INCREASING INCIDENCE OF LARGE ARTERY MANIFESTATIONS IN PATIENTS WITH GIANT CELL ARTERITIS, A POPULATION-BASED COHORT OVER 70 YEARS
Authors: Mohanad Elfishawi et al.
Due to the rising use of imaging (PET-CT, MRI, CT-angiography) in the work-up of Giant Cell Arteritis (GCA), large vessel involvement in GCA is increasingly diagnosed. However, very little is known about evolution of large vessel vasculitis over time. This study aimed to investigate incidence trends and outcomes of large artery manifestations in a population-based cohort of patients with GCA over 70 years. Incident large artery manifestations were defined as aortic aneurysm, aortic dissection, stenosis in the aorta, or any of its main branches diagnosed within 1 year prior to the diagnosis of GCA or anytime afterward.
The cohort of 289 patients showed the classical characteristics of GCA: 77% females; mean age 76.4 years; TAB positive in 81%; mean ESR 75.1mm/hour. Mean follow up period was 10.4 ± 7 years. Incident large artery manifestations developed in 104 patients throughout the follow up period, most were found incidentally on imaging.
Cumulative incidence rates of large artery manifestations at 5/15 years were 7.3%/14.8%, 15.9%/30.2% and 27.2%/48.8% for patients diagnosed in 1950-1974, 1975-1999 and 2000-2016, respectively. Patients with GCA diagnosed in 2000-2016 and 1975-1999 had more than 3.5-fold and 2-fold increase in incidence of large artery manifestations (HR:3.49 95%CI 1.67-7.3 and HR: 1.98 95% CI 0.97–4.07, respectively) compared to 1950-1974. However, there was no significant increase in aortic aneurysm or dissection.
Clinical predictors for large artery manifestations included weight loss, fatigue, arm claudication, ever smoker and bruit on physical examination. On the other hand, cranial symptoms were negatively associated with large artery manifestations.
There is a desperate need for data about long-term evolution of large vessel vasculitis in order to propose clinical recommendations regarding monitoring. This study adds very substantial information regarding this issue. Remarkably, incidence of large artery manifestations (mainly large artery stenosis) has increased over time, likely due to more frequent use of imaging studies. The incidence of aortic aneurysm/dissection has not changed over the last 7 decades.