Session Information
Date: Wednesday, November 16, 2016
Title: Vasculitis IV: Diagnosis and Assessment of Disease Activity
Session Type: ACR Concurrent Abstract Session
Session Time: 9:00AM-10:30AM
Background/Purpose: The aim of our prospective study was to evaluate the potential impact of the antiphospholipid antibodies (aPL-Abs) on the clinical presentation of giant cell arteritis (GCA).
Methods: GCA patients diagnosed for the first time between 1 September 2011 and 30 April 2016 at our secondary/tertiary rheumatology center and in whom aPL-Abs were determined at presentation were included. Three types of aPL-Abs were studied in the patients’ sera: anticardiolipin antibodies (aCL; IgG and IgM isotype), antibodies to β2-glycoprotein 1 (aβ2GP1; IgG, IgM and IgA isotypes) and lupus anticoagulants (LA). The patients were stratified according to the number of positive aPL-Abs tests into three groups: without aPL-Abs, those with a single aPL-Ab and those with two or more aPL-Abs. Medical records of GCA cases were analyzed and data compared between the three groups.
Results: During the 56-month observation period we performed aPL-Abs tests in 97/115 GCA patients (67 (69%) females, median (IQR) age 73.3 (67.2; 78.2) years). aCL, aβ2GP1 and LA were present in 47 (48%), 17 (18%) and 44 (45%) cases, respectively. 39 (40%) patients had single aPL-Ab, 28% had two and 5% had three aPL-Abs. aPL-Abs were not detected in 26 (27%) patients. Characteristics of aPL-Abs negative vs. positive (single and double or triple) groups are presented in Table 1. GCA patients with at least two aPL-Abs had more commonly had severe visual manifestations (transient and permanent visual loss) at presentation (100% vs. 22% of all visual disturbances; p=0.021), as well as symptoms (19% vs. 0%, p=0.029) and ultrasonographic signs of large vessel vasculitis (62% vs. 33%, p=0.054) than those without aPL-Abs. At least 1 year follow-up data (median (IQR) 101 (50.4; 104.4) weeks) were available in 71 patients. 35 (49%) patients relapsed during follow-up and relapses were not associated with the aPL-Abs positivity at presentation in our group.
| Table 1. GCA and aPL-Abs |
aPL-Abs (number of patients) |
||
|
Clinical characteristics |
aPL negative |
single positive |
double or triple positive |
| N | 26 | 39 |
32 |
| Gender (F) (%) | 57.7 | 66.7 |
81.3 |
| Age (years; median, IQR) | 73.6 (68.7; 78.8) | 75.1 (67.3; 78.5) | 70.9 (66.4; 77.2) |
| Smoking (%) | 38.5 | 38.5 | 43.8 |
| General symptoms (%) | 73.1 | 71.8 | 78.1 |
| Fever (≥38◦C) (%) | 23.1 | 23.1 | 28.1 |
| Weight loss (%) | 53.8 | 53.8 | 71.9 |
| Rheumatic polymyalgia | 23.1 | 15.4 | 12.5 |
| Headache (%) | 69.2 | 74.4 | 62.5 |
| Jaw claudication (%) | 38.5 | 46.2 | 37.5 |
| Visual disturbances (%) | 34.6 | 30.8 | 15.6 |
| TVL or PVL (%) | 7.7 (22.2*) | 10.3 (33.3*) | 15.6 (100.0*) |
| Stroke (%) | 0 | 2.6 | 3.1 |
| Dry cough (%) | 15.4 | 23.1 | 37.5 |
| Clin. changed TA (%) | 53.8 | 74.4 | 53.1 |
| TAB (%) | 81.0 | 80.0 | 88.0 |
| CDS TA (%) | 84.6 | 79.5 | 68.8 |
| LVV – clinically. (%) | 0 | 12.8 | 18.8 |
| LVV – CDS (%) | 33.3 | 56.8 | 62.1 |
| ESR (median, IQR) | 88 (66; 95) | 85 (64; 113) | 95 (75; 109) |
| CRP (median, IQR) | 66 (49; 116) | 76 (48; 129) | 75 (54; 127) |
| Patients with a relapse during follow up (%) |
55.0 |
43.3 |
52.4 |
|
Legend: aPL-Ab antiphospholipid antibody; F female; TVL transient visual loss (amaurosis fugax); PVL permanent visual loss; * % of those with visual disturbances; TA temporal artery; TAB temporal artery biopsy; CDS color Doppler sonography; LVV large vessel vasculitis; ESR erythrocyte sedimentation rate; CRP C-reactive protein; |
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Conclusion: Our results indicate that aPL-Abs could identify a subgroup of GCA patients with severe visual manifestations and extracranial large vessel disease.
To cite this abstract in AMA style:
Hocevar A, Jese R, Rotar Z, Žigon P, Čučnik S, Tomšič M. Antiphospoholipid Antibodies in Giant Cell Arteritis. What Can They Tell Us? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/antiphospoholipid-antibodies-in-giant-cell-arteritis-what-can-they-tell-us/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/antiphospoholipid-antibodies-in-giant-cell-arteritis-what-can-they-tell-us/