Session 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||
(number of patients)
double or triple positive
|Gender (F) (%)||57.7||66.7||
|Age (years; median, IQR)||73.6 (68.7; 78.8)||75.1 (67.3; 78.5)||70.9 (66.4; 77.2)|
|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|
|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*)|
|Dry cough (%)||15.4||23.1||37.5|
|Clin. changed TA (%)||53.8||74.4||53.1|
|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 (%)||
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;
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 December 1, 2020.
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