Giant cell arteritis and mortality

Abstract

Background: Giant cell arteritis (GCA) is a systemic vasculitis of elderly individuals associated with significant morbidity, including blindness, stroke, and myocardial infarction. Previous studies have investigated whether GCA is associated with increased mortality, with conflicting results. The objective of this study is to determine whether GCA, is associated with increased mortality.

Methods: Forty-four cases with GCA were identified from the University of Utah Health Sciences Center, the major tertiary care center for the Intermountain West. The Utah Population Database, a unique biomedical information resource, selected cases and age- and gender-matched controls. Cases were defined as patients with a temporal artery biopsy-proven diagnosis of GCA (international classification of diseases [ICD]-9 code 446.5) between 1991 and 2005. Exclusion criteria included a negative biopsy, alternative diagnoses, or insufficient clinical data. For each of the 44 cases, 100 controls were identified; thus, 4,400 controls were included in the data analysis. Median survival time and 5-year cumulative survival were measured for cases and controls.

Results: The median survival time for the 44 GCA cases was 1,357 days (3.71 years) after diagnosis compared with 3,044 days (8.34 years) for the 4,400 controls (p = 0.04). Five-year cumulative survival was 67% for the control group versus 35% for the cases (p < .001). Survival rates for cases and controls converged at approximately 11.12 years.

Conclusions: Patients with GCA were more likely than age- and gender-matched controls to die within the first 5 years following diagnosis.

Figure 1.

Kaplan-Meier analysis to compare the cumulative survival curves of 44 biopsy-proven giant cell arteritis (GCA) patients (dashed line) to 4,400 controls (solid line). One-hundred controls were randomly selected for each of the 44 GCA patients after being matched by birth year and gender. The 5-year survival of GCA patients is significantly reduced compared with that of the control group (p < .001).