1
|
Milchert M, Brzosko M. Familial aggregation of longevity in giant cell arteritis and polymyalgia rheumatica. Rheumatol Int 2020; 40:2071-2075. [PMID: 32683496 PMCID: PMC7591435 DOI: 10.1007/s00296-020-04649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022]
Abstract
The long-term mortality in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) is unexpectedly decreased or at least not increased regardless of several mortality risk factors that these diseases share with other chronic immune-mediated rheumatic diseases. The genetic and immunological profile of PMR/GCA patients is unique, therefore, the hypothesis that this profile provides some survival advantage to PMR/GCA patients should be considered. The longevity is a phenomenon that was demonstrated to be familial. The familial aggregation of longevity can be studied by analysis of life expectancy in family members. Here we test the hypothesis of the aggregation of an increased longevity in the families of PMR/GCA patients. We compared the age of death of 358 parents of 179 PMR and GCA patients with corresponding data retrieved from 506 parents of 253 randomly collected age and sex-matched controls. The number of nonagenarian (≥ 90-year -old) mothers of PMR/GCA patients was significantly higher (OR = 2.34, 95%CI 1.11–11.95, p < 0.0005) vs controls. Both nonagenarian parents were found in 6 patients (3.35%) and none in the control cohort (OR = 8.77, 95%CI 2.26–405.10, p = 0.003). Our data suggest the familial aggregation of nonagenarians in PMR/GCA patients.
Collapse
Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland.
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland
| |
Collapse
|
2
|
Hancock AT, Mallen CD, Muller S, Belcher J, Roddy E, Helliwell T, Hider SL. Risk of vascular events in patients with polymyalgia rheumatica. CMAJ 2014; 186:E495-501. [PMID: 25070989 DOI: 10.1503/cmaj.140266] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Polymyalgia rheumatica is one of the most common inflammatory rheumatologic conditions in older adults. Other inflammatory rheumatologic disorders are associated with an excess risk of vascular disease. We investigated whether polymyalgia rheumatica is associated with an increased risk of vascular events. METHODS We used the General Practice Research Database to identify patients with a diagnosis of incident polymyalgia rheumatica between Jan. 1, 1987, and Dec. 31, 1999. Patients were matched by age, sex and practice with up to 5 patients without polymyalgia rheumatica. Patients were followed until their first vascular event (cardiovascular, cerebrovascular, peripheral vascular) or the end of available records (May 2011). All participants were free of vascular disease before the diagnosis of polymyalgia rheumatica (or matched date). We used Cox regression models to compare time to first vascular event in patients with and without polymyalgia rheumatica. RESULTS A total of 3249 patients with polymyalgia rheumatica and 12 735 patients without were included in the final sample. Over a median follow-up period of 7.8 (interquartile range 3.3-12.4) years, the rate of vascular events was higher among patients with polymyalgia rheumatica than among those without (36.1 v. 12.2 per 1000 person-years; adjusted hazard ratio 2.6, 95% confidence interval 2.4-2.9). The increased risk of a vascular event was similar for each vascular disease end point. The magnitude of risk was higher in early disease and in patients younger than 60 years at diagnosis. INTERPRETATION Patients with polymyalgia rheumatica have an increased risk of vascular events. This risk is greatest in the youngest age groups. As with other forms of inflammatory arthritis, patients with polymyalgia rheumatica should have their vascular risk factors identified and actively managed to reduce this excess risk.
Collapse
Affiliation(s)
- Adam T Hancock
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK
| | - Christian D Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK
| | - Sara Muller
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK
| | - John Belcher
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK
| | - Toby Helliwell
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK
| | - Samantha L Hider
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK
| |
Collapse
|
3
|
Kermani TA, Warrington KJ, Crowson CS, Ytterberg SR, Hunder GG, Gabriel SE, Matteson EL. Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis 2012; 72:1989-94. [PMID: 23253927 DOI: 10.1136/annrheumdis-2012-202408] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate incidence-trends and timing of large-vessel (LV) manifestations in patients with giant cell arteritis (GCA), and to examine the influence of LV manifestations on survival. METHODS A population-based incident cohort of patients diagnosed with GCA between 1950 and 2004 was used. LV involvement was defined as large-artery stenosis or aortic aneurysm/dissection that developed in the 1 year before GCA diagnosis or at any time thereafter. Patients were followed up until death or 31 December 2009. RESULTS The study included 204 patients, 80% women, mean age at diagnosis of GCA 76.0 years (±8.2 years). Median length of follow-up was 8.8 years. The cumulative incidence of any LV manifestation at 10 years was 24.9% for patients diagnosed with GCA between 1980 and 2004 compared with 8.3% for patients diagnosed with GCA between 1950 and 1979. The incidence of any LV event was high within the first year of GCA diagnosis. The incidence of aortic aneurysm/dissection increased 5 years after GCA diagnosis. Compared with the general population, survival was decreased in patients with an aortic aneurysm/dissection (standardized mortality ratio (SMR) 2.63; 95% CI 1.78 to 3.73) but not in patients with large-artery stenosis (SMR 1.44; 95% CI 0.87 to 2.25). Patients with GCA and aortic manifestations had a higher than expected number of deaths from cardiovascular and pulmonary causes than the general population. Among patients with GCA, aortic manifestations were associated with increased mortality (HR=3.4; 95% CI 2.2 to 5.4). CONCLUSIONS Vigilance and screening for aortic aneurysms should be considered in all patients 5 years after the incidence of GCA. Aortic aneurysm/dissection is associated with increased mortality in GCA.
