Epidemiological and clinical features of giant cell arteritis in Tunisia

Headache as the most common manifestation of giant cell arteritis?: a systematic review with meta-analysis

OBJECTIVE

This study aimed to assess the relative frequency of clinical features of giant cell arteritis (GCA) and to investigate the predictors of temporal artery biopsy (TAB) outcomes.

METHODS

A literature search of Pubmed/Medline, Embase, ScienceDirect, Scopus, Web of Science (WoS), and Directory of Open Access journals (DOAJ) was conducted from January 1, 1990 to February 2025. Observational studies that reported original data on clinical features in patients diagnosed with GCA in accordance with 1990 ACR and/or 2022 ACR/EULAR classification criteria were deemed for inclusion. A random-effects meta-analysis was performed to determine the pooled prevalence estimates. The study's design adhered closely to the MOOSE standards. The JBI appraisal tool was used to evaluate the risk of bias. The study's protocol was pre-registered on PROSPERO (ID: CRD42024584763).

RESULTS

Out of initial 12,628 records, 62 articles (9971 patients) met all of the eligibility criteria. Mean patients' age upon diagnosis was 74.33 years (95%CI: 74.12-74.54 years). The most prevalent clinical feature of GCA was new-onset headache (75.7%; 95CI%: 72.2-79.0; 95%PI: 0.47-0.92). Other common symptoms of GCA were temporal artery abnormalities (51.5%; 95%CI: 45.2-57.7; 95%PI: 0.25-0.77), weakness/malaise (46.7%; 95%CI: 35.4-58.4; 95%PI: 0.09-0.88), and scalp tenderness (39.1; 95%CI: 35.3-43.1; 95%PI: 0.22-0.59). Positive TAB results were present in 73.8% of patients (95%CI: 68.1-78.8%; 95%PI: 0.35-0.94). The presence of headache (LogOR = -1.11; 95%CI: -1.92 to -0.29) or PMR (-0.71; 95%CI: -1.09 to -0.32) significantly decreases the chance of receiving positive TAB results.

CONCLUSIONS

Since there is a greater likelihood of obtaining negative biopsy results, the TAB may not be required when a patient exhibits a headache along with other clinical symptoms that enable them to be diagnosed with GCA.

Epidemiology of large vasculitis in Shanghai, China: A 10-year multicenter hospital-based study and systematic review

BACKGROUND

Takayasu arteritis (TAK) and giant cell arteritis (GCA) are two major large vessel vasculitis, with varied epidemiology by geographical location, age, and race. However, the epidemiological data in Chinese population is rarely reported. This study estimated the epidemiology of TAK and GCA in Shanghainese individuals residing in China over a 10-year period.

METHODS

TAK data for individuals over 16 years and GCA data for individuals over 50 years were retrieved from 38 comprehensive hospitals in Shanghai, China through the electronic medical record systems between January 1, 2011, and December 31, 2020. A systematic literature review was performed to determine the global distribution of TAK and GCA by searching PubMed, Ovid-Medline, Excerpta Medica Database (EMBASE), and Web of Science.

RESULTS

In 173 identified TAK cases (67% females; mean age, 46 ± 15 years), the period prevalence was 11.72 cases per million, and the mean annual incidence was 1.33 cases per million. The highest prevalence (17.74 cases per million) and incidence (1.71 cases per million) were observed in the 16- to 34-year-old age group. In 92 identified GCA cases (56% females; age, >50 years), the period prevalence was 2.73 cases per 100 000 persons, and the mean annual incidence was 1.91 cases per 100 000 persons. Meta-analysis of the incidence study of TAK and GCA showed that the pooled incidence rate of TAK and GCA was 1.29 per million and 15.48 per 100 000 person-years, respectively. Subgroup analysis showed that the incidence of TAK was significantly higher in Asia than in other regions, while the incidence of GCA was higher in Europe, especially North Europe.

CONCLUSION

The epidemiological patterns of TAK and GCA were comprehensively mapped globally and locally, in Shanghai, China.

