Background/Purpose:  Our aim was to describe patients with Giant-Cell Arteritis (GCA)-related stroke and to compare them to a control group of GCA patients without cerebrovascular involvement.

Methods:  We created a retrospective multicenter cohort of patients with 1) GCA diagnosed according to the American College of Rheumatology (ACR) criteria between 1995 and 2015; 2) stroke revealing vasculitis or occurring within four weeks of starting GCA therapy. The control group comprised GCA patients with no history of stroke from patient-reporting centers. For each patient included with stroke, five randomised patients without stroke were included in the control group. All of them satisfied the ACR criteria

Results:  Forty patients (21 (53%) women, median age 78 [60-91] years) with GCA-related stroke were included and were compared to 200 control patients with GCA. The stroke revealed GCA in 29 (73%) patients, whereas it occurred after diagnosis in 11 patients, 6 [1-14] days after the initiation of glucocorticosteroids (GC). No differences were observed between patients whose stroke revealed GCA and those suffering a stroke following GCA diagnosis. Vertebrobasilar territory was involved in 29 (73%) patients. Seven patients died within a few hours or days following a stroke. Compared to the control group, the stroke patients were older (78 [60-91] vs. 74 [50-94] years old, p=0.03), displayed more ophthalmic ischemic manifestations (25 (63%) vs. 50 (25%), p<0.001), had fewer anemia (22/37 (59%) vs. 137/167 (79%), p=0.03) and a higher level of hemoglobin at diagnosis (12.0 [9.4-16.1] vs. 11.1 [7.8-15.8] g/dl, p=0.02). Conversely, PMR was less frequent (8 (20%) vs. 76/198 (38%), p=0.03) and biological inflammatory parameters were lower at GCA diagnosis in patients with GCA-related stroke (ESR: 68 [10-119] mm vs. 80 [10-140], p=0.003; CRP: 61 [28-185] mg/l vs. 99 [6-400], p=0.04). Multivariate logistic regression revealed that the best predictors for the occurrence of stroke were the presence of ophthalmic ischemic manifestations at diagnosis (OR = 5, 95% CI, 2.14—12.33; p=0.0002) and absence of anemia (OR = 0.39, 95% CI, 0.16—0.99; p=0.04).

Conclusion:  Stroke, especially in the vertebrobasilar territory, is more likely to occur in GCA patients who experience recent ophthalmic ischemic manifestations and who display low inflammatory parameters.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/giant-cell-arteritis-related-stroke-a-retrospective-multicentre-case-control-study/