Collapse
Affiliation(s)
- Tanaz A Kermani
- Department of Medicine, Division of Rheumatology, Mayo Clinic, , Rochester, Minnesota, USA
| | | | | | | | | | | | | |
Collapse
|
4
|
Hancock AT, Mallen CD, Belcher J, Hider SL. Association between polymyalgia rheumatica and vascular disease: a systematic review. Arthritis Care Res (Hoboken) 2012; 64:1301-5. [PMID: 22514197 DOI: 10.1002/acr.21712] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To systematically identify and appraise the existing literature on the association between polymyalgia rheumatica (PMR) and vascular disease. METHODS The Medline, Embase, CINAHL, and Cochrane databases were searched from inception to September 2010. Search criteria included observational studies containing patients with isolated PMR reporting on a vascular outcome. Data were extracted and articles were assessed for quality. RESULTS The database search identified 545 articles. Eight articles reporting on 7 unique studies were included in the final review. Four studies reported on vascular mortality and 3 studies reported on other vascular outcomes. Four of the studies reported statistically significant positive associations between PMR and vascular disease and 3 studies reported no statistically significant results. The heterogeneity of the results was investigated; the strongest explanatory variable was that 2 of 3 studies that reported nonsignificant results were prospective, whereas all of those studies reporting significant results were retrospective. CONCLUSION There is some evidence to suggest that, like other inflammatory rheumatic disorders, PMR may be linked to an increased risk of vascular disease. Further studies are required to quantify the level of risk to determine whether patients with PMR should be actively screened for cardiovascular disease and its risk factors.
Collapse
Affiliation(s)
- Adam T Hancock
- Arthritis UK Primary Care Centre, Keele University, Stoke-on-Trent, UK.
| | | | | | | |
Collapse
|
5
|
Lu-Emerson C, Walker M, Huber BR, Ghodke B, Longstreth WT, Khot SP. Lethal giant cell arteritis with multiple ischemic strokes despite aggressive immunosuppressive therapy. J Neurol Sci 2010; 295:120-4. [PMID: 20609853 DOI: 10.1016/j.jns.2010.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/23/2010] [Accepted: 05/17/2010] [Indexed: 12/25/2022]
Abstract
Two patients with giant cell arteritis (GCA) had a malignant course despite aggressive immunosuppressive therapy. A 63-year-old woman presented with symptoms of headache, jaw claudication, scalp paresthesia, and visual disturbances. A temporal artery biopsy showed GCA. While on prednisone, she suffered ischemic strokes, and serial cerebral angiograms demonstrated bilateral, severe and progressive narrowing of distal vertebral and internal carotid arteries. Despite escalating immunosuppressive therapies, she suffered more infarcts and eventually died. Postmortem examination of arteries showed no active inflammation. A 65-year-old man presented with extrapyramidal symptoms though no symptoms typical of GCA. Imaging showed multiple ischemic strokes. Because serial angiograms demonstrated findings similar to the first patient, he underwent temporal artery biopsy that showed GCA. He died 7 months after his presentation with complications of aggressive immunosuppressive therapy. These two patients confirm that GCA can follow a lethal course despite escalating immunosuppressive therapies. Our two patients were unique in that eventually both anterior and posterior circulations were involved bilaterally in a characteristic location where the arteries penetrate the dura. This pattern should always raise the possibility of GCA and, if confirmed, should prompt aggressive immunosuppressive therapy. The dismal outcomes despite this approach may suggest a non-inflammatory arteriopathy, as seen on necropsy in one of our patients. Such an arteriopathy may require novel therapies to be considered for this severe variant of GCA.
Collapse
|
6
|
Marie I, Proux A, Duhaut P, Primard E, Lahaxe L, Girszyn N, Louvel JP, Levesque H. Long-term follow-up of aortic involvement in giant cell arteritis: a series of 48 patients. Medicine (Baltimore) 2009; 88:182-192. [PMID: 19440121 DOI: 10.1097/md.0b013e3181a68ae2] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To date, only a few series have analyzed the long-term outcome of giant cell arteritis (GCA) patients with aortic involvement, which prompted us to conduct the current retrospective study. Our aims were to 1) determine the prevalence of GCA in patients exhibiting nonatherosclerotic aortic involvement (that is, aortitis, aortic ectasia, and/or aneurysm); and 2) evaluate clinical features and long-term outcome of GCA patients exhibiting aortitis, aortic ectasia, and/or aortic aneurysm.From January 1997 to March 2008, 66 consecutive patients in the Department of Internal Medicine at the University of Rouen medical center received a diagnosis of nonatheromatous aortic complications (aortitis, aortic ectasia, and/or aneurysm). In these 66 patients, aortic involvement was related to GCA (n = 48), Takayasu arteritis (n = 6), relapsing polychondritis (n = 1), and infection (n = 11).Of the 48 patients with GCA, aortic involvement preceded the initial GCA diagnosis in 1 patient. Aortic involvement was identified in association with GCA in 40 patients (83.3%), and developed after the onset of GCA in the 7 remaining patients (14.6%). Aortic involvement was more often asymptomatic (77.1%). The aortic helical computed tomography (CT)-scan procedure principally showed isolated aortitis (circumferential thickening of the aortic wall >3 mm) in 41 patients (85.4%). In the remaining 7 patients with GCA (14.6%), aortic helical CT scan demonstrated aortic thoracic ectasia and aortitis (n = 3), aortic thoracic aneurysm and both thoracic and abdominal aortitis (n = 3), and both aortic abdominal aneurysm and aortitis (n = 1). All patients were given steroid therapy at a median daily dose of 1 mg/kg initially.At 6-month follow-up, 34 of 48 patients systematically underwent both thoracic and abdominal CT scan. Aortic helical CT scan demonstrated complete disappearance of aortitis in 8.8% of patients, improvement of aortitis in 47.1%, unchanged pattern of aortitis and/or aortic thoracic ectasia/aneurysm in 41.2%, and deterioration of aortic thoracic aneurysm in 1 patient (2.9%). At 18-month follow-up, 11 patients systematically underwent both thoracic and abdominal CT scan. Aortic helical CT scan showed complete disappearance of aortitis (n = 1), improvement of aortitis (n = 1), unchanged pattern of aortic thoracic ectasia/aneurysm (n = 2), and deterioration of aortic thoracic aneurysm (n = 1). At patients' last follow-up, the median daily dose of prednisone was 7 mg. Steroid therapy could be discontinued in 17 patients (35.4%).The current retrospective study suggests that aortic impairment may be more prevalent than previously reported. Our findings suggest that specific inflammatory thickening of the aortic wall is common at the time of GCA diagnosis, and that aortitis may be the first manifestation of GCA-associated aortic complications. Whether isolated aortitis leads to vascular wall injury responsible for late-onset aneurysmal disease remains to be determined. At this time, we recommend long-term monitoring for aortic aneurysms, especially in high-risk subjects, although the optimal frequency and imaging modality have not yet been determined. A yearly screening strategy for thoracic/abdominal aortic aneurysms has been proposed for patients with GCA, including physical examination, 2-view chest radiograph, and abdominal ultrasound.
