ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 863

Arterial Lesions in Giant Cell Arteritis

Tanaz A. Kermani1, Sehriban Diab2, Antoine Sreih3, David Cuthbertson4, Renee Borchin5, Simon Carette6, Lindsy J. Forbess7, Gary S. Hoffman8, Curry L. Koening9, Carol A. McAlear10, Paul A. Monach11, Larry W. Moreland12, Christian Pagnoux13, Philip Seo14, Robert F. Spiera15, Kenneth J. Warrington16, Steven R. Ytterberg17, Carol A. Langford18, Nader A. Khalidi19 and Peter A. Merkel20, 1Rheumatology, University of California Los Angeles, Santa Monica, CA, 2St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada, 3Department of Rheumatology, University of Pennsylvania, Philadelphia, PA, 4Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL, 5University of South Florida, Tampa, FL, 6Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 7Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, 8Rheumatic & Immunologic Dis, Cleveland Clinic Foundation, Cleveland, OH, 9Rheumatology, University of Utah, Salt Lake City, UT, 10University of Pennsylvania, Philadelphia, PA, 11Rheumatology, Boston University School of Medicine, Boston, MA, 12Rheumatology & Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, 13Division of Rheumatology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Canada, Toronto, ON, Canada, 14Medicine, Johns Hopkins University, Baltimore, MD, 15Hospital for Special Surgery, Cornell, New York, NY, 16Rheumatology, University of California Los Angeles, CA, USA Mayo, Rochester, MN, 17Rheumatology, Mayo Clinic, Rochester, MN, 18Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, 19Division of Rheumatology, St. Joseph’s Health Care, McMaster University, Hamilton, ON, Canada, 20Division of Rheumatology, University of Pennsylvania, Philadelphia, PA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Vasculitis - Poster I: Large Vessel Vasculitis and Polymyalgia Rheumatica

Session Type: ACR Poster Session A

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

   

Background/Purpose: This study aimed to describe large arterial lesions among patients with giant cell arteritis (GCA) and to understand what clinical characteristics are associated with development of new arterial lesions during follow-up.   

Methods: Patients with GCA enrolled in a prospective, multicenter, longitudinal study and/or a clinical trial were included. All patients were followed with standardized clinical assessments, including data from arterial imaging (stenoses, occlusions, aneurysms, and dissections). New lesions were defined as any new findings in a previously unaffected arterial segment.   

Results: Data on imaging of the aorta and its branches were available for 187 patients with GCA: 146 (78%) female, mean (±SD) age at diagnosis 68.5 (±8.5) years. Mean (±SD) duration of follow-up was 3.8 (±2.3) years. Disease duration at entry into the cohort was within 1 year for 124 subjects (56%). At least one arterial lesion was present in 110 (58%) patients on entry into the cohort; 72 patients (65%) with disease duration <1 year. Subclavian (62 patients, 33%) and axillary arteries (47 patients, 25%) were the most frequently involved (Table 1). Serial imaging was available in 108 (58%) of the entire cohort; 76 (69%) of 110 with any lesion at baseline. Median (range) number of imaging studies was 3 (1-10). New arterial lesions were noted in 39 (36%) with new axillary and/or subclavian artery involvement being the most frequently observed (Table 1). Only 33% of 18 patients with new subclavian and/or axillary lesions had symptoms of upper extremity claudication since the prior visit or at the time of the visit. Clinical symptoms of any active disease since the last visit or at the day time of the visit were present only in 14 of the 56 visits (25%) where a new angiographic lesion was first reported. There were no differences in age, sex, disease duration, duration of follow-up, or presence of any disease activity during follow-up between patients with and without new lesions (Table 2). Medication use including adjunctive immunosuppressive treatment at last follow-up is in Table 2.   

Conclusion: New arterial lesions on serial imaging are common in patients with GCA, especially among patients with established large-vessel involvement. The majority of new lesions identified through use of serial angiography occur in patients who do not have symptoms of active disease at the time new findings were noted. Additional studies are needed to further understand the role of serial imaging, significance of new arterial lesions, and impact of treatment on large-vessel disease in patients with GCA.  

