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Comparative Study
. 2015 Mar;54(3):463-70.
doi: 10.1093/rheumatology/keu329. Epub 2014 Sep 5.

Large-vessel giant cell arteritis: a cohort study

Francesco Muratore  1 , Tanaz A Kermani  1 , Cynthia S Crowson  2 , Abigail B Green  1 , Carlo Salvarani  1 , Eric L Matteson  2 , Kenneth J Warrington  3
Affiliations
Comparative Study

Large-vessel giant cell arteritis: a cohort study

Francesco Muratore et al. Rheumatology (Oxford). 2015 Mar.

Abstract

Objective: The aim of this study was to compare baseline variables, treatment and outcomes in patients with large-vessel GCA (LV-GCA), primarily of the upper extremities, with those with cranial disease (C-GCA).

Methods: All patients >50 years of age with radiographic evidence of subclavian LV-GCA diagnosed between 1 January 1999 and 31 December 2008 were identified and compared with those with biopsy-positive C-GCA diagnosed in the same period.

Results: The study included 120 LV-GCA patients and 212 C-GCA patients. Compared with C-GCA, patients with LV-GCA were younger [68.2 years (s.d. 7.5) vs 75.7 (7.4), P < 0.001] and had longer duration of symptoms at GCA diagnosis (median 3.5 vs 2.2 months, P < 0.001). A history of PMR was more common in LV-GCA patients (26% vs 15%, P = 0.012), but a smaller proportion had cranial symptoms (41% vs 83%, P < 0.001) and vision loss (4% vs 11%, P = 0.035). ACR classification criteria for GCA were satisfied in 39% of LV-GCA patients and 95% of C-GCA patients (P < 0.001). Compared with C-GCA, patients with LV-GCA had more relapses (4.9 vs 3.0/10 person-years, P < 0.001), higher cumulative corticosteroid (CS) doses at 1 year [11.4 g (s.d. 5.9) vs 9.1 (s.d. 3.7), P < 0.001] and required longer treatment (median 4.5 vs 2.2 years, P < 0.001).

Conclusion: Although patients with LV-GCA had a lower rate of vision loss, they had a higher relapse rate and greater CS requirements. The ACR criteria for GCA are inadequate for the classification of patients with LV-GCA.

Keywords: giant cell arteritis; imaging; large-vessel vasculitis; prognosis; treatment.

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Figures

F<sc>ig</sc>. 1
Fig. 1
Percentage of patients with at least one relapse by disease duration in patients with LV-GCA and C-GCA Log-rank P-value = 0.006. C-GCA: cranial GCA; LV-GCA: large-vessel GCA.
F<sc>ig</sc>. 2
Fig. 2
Percentage of patients who discontinued steroids for at least 6 months by disease duration in patients with LV-GCA and C-GCA Log-rank P-value = 0.023. C-GCA: cranial GCA; LV-GCA: large-vessel GCA.
See this image and copyright information in PMC

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