Collapse
Affiliation(s)
- Isabelle Marie
- From Department of Internal Medicine (IM, AP, LL, NG, JPL, HL) and Department of Radiology (EP), Rouen University Hospital, Rouen; and Department of Internal Medicine (PD), Amiens University Hospital, Amiens, France
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Andersson R, Malmvall BE, Bengtsson BA. Long-term corticosteroid treatment in giant cell arteritis. ACTA MEDICA SCANDINAVICA 2009; 220:465-9. [PMID: 3812030 DOI: 10.1111/j.0954-6820.1986.tb02796.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ninety patients with giant cell arteritis were followed up 9-16 years (median 11.3 years) after diagnosis. The mean duration of corticosteroid therapy was 5.8 years (range 0-12.8 years). Together, the patients had received corticosteroids for 492 patient-years. Five years after diagnosis, 43% of the patients were on corticosteroid therapy. After 9 years, 15 of 60 surviving patients (25%) were still being treated with 1.25-10 mg of prednisolone daily (median dose 5 mg). The relapse rate was about 50%, regardless of the time after diagnosis, when an attempt to withdraw the treatment was made. Forty-six per cent of the relapses occurred within one month and 96% within one year of the end of treatment. Most of the flare-ups occurred during the first year of therapy and in 55% of the patients on a prednisolone dosage of 5 mg or less. We did not find any increase in morbidity in our patients compared to the general population. Nor did we see any significant complications which we could attribute to the steroid treatment.
Collapse
|
8
|
Crow RW, Katz BJ, Warner JEA, Alder SC, Zhang K, Schulman S, Digre KB. Giant cell arteritis and mortality. J Gerontol A Biol Sci Med Sci 2009; 64:365-9. [PMID: 19196636 DOI: 10.1093/gerona/gln030] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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.
Collapse
Affiliation(s)
- R Wade Crow
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Maladie de Horton et pseudopolyarthrite rhizomélique : nouveautés thérapeutiques ? Évolution et pronostic. Rev Med Interne 2008; 29 Suppl 3:S281-5. [DOI: 10.1016/j.revmed.2008.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
10
|
Bablekos GD, Michaelides SA, Karachalios GN, Nicolaou IN, Batistatou AK, Charalabopoulos KA. Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review. Am J Med Sci 2006; 332:198-204. [PMID: 17031245 DOI: 10.1097/00000441-200610000-00007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Pericardial effusion has been known to be a rare manifestation of giant cell arteritis. During the last six decades, only 24 cases have been cited in the literature. In this report, we describe the case of a patient presenting with nonspecific symptoms and development of pericardial effusion. PROCEDURES AND FINDINGS A 71-year-old woman was admitted to the hospital with low-grade fever, exertion breathlessness, atypical diffuse muscular pain, and weight loss over a period of about 5 weeks. Pericardial effusion and giant cell arteritis were diagnosed by echocardiography and left temporal artery biopsy, respectively. Treatment with corticosteroids resulted in remarkable improvement of symptoms and complete remission of pericardial effusion. One year after admission, the patient remained in a stable good condition, under low steroid maintenance dosage. CONCLUSIONS The diversity of clinical manifestations (such as pericardial effusion) in such a potentially severe disease should alert the physician to prompt diagnosis and treatment in view of impending irreparable vascular damages, even in cases in which the initial presentation is quite uncommon.
Collapse
Affiliation(s)
- George D Bablekos
- Department of Experimental Physiology, Clinical Unit, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
| | | | | | | | | | | |
Collapse
|
11
|
Le Page L, Duhaut P, Seydoux D, Bosshard S, Ecochard R, Abbas F, Pétigny V, Cevallos R, Smail A, Salle V, Chatelain D, Loire R, Pellet H, Piette JC, Ducroix JP. [Incidence of cardiovascular events in giant cell arteritis: preliminary results of a prospective double cohort study (GRACG)]. Rev Med Interne 2005; 27:98-105. [PMID: 16310894 DOI: 10.1016/j.revmed.2005.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2005] [Indexed: 11/20/2022]
Abstract
UNLABELLED Giant cell arteritis is the most frequent vasculitis. Cardiovascular events such as cerebrovascular accident or ischemic heart disease may occur in patients with giant cell arteritis. However, their real incidence, as well as their relative risk compared to the general population, remains unknown. PURPOSE To assess in a prospective, double cohort study, the incidence of cardiovascular events in giant cell arteritis patients compared to controls, after controlling for cardiovascular risk factors. PATIENTS AND METHODS We included on predefined criteria 432 newly diagnosed patients with giant cell arteritis, each assigned to sex- and age-matched controls randomly selected from the general population. Cardiovascular risk factors (high-blood pressure, diabetes, smoking, hypercholesterolemia and preexisting peripheral vascular disease) were collected at inclusion. During the 24-month follow-up, all cardiovascular events were collected. After stratification for cardiovascular risk factors, a log-rank test was performed to compare cases and controls. A parametric survival model was used for multivariate analysis. RESULTS Cardiovascular events all combined were significantly increased in patients with giant cell arteritis (RR = 2.15 [1.21-3.81], P = 0.009), and were mainly associated with age (P = 0.0001), past history of cardiovascular disease (P = 0.023) but also with giant cell arteritis (P = 0.009). However, each subset of cerebrovascular accident (RR = 2.42 [0.84-7]) or ischemic heart disease (RR = 1.67 [0.72-3.89]) increased but did not significantly. CONCLUSION Cardiovascular events incidence is increased in patients with giant cell arteritis, and prescription of preventive antiagregant treatment may be discussed.