Table 1: Distribution and frequency of arterial involvement at first and on follow-up imaging in patients with giant cell arteritis
  Arterial Territory

Number of patients with any involvement on baseline imaging

(Total = 187)

Number of patients with any new lesions on follow-up imaging

(Total = 108)

  Thoracic Aorta (overall)

20

6

 

·  Thoracic Root

13

6

 

·  Arch

6

2

 

·  Descending Thoracic Aorta

6

1

  Abdominal Aorta (overall)

6

1

 

·  Suprarenal Abdominal Aorta

2

0

 

·  Infrarenal Abdominal Aorta

6

1

  Common carotid

13

9

  External Carotid

3

2

  Internal Carotid

16

4

  Vertebral

17

4

  Innominate

7

4

  Subclavian

62

16

  Axillary

47

15

  Mesenteric

14

6

  Renal

20

6

  Iliac

15

5

 

Table 2: Comparison of patients with giant cell arteritis with and without new arterial lesions on follow-up imaging.

Variable

New lesions (N=39)

No new lesions (N=69)

p-value

Mean age

67.4 years

67.0 years

0.78

Mean disease duration

1.42 years

1.43 years

1.0

Disease duration ≤1 year

14 (36%)

25 (37%)

1.0

Mean duration of follow-up

4.0 years

4.2 years

0.44

Female

33 (85%)

60 (87%)

0.78

Positive biopsy

14/17 (82%)

32/45 (71%)

0.52

Median number studies

4.5 (1-10)

2.5 (2-7)

<0.01

Any lesion at first imaging

37 (95%)

48 (70%)

<0.01

Any activity

14 (35%)

29 (42%)

0.55

Aspirin use at last follow-up

25 (64%)

31 (45%)

0.07

Prednisone use at last follow-up

33 (85%)

34 (49%)

<0.01

Methotrexate use at last follow-up

10 (24%)

12 (17%)

0.33

Azathioprine use at last follow-up

2 (5%)

2 (3%)

0.62

 

Disclosure: T. A. Kermani, GlaxoSmithKline, 2; S. Diab, None; A. Sreih, Bristol-Myers Squibb, 2,Celgene, 2,Chemocentryx, 2,Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2,Krog and Partners, 5; D. Cuthbertson, None; R. Borchin, None; S. Carette, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2; L. J. Forbess, None; G. S. Hoffman, None; C. L. Koening, None; C. A. McAlear, None; P. A. Monach, Genentech and Biogen IDEC Inc., 2,Bristol-Myers Squibb, 2,MedScape, 5,GlaxoSmithKline, 2,Vasculitis Foundation Board of Directors, 6,Editorial Board of Arthritis and Rheumatology, 6; L. W. Moreland, Genentech and Biogen IDEC Inc., 2,Pfizer Inc, 2,questcor, 2,Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2,Pfizer Inc, 5,Boehringer Ingelheim, 5,Acerta, 5,CVS/Caremark, 5,Smith Kline Beecham, 5; C. Pagnoux, Chemocentryx, 5,Chemocentryx, 9,Roche Pharmaceuticals, 9,Roche Pharmaceuticals, 5,Sanofi-Aventis Pharmaceutical, 5,Hoffmann-La Roche, Inc., 8; P. Seo, None; R. F. Spiera, GlaxoSmithKline, 2,Roche Pharmaceuticals, 2,Boehringer Ingelheim, 2,PRISM, 2,Cytori, 2,Corbus Pharmaceuticals, 2,GlaxoSmithKline, 5,Roche Pharmaceuticals, 5,Boehringer Ingelheim, 5,Bristol-Myers Squibb, 2; K. J. Warrington, GlaxoSmithKline, 2; S. R. Ytterberg, Sanofi-Aventis Pharmaceutical, 5; C. A. Langford, Genentech and Biogen IDEC Inc., 2,GlaxoSmithKline, 2,Bristol-Myers Squibb, 2; N. A. Khalidi, Roche Pharmaceuticals, 2,Bristol-Myers Squibb, 2; P. A. Merkel, Bristol Myers Squibb, 2,CaridianBCT, 2,Celgene, 2,Chemocentryx, 2,Genentech/Roche, 2,GlaxoSmithKline, 2,Kypha, 2,Bristol-Myers Squibb, 5,Chemocentryx, 5,Genentech/Roche, 5,GlaxoSmithKline, 5,PrinicipioBio, 5,Auven, 5,Proteon Therapeutics, 5.

To cite this abstract in AMA style:

Kermani TA, Diab S, Sreih A, Cuthbertson D, Borchin R, Carette S, Forbess LJ, Hoffman GS, Koening CL, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Spiera RF, Warrington KJ, Ytterberg SR, Langford CA, Khalidi NA, Merkel PA. Arterial Lesions in Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/arterial-lesions-in-giant-cell-arteritis/. Accessed .

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