Risk of Mortality of Patients with Giant Cell Arteritis: A Systematic Review and Meta-Analysis

Catherine Hill¹, Rachel Black², Johannes Nossent³, Carlee Ruediger⁴, Jem Ninan⁵ and Susan Lester⁶, ¹Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia, ²Medicine, University of Adelaide, Adelaide, Australia, ³Medicine, University of Western Australia, WA, Australia, ⁴Rheumatology, The Queen Elizabeth Hospital, Woodville, Australia, ⁵Rheumatology, Modbury Hospital, Modbury, Australia, ⁶Rheumatology, Basil Hetzel Institute, QEH, Woodville South, Australia

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: giant cell arteritis, meta-analysis and morbidity and mortality

Session Information

Date: Monday, November 9, 2015

Title: Vasculitis Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Previous
studies of mortality associated with GCA have shown conflicting results.We
conducted a systematic review and meta-analysis of observational studies to
compare the mortality risk in patients with GCA compared to the general
population.

Methods: We searched for
published studies indexed in MEDLINE and EMBASE and the Cochrane database from
inception to June 18, 2015 using the terms “giant cell arteritis” and “temporal
arteritis” combined with the terms for death, mortality and survival. A manual
search of references of retrieved articles was also performed.

The inclusion criteria
were (1) observational studies of biopsy-proven GCA published as original
studies to evaluate the association between GCA and mortality (2) comparison of
mortality of patients to general
population. No language limitation was imposed. Studies published only
in abstract form were excluded.

Study eligibility was
independently determined by the two investigators. Differing decisions were
resolved by consensus with a third reviewer. The quality of each study was
independently assessed by the two investigators using Newcastle-Ottawa scale.

Studies were included in
the meta-analysis, if numerical data was extractable from the published paper.
This included studies in which the standardised mortality ratio (SMR), relative
risk (RR’s), hazard ratio (HRs) were provided. If data was only presented in
graph form, then the graphs were digitized and the HR estimated from a
cumulative complementary log-log regression model. The R library metaphor was
used to perform a random effects, inverse variance weighted meta-analysis.

Results: Out of 435 potentially
relevant articles, 60 full papers were reviewed and subsequently 23 studies were
included. This included 21 studies published in English, one in Norwegian and
one in French, with publication dates from 1971-2015. There were 5092 cases of GCA
(range 19-1787). The majority of studies were from Nordic countries (n=10), North
America (5), France (3), UK (2), Spain (1), Israel (1) and Australia (1). Usable
data was obtained from 20/23 studies. The combined SMR for GCA mortality indicated
a small increase in mortality with GCA: SMR 1.15, 95% CI 1.01, 1.30), p = 0.035.
There was evidence of heterogeneity between studies (I² = 77%).

Conclusion: This meta-analysis
demonstrated that there is an increased mortality associated with GCA, compared
to the general population. However, this increase is small, although
statistically significant.

Disclosure: C. Hill, None; R. Black, None; J. Nossent, None; C. Ruediger, None; J. Ninan, None; S. Lester, None.

To cite this abstract in AMA style:

Hill C, Black R, Nossent J, Ruediger C, Ninan J, Lester S. Risk of Mortality of Patients with Giant Cell Arteritis: A Systematic Review and Meta-Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/risk-of-mortality-of-patients-with-giant-cell-arteritis-a-systematic-review-and-meta-analysis/. Accessed .

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