Collapse
Affiliation(s)
- L Le Page
- Service de médecine interne et RECIF, CHU Nord, Amiens, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Direct medical costs of polymyalgia rheumatica. ACTA ACUST UNITED AC 2005; 53:578-84. [PMID: 16082650 DOI: 10.1002/art.21311] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe the patterns of care and direct medical costs of polymyalgia rheumatica (PMR) to test the hypothesis that the direct medical costs incurred by patients with PMR are higher than costs incurred by age- and sex-matched population-based controls from the same community. METHODS The study population comprised 193 Olmsted County, Minnesota residents who were first diagnosed with PMR between January 1, 1987 and December 31, 1999. Inclusion criteria were as follows: age > or = 50 years; bilateral aching and morning stiffness (lasting > or = 30 minutes) persisting for at least 1 month and involving the neck, shoulders, or hip girdle regions; and an erythrocyte sedimentation rate (ESR) > or = 40 mm/hour. In patients who fulfilled the first 2 criteria, but had a normal ESR, a rapid response to low-dose corticosteroids served as the third criterion. A total of 695 age- and sex-matched subjects without PMR served as control subjects. Billing data from the Olmsted County Healthcare Expenditure and Utilization Database (OCHEUD) were used to provide estimates of nationally representative unit costs in the year 2002 inflation-adjusted dollars. All subjects were followed using the OCHEUD records until December 31, 2002 to assess the total direct medical costs. Generalized quantile regression modeling was used to estimate the effect of PMR on direct medical costs, after adjusting for age, sex, Charlson comorbidity score, number of hospital days, and number of radiographs. RESULTS During the first year following diagnosis, subjects with PMR used a substantially higher number of outpatient services and laboratory tests compared with controls, but during the subsequent 4 years, there were no differences between the 2 groups. In age- and sex-adjusted analysis, PMR was associated with a significant incremental cost of 2,233 dollars at the 10th percentile of costs and 27,712 dollars at the 90th percentile of costs. However, further adjustments for comorbidities, number of hospital days, radiographs, and imaging eliminated the incremental cost difference between the subjects with PMR and control subjects. PMR subjects were significantly more likely to have a history of myocardial infarction (odds ratio [OR] 1.78, 95% confidence interval [95% CI] 1.13, 2.82), peripheral vascular diseases (OR 2.21, 95% CI 1.37, 3.60), and cerebrovascular diseases (OR 1.60, 95% CI 1.08, 2.39) compared with the controls. CONCLUSION Incremental direct medical costs associated with the management of PMR can be substantial, especially early in the disease course. These incremental costs appear to originate mainly from comorbid cardiovascular conditions that were shown to be more prevalent among subjects with PMR.
Collapse
|
13
|
Abstract
Systemic inflammatory diseases commonly affect the sclera, cornea, retina, and orbit, and can pose a serious threat to sight. They encompass both primary and secondary vasculitic disorders and specific granulomatous inflammatory conditions. As well as direct eye involvement from the systemic inflammatory process, there can be signs of ocular ischaemia due to carotid or ophthalmic arteritis, hypertensive retinopathy, and ocular complications such as chloroquine maculopathy related to anti-inflammatory drug treatment. Additionally, systemic infection relating to the eye, either as the result of primary infective disease processes or infection secondary to immunosuppression, might be mistaken as endogenous intraocular inflammation. Infection can closely mimic the ocular signs of endogenous inflammation, and in selected patients (such as those who have been immunosuppressed to treat vasculitis and who additionally have had invasive surgery, indwelling intravenous catheters, or systemic sepsis), it might be necessary to specifically exclude infection by the sampling and culturing of intraocular fluids and tissue.
Collapse
Affiliation(s)
- Peter McCluskey
- Department of Ophthalmology at St Vincent's Hospital and Royal Prince Alfred Hospital, Sydney, Australia.
