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Multicenter Study
. 2019 Jul;18(7):714-720.
doi: 10.1016/j.autrev.2019.05.008. Epub 2019 May 4.

Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years

Laure Delaval  1 , Aurélie Daumas  2 , Maxime Samson  3 , Mikael Ebbo  2 , Hubert De Boysson  4 , Eric Liozon  5 , Henry Dupuy  6 , Mathieu Puyade  7 , Daniel Blockmans  8 , Ygal Benhamou  9 , Karim Sacré  10 , Alice Berezne  11 , Hervé Devilliers  12 , Grégory Pugnet  13 , François Maurier  14 , Thierry Zénone  15 , Claire de Moreuil  16 , François Lifermann  17 , Laurent Arnaud  18 , Olivier Espitia  19 , Alban Deroux  20 , Vincent Grobost  21 , Estibaliz Lazaro  6 , Christian Agard  19 , Alexandre Balageas  22 , Kevin Bouiller  23 , Cécile-Audrey Durel  24 , Sébastien Humbert  23 , Virginie Rieu  21 , Mélanie Roriz  25 , Odile Souchaud-Debouverie  7 , Stéphane Vinzio  26 , Yann Nguyen  1 , Alexis Régent  1 , Loïc Guillevin  1 , Benjamin Terrier  27
Affiliations
Multicenter Study

Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years

Laure Delaval et al. Autoimmun Rev. 2019 Jul.

Abstract

Background: Age at onset of large-vessel vasculitis (LVV) is commonly used to distinguish giant cell arteritis (GCA) and Takayasu arteritis (TA). However, LVV between age 50 and 60 years may be difficult to classify.

Methods: We conducted a retrospective study including LVV aged between 50 and 60 years at onset (LVV50-60, cases) and compared them to LVV aged over 60 years (LVV>60, controls). LVV was defined histologically and/or morphologically. Controls fulfilled ACR 1990 criteria for GCA or presented isolated aortitis.

Results: We included 183 LVV50-60 and 183 gender-matched LVV>60. LVV50-60 had more frequent peripheral limb manifestations (23 vs. 5%), and less frequent cephalic (73 vs. 90%) and ocular signs (17 vs. 27%) than LVV>60. Compared to LVV>60, CT angiography and PET/CT scan were more frequently abnormal in LVV50-60 (74 vs. 38%, and 90 vs. 72%, respectively), with aorta being more frequently involved (78 vs. 47%). By multivariate analysis, absence of cephalic symptoms, presence of peripheral limb ischemia and aorta involvement, and increased CRP level were significantly associated with LVV50-60 presentation compared to LVV>60. At last follow-up, compared to LVV>60, LVV50-60 received significantly more lines of treatment (2 vs. 1), more frequent biologics (12 vs. 3%), had more surgery (10 vs. 0%), and had higher prednisone dose (8.8 vs. 6.5 mg/d) at last follow-up, CONCLUSION: LVV onset between 50 and 60 years identifies a subset of patients with more frequent aorta and peripheral vascular involvement and more refractory disease compared to patients with LVV onset after 60.

Keywords: Giant cell arteritis; Large-vessel vasculitis; Outcome measures; Refractory disease; Takayasu arteritis.

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