. Thirty-nine patients experienced at least one symptomatic vascular event during follow-up, with a median time of 21.5 months. Arterial hypertension, diabetes, lower limbs arteritis or vascular complication at diagnosis were significantly more frequent in VE+ patients, as an abnormal CT-scan at diagnosis, aortitis, particularly of the descending thoracic aorta and atheroma. Deaths were more frequent in the VE+ group. Among 254 GCA patients, 39 experienced at least one vascular event during follow-up. Aortic surgery, stroke, upper and lower limb ischemia were vascular event risk factors. Aortic atheroma and descending thoracic aorta aortitis on CT-scan were vascular event risk factors. This study on GCA cases with large vessels imaging at diagnosis, showed that aortic surgery, stroke, upper or lower limb ischemia, aortic atheroma and aortitis of the descending thoracic aorta on CT-scan, at GCA diagnosis, were independent predictive factors of a vascular event.

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“…4 Serious complications of visual loss and extra-cranial arterial manifestations such as aortic aneurysms can also occur. 4,5 Sensorineural hearing loss (SNHL) represents an atypical presentation of GCA, with only a few documented case reports. This case illustrates a debilitating presentation of GCA and highlights GCA as an important differential in the consideration of SNHL.…”

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confidence: 99%

A Giant Silence – An atypical association of sensorineural hearing loss with Giant Cell Arteritis

Shi

Malik

2022

Int J of Rheum Dis

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Giant cell arteritis (GCA) is a chronic vasculitic disorder predominantly affecting medium to large sized arteries. It is the most common systemic arteritis in European and American populations, with a prevalence of 0.2% in those aged over 50 years. 1 Aging is the biggest risk factor with individuals >50 years old predominantly affected, with peak incidence at age 70-80 years. 2 Other risk factors include Scandinavian ethnicity, female gender, family history and polymyalgia rheumatica. 3 The classic symptoms of presentation include acute to subacute onset of headache, jaw claudication, scalp tenderness and constitutional symptoms. 4 Serious complications of visual loss and extra-cranial arterial manifestations such as aortic aneurysms can also occur. 4,5 Sensorineural hearing loss (SNHL) represents an atypical presentation of GCA, with only a few documented case reports. This case illustrates a debilitating presentation of GCA and highlights GCA as an important differential in the consideration of SNHL.

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Symptomatic Aortitis at Giant Cell Arteritis Diagnosis: A Prognostic Factor of Aortic Event.

Cited by 4 publications

References 16 publications

Large-vessel involvement is predictive of multiple relapses in giant cell arteritis

Large-vessel involvement is predictive of multiple relapses in giant cell arteritis

Risk factors for symptomatic vascular events in giant cell arteritis: a study of 254 patients with large-vessel imaging at diagnosis

A Giant Silence – An atypical association of sensorineural hearing loss with Giant Cell Arteritis

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