| | | |
Collapse
|
14
|
Liozon E, Loustaud-Ratti V, Soria P, Bezanahary H, Fauchais AL, Nadalon S, Rhaiem K, Ly K, Vidal E. Maladie de Horton : associations morbides chez 250 malades. Presse Med 2004; 33:1304-12. [PMID: 15615235 DOI: 10.1016/s0755-4982(04)98914-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Miscellaneous disorders have been described in association with temporal (giant cell) arteritis (TA), most often anecdotally, except with arteriosclerosis. METHOD In a retrospective study, we reported our personal experience of disease associations in a series of 250 patients diagnosed with TA and followed-up in the department between 1976 and 2003. RESULTS Disease associations were found in 43 patients, i.e. 17% of cases: concurrent malignancy (23 patients: 17 cancers and 6 blood diseases), primary Gougerot-Sjögren's syndrome (6 cases), endocrine disease other than Hashimoto's thyroiditis (7 cases: 3 hyperparathyroidism [HPP], 3 hyperthyroidism, 1 association HPP + hyperthyroidism), polyneuropathy (3 cases), essential thrombocythaemia (2 cases), anti-neutrophilic cytoplasmic (anti-myeloperoxidase) antibodies (2 cases), and miscellaneous associations (1 case of RS3PE syndrome, nephrotic syndrome, myasthenia, sarcoidosis, and macro-creatine kinase type 2). More than one disease associated was present 5 patients. In 77% of the patients, there was a strong temporal association between TA and the alternate illness. No systemic necrotizing vasculitis or rheumatoid arthritis was observed in any patient. CONCLUSION In our experience, there was a frequent, non-fortuitous, association between TA and malignancy. Auto-immune conditions were rare, but the prevalence of Gougerot-Sjögren's syndrome might have been underestimated. Hyperthyroidism and HPP are not exceptional and must be recognised in order to avoid severe bone loss induced by corticosteroids.
Collapse
Affiliation(s)
- E Liozon
- Service de médecine interne A, Hôpital universitaire Dupuytren, Limoges (87).
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Salvarani C, Crowson CS, O'Fallon WM, Hunder GG, Gabriel SE. Reappraisal of the epidemiology of giant cell arteritis in Olmsted County, Minnesota, over a fifty-year period. Arthritis Care Res (Hoboken) 2004; 51:264-8. [PMID: 15077270 DOI: 10.1002/art.20227] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate time trends in the incidence and survival of giant cell arteritis (GCA) over a 50-year period in Olmsted County, Minnesota. METHODS Using the unified record system at the Mayo Clinic, we identified all incident cases of GCA first diagnosed between 1950 and 1999. Incidence rates were estimated and adjusted to the 1980 United States white population for age and sex. The annual incidence rates were graphically illustrated using a 3-year centered moving average. Survival rates were computed and compared with the expected rates in the population. RESULTS There were 173 incident cases of GCA during the 50-year study period. Of these, 79% were women and the mean age at diagnosis was 74.8 years. The overall age- and sex-adjusted incidence per 100,000 persons 50 years of age or older was 18.8 (95% confidence interval [95% CI] 15.9-21.6). Incidence was higher in women (24.4; 95% CI 20.3-28.6) than in men (10.3; 95% CI 6.9-13.6). Incidence rates increased significantly over the study period (P = 0.017); in particular, a progressive increase was observed from 1950 to 1979; subsequently, no substantial increases in incidence rates were observed. A cyclic pattern of annual incidence rates was apparent, with evidence of 6 peak periods. Survival among individuals with GCA was not significantly different from that expected in the population (P = 0.80). CONCLUSIONS The incidence of GCA increased over the first 3 decades of the study, then remained stable over the last 20 years. The previously observed cyclic pattern of annual incidence rates was still apparent over a 50-year period. Overall survival in GCA was similar to that in the population.
Collapse
|
16
|
Nuenninghoff DM, Hunder GG, Christianson TJH, McClelland RL, Matteson EL. Mortality of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: A population-based study over 50 years. ACTA ACUST UNITED AC 2003; 48:3532-7. [PMID: 14674005 DOI: 10.1002/art.11480] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the mortality of giant cell arteritis (GCA) with large-artery complication compared with that of GCA without large-artery complication. METHODS An inception cohort of 168 residents of Olmsted County, Minnesota, in whom GCA was diagnosed between January 1, 1950, and December 31, 1999, was followed up. Mortality in patients with incident large-artery complication (aortic aneurysm, aortic dissection, and large-artery stenosis) was determined and compared with that in patients in whom large-artery complication did not develop. RESULTS No difference in survival was observed between the total group of patients with any type of large-artery complication and patients without large-artery complication or the general population. However, mortality was markedly increased in the 9 patients in whom thoracic aortic dissection developed (median survival 1.1 years [interquartile range 0.2-7.8 years]) compared with that in all other patients with GCA (P < 0.001). No difference in survival was observed between the group of patients with either aortic aneurysm and/or dissection (thoracic and/or abdominal aorta) and the group with GCA without large-artery complication. Survival of patients with GCA and large-artery stenosis was not different from that of patients with GCA without large-artery complication. CONCLUSION Thoracic aortic dissection in GCA is associated with markedly increased mortality. Overall, mortality in the whole group of patients with GCA with large-artery complication was similar to that in patients with GCA without large-artery complication.
Collapse
|
17
|
Gran JT, Myklebust G, Wilsgaard T, Jacobsen BK. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology (Oxford) 2001; 40:1238-42. [PMID: 11709607 DOI: 10.1093/rheumatology/40.11.1238] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To estimate survival in polymyalgia rheumatica (PMR) and temporal arteritis (TA). METHODS The present study encompassed 338 incident cases who were diagnosed at the Department of Rheumatology during the period 1987-1997 and 60 cases diagnosed in the same period but admitted to hospital for reasons other than PMR or TA. The 398 patients were each assigned four age- and sex-matched controls from the same population and mortality ascertained. RESULTS Among the 338 incident cases, there were 69 deaths compared with 360 deaths among their 1352 controls. The mortality was thus 28% lower in cases than in controls [relative risk (RR)=0.72, 95% confidence interval (CI) 0.55-0.95]. The 274 incident cases with pure PMR had increased survival compared with controls (RR=0.70, 95% CI 0.52-0.95), whilst among the 64 incident TA patients and their controls, no difference in mortality was found (RR=1.2, 95% CI 0.55-2.74). Patients diagnosed at other departments and their controls had the same mortality. In the incident cases, the mean initial dose of prednisolone, the mean maintenance dose of prednisolone, the mean initial erythrocyte sedimentation rate and C-reactive protein and frequency of peripheral arthritis did not differ between survivors and those dying during the observation period. CONCLUSION The study showed increased survival in patients with PMR compared with controls, whilst mortality in TA equalled that of controls. There was no association between use of corticosteroids and level of disease activity and death. The increased survival in PMR might be explained by improved medical surveillance.