Giant cell arteritis: insights from a monocentric retrospective cohort study

Giant cell arteritis (GCA), more common in Northern European populations, has limited data in Arabcountries. Our study reports GCA's clinical manifestations in Jordan and reviews published research on GCA across Arab nations. In this retrospective analysis, GCA patients diagnosed from January 2007 to March 2019 at a Jordanian academic medical center were included through referrals for temporal artery biopsy (TAB). A comprehensive search in PubMed, Scopus, and the DOAJ (Directory of Open Access Journals) databases was conducted to identify all relevant English-language manuscripts from Arab countries on GCA without time limitations. Among 59 diagnosed GCA patients, 41 (69.5%) were clinically diagnosed with a negative TAB, and 19 (30.5%) had a positive result. Females comprised 74.6% (n = 44) with 1:3 male-female ratio. The mean age at diagnosis was 67.3 (± 9.5) years, with most presenting within two weeks (n = 40, 67.8%). Headache was reported by 54 patients (91.5%). Elevated ESR occurred in 51 patients (78%), with a mean of 81 ± 32.2 mm/hr. All received glucocorticoids for 13.1 ± 10 months. Azathioprine, Methotrexate, and Tocilizumab usage was 15.3% (n = 9), 8.5% (n = 5), and 3.4% (n = 2), respectively. Remission was observed in 57.6% (n=34), and 40.7% (n = 24) had a chronic clinical course on treatment. Males had higher biopsy-based diagnoses (p = .008), and biopsy-diagnosed patients were older (p = .043). The literature search yielded only 20 manuscripts originating in the Arab world. The predominant study types included case reports and retrospective analyses, with only one case series and onecase-control study.

Race and Gender on the Mortality of Giant Cell Arteritis in Hospitalized Patients: A 15-Year National Inpatient Study

BACKGROUND

Critical appraisal of mortality in giant cell arteritis (GCA) through a racial lens is imperative as gender and racial disparities remain a global healthcare concern.

OBJECTIVE

To analyze the impact of race and gender on the mortality of GCA in United States (US)-hospitalized patients.

METHODS

In this retrospective cohort study, the National Inpatient Sample (NIS) database from January 2003 to December 2018 was searched to identify all patients aged >18 years hospitalized with giant cell arteritis. Patients' baseline characteristics were summarized using descriptive statistics. Inferential statistics were done for categorical and continuous variables. Multivariate logistic regression, adjusting for patient and hospital-level cofounders was performed to find an association between race and outcomes of interest.

RESULTS

Over the 15-year study period, a total of 8,352 patients (72.7% White, 14.5% Black or African American, 7.6% Hispanic, 2.2% Asian, 0.4% Alaska Native, and 2.6% under-represented populations) were hospitalized for GCA. The mean age at diagnosis was 73.6 ± 0.12 years. Women represented 71.9% of GCA patients and had a lower risk of mortality (OR 0.463, 95% CI: 0.235 - 0.912, p <0.05). Patients with GCA were hospitalized for an average of 4.64 days ± 0.04 days and 0.55% died. The mortality rate was lowest in Black or African American (0.1%) populations and highest among Alaska Native patients (8%). Mortality was 68% lower in those who had temporal artery biopsy (OR 0.32, 95% CI: 0.16-0.64, p <0.05).

CONCLUSION

GCA disproportionally affected female patients, but mortality was higher in male patients. Alaska Native patients had the least number of hospitalizations but the highest in-hospital mortality rate. Black or African Americans had the lowest mortality rate.

Choroidal ischemia as one cardinal sign in giant cell arteritis

Purpose

To describe chorioretinal signs in a case series of Giant Cell Arteritis (GCA).

Methods

This is a multicenter retrospective observational case series with GCA that presented with a headache and an abrupt, unilateral loss in vision. Workup included temporal artery biopsies, intravenous fluorescein angiography, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), blood levels of erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

Results

There are a total of 8 GCA instances presented. Average age was 74.5. (Range 68–83 years). The patients reported that one eye's visual loss had suddenly started, along with a fresh headache and other systemic symptoms. Eight patients exhibited choroidal ischemia, five paracentral acute middle maculopathy (PAMM) lesions, five cotton wool spots, four anterior ischemic optic neuropathy, and one central retinal arterial occlusion at the time of presentation. The average ESR at presentation was 68 mm/hr (range 4–110), and 4/6 individuals had a significant increase. The mean CRP level was 6.2 mg/dL (range 2.0–15.4), and the level was always over the normal range. All patients' temporal artery biopsies were positive.

Conclusion

Alongside PAMM lesions, cotton wool spots, anterior ischemic optic neuropathy, and central retinal artery occlusion, choroidal ischemia is a key angiographic indicator in the diagnosis of GCA. It may be crucial to recognize these typical ischemic chorioretinal signs while diagnosing GCA.

