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Review
. 2023 Jun;22(6):103341.
doi: 10.1016/j.autrev.2023.103341. Epub 2023 Apr 14.

Increased incidence of giant cell arteritis and associated stroke during the COVID-19 pandemic in Spain: A nation-wide population study

Víctor Moreno-Torres  1 , Vicente Soriano  2 , Jorge Calderón-Parra  3 , María Martínez-Urbistondo  4 , Ana Treviño  2 , Zayrho de San Vicente  5 , Carmen de Mendoza  6 , Guillermo Ruiz-Irastorza  7
Affiliations
Review

Increased incidence of giant cell arteritis and associated stroke during the COVID-19 pandemic in Spain: A nation-wide population study

Víctor Moreno-Torres et al. Autoimmun Rev. 2023 Jun.

Abstract

Introduction: SARS-CoV-2 infection and COVID-19 vaccines might have increased the incidence of giant-cell arteritis (GCA) and the risk of associated stroke in Spain.

Methods: Retrospective nation-wide observational analysis of all adults hospitalized with GCA in Spain during 5 years (Jan-2016 and Dec-2021). The incidence and proportion of admissions with or because of GCA and GCA-associated stroke were compared between pre-pandemic (2016-2019) and pandemic (2020 and 2021) years. Sensitivity analyses were conducted for the different COVID-19 waves and vaccine timing schedules.

Results: A total of 17,268 hospital admissions in patients diagnosed with GCA were identified. During 2020 there were 79.3 and 8.1 per 100,000 admissions of GCA and GCA-associated stroke, respectively. During 2021 these figures were 80.8 and 7.7 per 100,00 admissions, respectively. As comparison, yearly admissions due to GCA and GCA-associated stroke were 72.4 and 5.7 per 100,00, respectively, during the pre-pandemic period (p < 0.05). Coincident with the third wave of COVID-19 (and first vaccine dosing), the rate of GCA-associated stroke admissions increased significantly (from 6.7 to 12%; p < 0.001). Likewise, there was an increase in GCA-associated stroke (6.6% vs 4.1%, p = 0.016) coincident with the third dose vaccination (booster) in patients older than 70 at the end of 2021. In multivariate analysis, only patients admitted during the third COVID-19 wave (and first vaccine dosing) (OR = 1.89, 95% CI 1.22-2.93), and during the third vaccination dosing in patients older than 70 (booster) (OR = 1.66, CI 1.11-2.49), presented a higher GCA-associated stroke risk than the same months of previous years after adjustment by age, sex, classical cardiovascular risk factors and COVID-19 diagnosis.

Conclusions: The COVID-19 pandemic led to an increased incidence of GCA during 2020 and 2021. Moreover, the risk of associated stroke significantly risen accompanying times of COVID-19 vaccine dosing, hypothetically linked to an increased thrombotic risk of mRNA-SARS-CoV-2 vaccines. Hence, forthcoming vaccine policies and indications must weigh the risk of severe COVID-19 with the risk of flare or stroke in patients with GCA.

Keywords: COVID-19; Giant cell arteritis; SARS-CoV-2 vaccine; Stroke.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Victor Moreno-Torres reports financial support was provided by Academia Médico-Quirúrgica Española. Guillermo Ruiz-Irastorza reports financial support was provided by Department of Education of the Basque Government.

Figures

Fig. 1
Fig. 1
Incidence of GCA and GCA-associated stroke in Spain during the COVID-19 pandemic in Spain. Footnote: The figure represents the monthly incidence of GCA (A) and GCA-associated stroke (B) admissions during the COVID-19 pandemic in Spain. Incidence is expressed by 100,000 annual national admissions.
Fig. 2
Fig. 2
Factors related to GCA-associated stroke during the COVID-19 pandemic in Spain. Footnote: The figure represents the binary logistic regression analysis to determine factors related to GCA-associated stroke risk during the pandemic, including the seven periods of the COVID-19 pandemic. For adjustment, age, male sex, baseline CRF and COVID-19 diagnosis during admission were considered.
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