Collapse
Affiliation(s)
- J T Gran
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE To develop a clinical guide to the evaluation of temporal arteritis. DESIGN A Medline English-language search of the literature from 1966 to 1998, including more than 300 articles about temporal arteritis, was performed to develop a guide to the evaluation of temporal arteritis. RESULTS A user-friendly guide to the evaluation of temporal arteritis was developed based on the following criteria: (1) clinical suspicion, (2) laboratory testing, and (3) temporal artery biopsy. CONCLUSION A clinical guide to the evaluation of temporal arteritis may assist clinicians in the care of patients with this condition.
Collapse
Affiliation(s)
- A G Lee
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | | |
Collapse
|
19
|
Abstract
Giant cell (temporal) arteritis continues to be a sight-threatening, systemic vasculitis with a poorly understood pathogenesis. The characteristic granulomatous inflammation of the vessel wall commonly leads to local ischemia. Recent advances in immunological investigations have characterized the cellular components of the disease process, but the etiology has so far remained unresolved. A reappraisal of the clinical features of giant cell (temporal) arteritis demonstrates the heterogeneity of the manifestations of the disease, including ischemic optic neuropathy. A range of new laboratory investigations and blood flow studies with color Doppler imaging have demonstrated promising roles, with respect to diagnosis and long-term follow-up. Prompt diagnosis and expeditious treatment require a high index of clinical suspicion, particularly for atypical cases. Corticosteroids remain the treatment of choice, other immuno-suppressive agents being used as second line steroid-sparing agents. Giant cell (temporal) arteritis leads to increased vascular and visual morbidity and, if untreated, may prove fatal. To maintain high standards of management of this enigmatic disorder, ophthalmologists need to be aware of the clinical spectrum of giant cell (temporal) arteritis and currently available diagnostic tests and treatment strategies.
Collapse
Affiliation(s)
- F D Ghanchi
- Tennent Institute of Ophthalmology, University of Glasgow, Western Infirmary, United Kingdom
| | | |
Collapse
|
20
|
Wilke WS. Large vessel vasculitis (giant cell arteritis, Takayasu arteritis). BAILLIERE'S CLINICAL RHEUMATOLOGY 1997; 11:285-313. [PMID: 9220079 DOI: 10.1016/s0950-3579(97)80047-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Giant cell arteritis and Takayasu arteritis are separate but similar idiopathic diseases clinically characterized by constitutional symptoms, shared surrogate markers of systemic inflammation and indistinguishable granulomatous pan-arteritis of large vessels. This review emphasizes and analyses changing perceptions about the diseases. Recent series suggest that aortic involvement in giant cell arteritis may be more common than was previously appreciated. The case for and against inflammatory arthritis in giant cell arteritis is discussed. Ethnic new geographical variation in Takayasu arteritis-disease expression is reviewed. New philosophies of treatment are presented for both diseases. Prognosis in giant cell arteritis and its relationship to treatment is analysed. The utility of the laboratory for diagnosis and monitoring disease activity is appraised for each.
Collapse
Affiliation(s)
- W S Wilke
- Cleveland Clinic Foundation, Department of Rheumatic and Immunologic Diseases, OH 44195, USA
| |
Collapse
|
21
|
Hedderwick SA, Bonilla HF, Bradley SF, Kauffman CA. Opportunistic infections in patients with temporal arteritis treated with corticosteroids. J Am Geriatr Soc 1997; 45:334-7. [PMID: 9063280 DOI: 10.1111/j.1532-5415.1997.tb00949.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S A Hedderwick
- Department of Internal Medicine, Department of Veterans Affairs Medical Center, University of Michigan Medical School, Ann Arbor, USA
| | | | | | | |
Collapse
|
22
|
Abstract
Vasculitis comprises a broad group of syndromes characterized by inflammation and necrosis in the walls of blood vessels, resulting in narrowing or occlusion of the lumen. The distribution of blood vessel involvement varies considerably and serves as the basis for one classification of the vasculitic syndromes: large vessels (Takayasu arteritis, giant-cell arteritis); medium and small muscular arteries (polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, vasculitis in rheumatic diseases); and small vessels ("hypersensitivity" vasculitis, Henoch-Schonlein purpura, microscopic polyangiitis, cryoglobulinemia). The pathogenesis of most forms of vasculitis is only beginning to be understood, but is probably varied and complex. Because of the variability of vasculitides, there is no single, uniform method of diagnosis and treatment. However, a detailed history, careful physical examination, and appropriate laboratory tests are needed in all cases to determine the type of onset, course of illness, organ systems affected, and extent of involvement. Biopsy examination of involved tissues is nearly always essential for diagnosis, except in Takayasu arteritis, when aortography is usually indicated. In most cases of vasculitis, corticosteroid therapy is necessary. When the organ involvement is broader and more progressive (e.g., in cases of polyarteritis nodosa or Wegener's granulomatosis), a combination of cytotoxic drug and corticosteroids is often needed.
