Supplement Article |
OP24. LARGE VESSEL INVOLVEMENT IN GIANT CELL ARTERITIS: INCIDENCE, PREDICTORS, AND MORTALITY
Mayo Clinic, Rochester, Minnesota, USA
Objective: Large artery involvement may be a catastrophic complication of giant cell arteritis (GCA), but its epidemiology is poorly understood. We examined the incidence and predictors, and influence on mortality, of large-artery involvement (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with GCA.
Methods: Retrospective population based study of all Olmsted County, Minnesota, residents diagnosed with GCA between 01/01/1950 and 12/31/1999 (n = 168), with up to 50 years of follow-up.
Results: There were 46 incident cases (27%) of large-artery involvement. These included 30 incident cases (18%) of either aortic aneurysm and/or aortic dissection. Of these, 18 (11%) involved the thoracic aorta, 9 of which (5%) developed aortic dissection. There were 21 incident cases (13%) of large-artery stenosis. Fifteen (9%) had incident cervical artery stenosis and 6 (4%) had incident subclavian/axillary/brachial artery stenosis. One patient (0.6%) had incident iliac and femoral artery stenosis due to GCA.
Hyperlipidemia and coronary artery disease were associated with aortic aneurysm and/or dissection (p<0.05 for both). Cranial symptoms (headache, scalp tenderness, abnormal temporal arteries) [hazard ratio 0.10 {95% CI 0.03–0.35; p<0.0005}] and a higher sedimentation rate [hazard ratio 0.80 {95% CI 0.67–0.95; p<0.05}] were protective of large-artery stenosis.
There was no difference in survival between the total group of patients with any type of large-artery complication and those without large-artery findings, or compared with the general population. However, patients who developed thoracic aortic dissection (N = 9) had a markedly increased mortality compared with all other patients with GCA (p<0.001), with a median survival of 1.1 years (IQ-range 0.2–7.8 years). For the group with either aortic aneurysm and/or dissection (thoracic and/or abdominal aorta), there was no difference in survival compared with the group with GCA without large-artery complication. Survival of patients with GCA and large-artery stenosis was not different from that of those with GCA without large-artery complications.
Conclusions: Large-artery involvement is common in GCA. The protective effect of cranial symptoms and of a higher sedimentation for large-artery stenosis may be explained by earlier appropriate therapy with glucocorticosteroids of patients presenting with these findings. Overall, the mortality in the whole group of patients with GCA with large-artery complications was similar to that observed in patients with GCA without large-artery complications. However, thoracic aortic dissection in GCA is associated with a markedly increased mortality. Increased awareness of large-artery involvement in GCA, particularly its association with rather early occurring aortic dissection, may decrease associated morbidity and mortality.