Incidence of giant cell arteritis in six districts of Paris, France (2015-2017)

This prospective population-based study estimated the incidence of giant cell arteritis (GCA) in northeastern Paris. GCA cases diagnosed between 2015 and 2017 were obtained from local hospital and community-based physicians and the national health insurance system database. Criteria for inclusion were living in the study area at that time and fulfilling the 1990 American College of Rheumatology classification criteria and/or its expanded version. Cranial and large-vessel GCA cases were defined by the presence or absence of cranial signs and/or symptoms, respectively. Annual incidence was calculated by dividing the number of incident cases by the size of the study population ≥ 50 years old. Completeness of case ascertainment was assessed by a three-source capture-recapture analysis. Among the 62 included cases, 42 (68%) were women, mean (± SD) age 77.3 ± 9.1 years. The annual incidence of GCA in northeastern Paris and completeness of case ascertainment were estimated at 7.6 (95% CI 5.9-9.8) per 100,000 inhabitants ≥ 50 years old and 66% (95% CI 52-92%), respectively. Incidence increased with age, peaked at age 80-89 years, and was almost twice as high in women versus men. Large-vessel GCA cases, mean (± SD) age 68.6 ± 11.5 years, accounted for 8% of all GCA cases. In this study, GCA epidemiology was mainly driven by cases with cranial GCA signs or symptoms and incidence results were consistent with recent European and past French studies.

Shedding light on vasculitis in Egypt: a multicenter retrospective cohort study of characteristics, management, and outcome

OBJECTIVES

The frequency of different vasculitides and their characteristics vary among different regions. The identification of geographic disparities of disease phenotypes helps the development of international criteria, allowing the classification of patients of different ethnicities. This study aimed to describe the frequency, characteristics, course, response to treatment, and outcome of the different adulthood vasculitides in Egypt.

METHODS

This was a multicenter study in which the medical records of adult Egyptian patients diagnosed with vasculitis between 2002 and 2018 were retrospectively reviewed.

RESULTS

The most frequent vasculitides in Egypt were Behçet's disease (76%), hepatitis C virus vasculitis (13.9%), and granulomatosis with polyangiitis (3.9%). Most patients (73.8%) had a major event at the time of diagnosis. Generalized granulomatosis with polyangiitis was more common than the localized type (90% versus 10%, respectively). The aortic arch and its branches were the most common affected sites of Takayasu arteritis. Of vasculitides, Behçet's disease and giant cell arteritis were associated with the greatest rates of relapse (62.7% and 33.3%, respectively). Delayed diagnosis and permanent organ damage were reported in 69.9% and 68.9% of patients, respectively. A low mortality rate was noted (1.3%).

CONCLUSIONS

The most common types of adulthood vasculitides in Egypt are Behçet's disease, hepatitis C virus vasculitis, and granulomatosis with polyangiitis. Major organ involvement is frequent. Delayed diagnosis and permanent organ damage are common.

[Current patient care of giant cell arteritis in Rhineland-Palatinate]

BACKGROUND

Giant cell arteritis (GCA) is one of the most common forms of inflammatory vasculitis in older patients. Because of possible irreversible vision deterioration, a fastest possible diagnosis and therapy is of absolute importance. To date, there are still no reliable data to obtain an initial assessment of the outpatient health care situation of patients diagnosed with GCA in Rhineland-Palatinate.

METHODS

The specialists (neurologists, rheumatologists, ophthalmologists and general practitioners) participating in the statewide rheumatology network ADAPTHERA were questioned with the help of a questionnaire regarding disease frequency, activity, drug therapy and possible comorbidities. In addition, the collected data were compared and supplemented by the ambulatory coding of the Association of Statutory Health Insurance Physicians in Rhineland-Palatinate.

RESULTS

Based on the information provided by general practitioners, 272 GCA patients were treated in Rhineland-Palatinate during the survey period. The average duration of the disease until diagnosis was 3.6 (SD ± 4.8) months. Drug therapy in the form of glucocorticoids was in first place followed by methotrexate, acetylsalicylic acid (ASA) and azathioprine. Cardiovascular diseases, chronic pain syndromes, depression, osteoporosis and diabetes mellitus were also described as comorbidities.

CONCLUSION

The majority of patients with GCA are being cared for by general practitioners (GP). Long-term therapy and timely rheumatological co-treatment seem to be problematic. The primary care providers expressed their wishes for rheumatological training and further education measures. In terms of diagnosis and treatment, there is a demand to implement a "vasculitis fast-track" module.

Association between glucocorticoid therapy and incidence of diabetes mellitus in polymyalgia rheumatica and giant cell arteritis: a systematic review and meta-analysis

Background

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are almost always treated with glucocorticoids (GCs), but long-term GC use is associated with diabetes mellitus (DM). The absolute incidence of this complication in this patient group remains unclear.

Objective

To quantify the absolute risk of GC-induced DM in PMR and GCA from published literature.