Collapse
Affiliation(s)
- G Hunder
- Division of Rheumatology, Mayo Clinic and Mayo Medical School, Rochester, Minnesota 55905, USA
| |
Collapse
|
23
|
Matteson EL, Gold KN, Bloch DA, Hunder GG. Long-term survival of patients with giant cell arteritis in the American College of Rheumatology giant cell arteritis classification criteria cohort. Am J Med 1996; 100:193-6. [PMID: 8629654 DOI: 10.1016/s0002-9343(97)89458-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To characterize survivorship among patients with giant cell arteritis in a well-defined, multicenter cohort. PATIENTS AND METHODS Follow-up was obtained for 205 (95.8%) of the 214 patients enrolled in the 1990 American College of Rheumatology vasculitis classification study. Standardized mortality ratios (SMR) were calculated comparing mortality data from this group of patients with giant cell arteritis versus the general population. RESULTS There were 49 deaths (33 women and 16 men among the 205 patients available for follow-up. Survivorship was virtually identical to that of the general population (SMR = 1.034 +/- 0.121), and was similar for women (SMR = 1.022 +/- 0.149) and men (SMR = 1.078 +/- 0.206) (SMR = 1 indicates that expected and observed survival are identical). CONCLUSION The life expectancy of patients with giant cell arteritis is the same as that of the general population.
Collapse
Affiliation(s)
- E L Matteson
- Division of Rheumatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
24
|
Abstract
Twenty-three cases of aortic dissection in patients with giant-cell arteritis are reviewed and an additional case is reported. Forty-six percent presented catastrophically with aortic dissection and no prior history of giant cell arteritis. Eighty percent died within 2 weeks of the event; four patients had successful surgical grafts. There was diffuse involvement of the aorta with giant cells in 89%, but dissecting tears occurred primarily in the proximal aorta in 85% of cases. The majority of cases with a preceding history of giant cell arteritis were on low doses of steroid or on no treatment at the time of dissection, and the median erythrocyte sedimentation rate of these patients was 62 mm/h (range 21-98). Evidence of some form of hypertension, whether acute or chronic, mild or severe, was found in 77% of patients. Inadequate treatment of giant-cell arteritis and underlying hypertension (treated or untreated) are potential factors leading to aortic dissection in these patients.
Collapse
Affiliation(s)
- G Liu
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | |
Collapse
|
25
|
Nordborg E, Nordborg C, Malmvall BE, Andersson R, Bengtsson BÅ. GIANT CELL ARTERITIS. Rheum Dis Clin North Am 1995. [DOI: 10.1016/s0889-857x(21)00482-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
26
|
Salvarani C, Gabriel SE, O'Fallon WM, Hunder GG. Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970-1991. ARTHRITIS AND RHEUMATISM 1995; 38:369-73. [PMID: 7880191 DOI: 10.1002/art.1780380311] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the incidence, prevalence, and survival of polymyalgia rheumatica (PMR) over a 22-year period in Olmsted County, Minnesota. METHODS Using the unified record system at the Mayo Clinic for the Olmsted County population, we reviewed all medical records with a diagnosis of PMR from 1970 through 1991. RESULTS There were 245 (173 female; 72 male) incidence cases of PMR between 1970 and 1991. The average annual age- and sex-adjusted incidence of PMR per 100,000 population > or = 50 years was 52.5 (95% confidence interval [CI] 45.9-59.2), with a significantly higher incidence in females (61.7; 95% CI 52.3-71.2) than in males (39.9; 95% CI 30.7-49.2). The incidence varied over the period of observation, but no significant trends were found. The prevalence of PMR among persons > or = 50 years on January 1, 1992 was 6/1,000. There was a small but significantly increased survival rate among male PMR patients compared with the general population. CONCLUSION Our data demonstrate that PMR is a common nonfatal disease in the elderly, the incidence and clinical manifestations of which have varied but remained relatively stable over the last 2 decades.
Collapse
Affiliation(s)
- C Salvarani
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905
| | | | | | | |
Collapse
|
27
|
Rajala SA, Ahvenainen JE, Mattila KJ, Saarni MI. Incidence and survival rate in cases of biopsy-proven temporal arteritis. Scand J Rheumatol 1993; 22:289-91. [PMID: 8266030 DOI: 10.3109/03009749309095141] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In the population of the city of Tampere, Finland, 66 patients with histologically verified temporal arteritis were identified during the 20-year period from 1969 to 89. The cases were followed up to March 31st in 1991. The annual age- and sex-adjusted incidence of temporal arteritis per 100,000 population aged 50 or older was 4.5 in 1970-79 and 9.2 in 1980-89. The patients showed excess mortality although this was not statistically significant. After excluding hypertensive disease, angina pectoris and congestive heart disease the survival of the remaining subgroup did not differ from the control population.
Collapse
Affiliation(s)
- S A Rajala
- Department of Internal Medicine, Hatanpää Hospital, Tampere, Finland
| | | | | | | |
Collapse
|
28
|
Abstract
Out of 66 patients who were diagnosed as suffering from polymyalgia rheumatica (PMR; n = 40), temporal arteritis (AT; n = 14) or both (n = 12) in a 6.5 year period (incidence 3.4/100,000 per year), 9 died and 49 were followed up for an average period of 28 months. Exacerbations of the illness (n = 24) and complications in the course (n = 32) were more frequent with an initial ESR greater than 90 mm/h. Postural vertigo (n = 11), amaurosis fugax (n = 11) and polyneuropathy (n = 8) were the most frequent neurological complications. Persisting unilateral blindness and aromatic anosmia developed in 2 patients each. Complications were significantly more frequent in patients with initial symptoms of AT (chi 2 P less than 0.001). CRP-levels correlated better with persisting symptoms in the course than did the ESR. Recurrences after treatment were significantly more frequent when the length of corticosteroid-therapy was less than 20 months (chi 2 P less than 0.009). On follow up there were normal values for neopterin, tumour necrosis factor and antibodies against Borrelia burgdorferi.
Collapse
Affiliation(s)
- P Berlit
- Neurological Clinic Mannheim, University of Heidelberg, Germany
| |
Collapse
|
29
|
Affiliation(s)
- J S Goodwin
- Department of Medicine, University of Wisconsin Medical School, Milwaukee
| |
Collapse
|
30
|
Liozon F, Vidal E, Gaches F, Venot J, Liozon E, Cransac M, Loustaud V, Berdah JF. [Death in Horton disease. Prognostic factors]. Rev Med Interne 1992; 13:187-91. [PMID: 1410898 DOI: 10.1016/s0248-8663(05)81324-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The authors reported causes of death and searched for prognosis factors in Giant Cell Arteritis (GCA). The diagnosis was confirmed by temporal biopsy in all cases. Fourteen patients died during treatment; thirty-six patients had completely recovered (follow up > 6 months after withdrawal of steroid therapy). The commonest causes of death were cardiovascular (n = 7) and digestive (n = 4); they occurred after an average of 195 days of treatment, half of them during the first three months. One death was due to GCA (autopsy) and five deaths were attributed to the treatment with corticosteroids. The prognosis factors were searched for by comparing age, sex, clinical signs, laboratory data before treatment, past medical history in the both series; further more initial dose of Prednisone and the dose after 180 days of steroid therapy were compared in the two groups. The adverse prognosis factors revealed by this study were: advanced age (p < 0.01), previous ischaemic heart disease (p < 0.05) and higher dose of corticosteroids administered at 6 months of treatment (< 0.01).
Collapse
Affiliation(s)
- F Liozon
- Service de Médecine Interne, CHU, Limoges
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Myles AB. Prognosis of polymyalgia rheumatica and giant cell arteritis. BAILLIERE'S CLINICAL RHEUMATOLOGY 1991; 5:493-503. [PMID: 1807824 DOI: 10.1016/s0950-3579(05)80068-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Polymyalgia rheumatica and giant cell arteritis are amongst the most satisfying conditions for clinicians to diagnose and treat because the unpleasant effects and serious consequences of these conditions can be almost entirely prevented by corticosteroid treatment; the fact that the side-effects of this treatment sometimes seem to be more serious than the complications of the disease is an indication of its effectiveness. Unfortunately, there is no objective way of determining the prognosis in the individual, and decisions concerning duration of treatment remain empirical.
Collapse
|
32
|
|
33
|
|
34
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 23-1990. An 84-year-old man with thickening of the aortic wall, marked fatigue, and a coagulopathy. N Engl J Med 1990; 322:1656-65. [PMID: 2111460 DOI: 10.1056/nejm199006073222308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
35
|
Andersson R, Rundgren A, Rosengren K, Bengtsson BA, Malmvall BE, Mellström D. Osteoporosis after long-term corticosteroid treatment of giant cell arteritis. J Intern Med 1990; 227:391-5. [PMID: 2351926 DOI: 10.1111/j.1365-2796.1990.tb00177.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The mineral content of the heel bone, and signs of osteoporosis on X-ray of the spine, were evaluated in 26 patients (20 women and 6 men) with giant cell arteritis (GCA), treated with prednisolone for an average period of 5 years. The mean age was 78 years (range 66-95 years). These results were compared with those obtained from a large population study of individuals aged 72, 75, 82 and 85 years. An increase of obvious and severe spinal osteoporosis from 16 to 85% was observed in the women in the population study between the ages of 72 and 85. No additional osteoporosis that could be attributed to the cortisone treatment was found among the GCA patients. The bone mineral content was not reduced in the patients compared to the general population. We conclude that there is no justification for attempting non-steroid treatment in GCA on account of the risk of osteoporosis. Corticosteroids are the only safe treatment for prevention of complications of GCA.
Collapse
Affiliation(s)
- R Andersson
- Department of Infectious Diseases, Ostra Hospital, Göteborg, Sweden
| | | | | | | | | | | |
Collapse
|
36
|
|
37
|
Paice EW. Giant cell arteritis: difficult decisions in diagnosis, investigation and treatment. Postgrad Med J 1989; 65:743-7. [PMID: 2694137 PMCID: PMC2429811 DOI: 10.1136/pgmj.65.768.743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- E W Paice
- Department of Rheumatism and Rehabilitation, Whittington Hospital, Hill, London, UK
| |
Collapse
|
38
|
Landin K, Bengtsson BA, Wilhelmsen L. Addison's disease, malignant lymphoma and death from cerebral giant cell arteritis. J Intern Med 1989; 226:205-7. [PMID: 2794851 DOI: 10.1111/j.1365-2796.1989.tb01381.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 61-year-old woman with Addison's disease and malignant lymphoma for several years was admitted to hospital with a 2-month history of fatigue and a 7 kg weight loss. The erythrocyte sedimentation rate was 92 mm h-1 and a temporal biopsy was performed as a part of the clinical investigation. She suddenly suffered a paresis of the right arm, sudden blindness and her blood pressure fell to 100/60 mmHg. Hydrocortisone was given intravenously followed by betamethasone, and an Addison crisis as well as a giant cell arteritis (GCA) was suspected. Activity in the malignant lymphoma was also a possibility. The patient did not improve and died 8 d later. The temporal biopsy indicated GCA. The autopsy showed a pronounced intimal inflammatory reaction of the intracerebral arteries and an infarction in the left posterior hemisphere. A possible link between GCA and other autoimmune diseases is discussed.
Collapse
Affiliation(s)
- K Landin
- Department of Medicine II, Sahlgrenska Hospital, Gothenburg, Sweden
| | | | | |
Collapse
|
39
|
Nordborg E, Bengtsson BA. Death rates and causes of death in 284 consecutive patients with giant cell arteritis confirmed by biopsy. BMJ (CLINICAL RESEARCH ED.) 1989; 299:549-50. [PMID: 2507065 PMCID: PMC1837376 DOI: 10.1136/bmj.299.6698.549] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|