Methods

We identified literature from inception to February 2017 reporting diabetes following exposure to oral GC in patients with PMR and/or GCA without pre-existing diabetes. A random-effects meta-analysis was performed to summarise the findings.

Results

25 eligible publications were identified. In studies of patients with GCA, mean cumulative GC dose was almost 1.5 times higher than in studies of PMR (8.2 g vs 5.6 g), with slightly longer treatment duration and longer duration of follow-up (6.4 years vs 4.4 years). The incidence proportion (cumulative incidence) of patients who developed new-onset DM was 6% (95% CI 3% to 9%) for PMR and 13% (95% CI 9% to 17%) for GCA. Based on UK data on incidence rate of DM in the general population, the expected background incidence rate of DM over 4.4 years in patients with PMR and 6.4 years in patients with GCA (follow-up duration) would be 4.8% and 7.0%, respectively. Heterogeneity between studies was high (I²=79.1%), as there were differences in study designs, patient population, geographical locations and treatment. Little information on predictors of DM was found.

Conclusion

Our meta-analysis produced plausible estimates of DM incidence in patients with PMR and GCA, but there is insufficient published data to allow precise quantification of DM risk.

Vasculitis in Africa

PURPOSE OF REVIEW

Systemic vasculitides are characterized by inflammation of blood vessel walls leading to a myriad of organ disorders depending on the size, site, and location of the affected blood vessel. The epidemiology of vasculitis in the developing world has been inadequately documented. The description of the vasculitides in Africa, both from hospital series as well as taking into consideration, previous epidemiological studies in the community, indicates that these conditions have been rare until relatively recently. In view of these past observations, this review of publications on the topic looks to shed light on the current state of vasculitis in Africa.

RECENT FINDINGS

Takayasu and Kawasaki appear to be the most commonly reported vasculitides in Africa. Most of the published reports are from North and South Africa. Furthermore, the contribution of vasculitis associated with infections, and in particular HIV, is significant. There are increasing numbers of publications reflecting a growing recognition of the vasculitides in Africa.

Evaluating the Incidence of Arteritic Ischemic Optic Neuropathy and Other Causes of Vision Loss from Giant Cell Arteritis

PURPOSE

To determine the incidence of permanent visual loss from giant cell arteritis (GCA).

DESIGN

Retrospective, population-based cohort.

PARTICIPANTS

All residents of Olmsted County, Minnesota, diagnosed with GCA between January 1, 1950, and December 31, 2009.

METHODS

All cases of GCA were identified using the Rochester Epidemiology Project (REP), which is a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota, residents. The medical records were reviewed to identify and determine the cause of permanent vision loss among patients with GCA. Systemic symptoms of GCA and visual outcomes also were determined.

MAIN OUTCOME MEASURES

Incidence and outcomes of permanent vision loss from GCA.

RESULTS

Among the 245 new cases of GCA over the 60-year period, 20 patients (8.2%) had permanent vision loss due to GCA. The frequency of arteritic ischemic optic neuropathy (A-ION) was 6.9% (95% confidence interval [CI], 4.0-11.1) accounting for 85% of cases of permanent vision loss. The frequency of central retinal artery occlusion (CRAO) was 1.6% (95% CI, 0.4-4.2), and the frequency of cilioretinal artery occlusion was 0.4% (95% CI, 0.01-2.3). The population-based age- and sex-adjusted annual incidence of A-ION from GCA among persons aged ≥50 years was 1.3 (95% CI, 0.7-2.0) per 100 000 population. Some 20% of patients with permanent vision loss from GCA had vision loss without constitutional symptoms of GCA. Overall, there was no significant difference between presenting and final visual acuities.

CONCLUSIONS

These population-based data provide the most accurate incidence of permanent vision loss from GCA. This study confirms that visual outcomes from GCA-related vision loss are poor and that 20% of patients with permanent visual loss from GCA can present without systemic symptoms of GCA.

Hospitalized infections in giant cell arteritis: a population-based retrospective cohort study

OBJECTIVE

To assess the occurrence of infections requiring or acquired during hospitalization in patients with giant cell arteritis (GCA).

METHODS

We retrospectively reviewed a population-based incidence cohort of patients with GCA diagnosed between 1950 and 2009 and compared this cohort with a non-GCA one matched for age, sex, and calendar year from the same population.

RESULTS

We identified 245 patients in the GCA cohort and 245 patients in the non-GCA cohort. Seventy-four GCA subjects (134 episodes) and 79 non-GCA (153 episodes) had infections requiring or acquired during hospitalization [rate ratio (RR) 0.94; 95% CI 0.74, 1.18]. Sixty-seven subjects (107 episodes) in the GCA cohort and 63 subjects (110 episodes) in non-GCA cohort required hospitalization secondary to an infection (RR 1.04; CI 0.80, 1.36). Pneumonia, urinary tract infections (UTI), skin and soft tissue infections accounted for the majority of infections requiring hospitalization and had similar occurrence in both cohorts. UTI accounted for the majority of infections requiring hospitalization in the first 6 months after GCA incidence (RR 3.93; CI 0.85, 56.52). No difference between the 2 cohorts was noted in overall infections acquired during hospitalization (RR 0.68; CI 0.41, 1.08).

CONCLUSION

There is no overall increased risk of infections requiring or acquired during hospitalization in patients with GCA who are taking glucocorticoid therapy. There may be an increased risk of infections requiring hospitalization, especially of the urinary tract, in the first 6 months after GCA incidence, although this did not achieve statistical significance in our study.

Giant cell arteritis: epidemiology, diagnosis, and management

Giant cell arteritis (GCA), also called temporal arteritis, is a vasculitis that affects large and middle-sized blood vessels--with predisposition to the involvement of cranial arteries derived from the carotid artery--in individuals older than 50 years of age. Familial aggregation of GCA has been observed. Incidence of GCA is higher in white individuals than those of other ethnicities, particularly those of Scandinavian background. A temporal artery biopsy is the gold standard test for the diagnosis of GCA. Several imaging modalities, in particular ultrasonography, are useful in the diagnosis of GCA. Corticosteroids are the cornerstone of treatment in GCA. Alternative, steroid-sparing drugs, particularly methotrexate, should be considered in GCA patients with severe corticosteroid-related side effects and/or in those who require prolonged corticosteroid therapy due to relapses of the disease.

Giant cell arteritis: clinical features of patients visiting a headache clinic in Japan

OBJECTIVE

The first symptom of giant cell arteritis (GCA) is usually a headache. Japan has a low prevalence of GCA, and clinical features of this disorder have not been fully investigated. We conducted a retrospective evaluation of clinical features in patients with giant cell arteritis who visited a headache clinic in Japan.

METHODS

Clinical and demographic data were obtained from clinical examinations, face-to-face interviews, and hospital records.

PATIENTS

Subjects comprised 19 patients (9 men, 10 women).

RESULTS

Mean age at disease onset was 78.1 ± 4.8 years (range, 71-86 years). Seventeen of 19 patients (89.5%) had consulted other medical institutions before consulting our hospital, but only 2 of those patients had been diagnosed with GCA at these medical institutions. Manifestations at disease onset included headache (89.5%), ear pain (5.3%), and jaw pain (5.3%). Ocular manifestations were reported in 2 patients (10.5%). No loss of vision occurred. One patient showed trigeminal nerve palsy involving the third division of the nerve. Jaw claudication was observed in 3 patients (15.8%). Concomitant polymyalgia rheumatica was seen in 3 patients (15.8%). No patient showed upper respiratory tract symptoms, arm claudication, or aortic aneurysms.

CONCLUSION

Although most patients had consulted other medical institutions before consulting our hospital, they were not diagnosed with GCA at these institutions. Infrequent clinical findings of GCA and lack of symptoms other than headache may contribute to the high rate of unrecognized and misdiagnosed cases of GCA.

Diagnosis and management of giant cell arteritis: a review

PURPOSE OF REVIEW

This article aims to provide a review of giant cell arteritis (GCA) clinical features, differential diagnosis, treatment options, and recent literature.

RECENT FINDINGS

GCA, first described by Horton et al., is a systemic immune-mediated vasculitis affecting medium-sized and large-sized arteries. Characteristic findings include headache, jaw claudication, visual loss, and constitutional symptoms (malaise, fever, weight loss, loss of appetite). Localized GCA symptoms are the end-result of vascular insufficiency and tissue ischemia. Temporal artery biopsy (TAB) remains the gold standard for diagnosis. Additional diagnostic tests include blood tests (erythrocyte sedimentation rate, ESR; C-reactive protein, CRP; platelets) and imaging modalities (ultrasound of the arteries; fluorescein angiography, FA; MRI; and positron emission tomography, PET). The mainstay of management includes high-dose corticosteroids, and additional cytotoxic drugs, antitumor necrosis factor monoclonal antibody, and antiplatelet aggregation therapy may be used. The goal of treatment is to prevent ischemic damage and halt progression of visual loss in the affected eye and prevent involvement of the fellow eye.

SUMMARY

Further research is warranted concerning the immunogenetics of GCA. Further treatment trials are also needed to develop more specific and sensitive diagnostic tests and new corticosteroid-sparing treatment modalities.