ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 795

Characteristics and Treatment Outcomes of Giant Cell Arteritis with Large-Vessel Lesions in a Nationwide, Retrospective Cohort Study in Japan

Takahiko Sugihara1, Hitoshi Hasegawa2, Haruhito Uchida3, Hajime Yoshifuji4, Yoshikazu Nakaoka5, Yoshiko Watanabe6, Eisuke Amiya7, Masanori Konishi8, Yasuhiro Katsumata9, Yoshinori Komagata10, Taio Naniwa11,12, Takahiro Okazaki13, Yoshiya Tanaka14, Tsutomu Takeuchi15, Masayoshi Harigai16, Yoshihiro Arimura17 and Mitsuaki Isobe8,18, 1Department of Medicine and Rheumatology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan, 2Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan, 3Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan, 4Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan, 5Osaka University Graduate School of Medicine, Osaka, Japan, 6First Department of Physiology, Kawasaki Medical School, Kurashiki, Japan, 7Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine, Tokyo, Japan, 8Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan, 9Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan, 10First Dept. of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan, 11Division of Rheumatology, Dept of Internal Medicine,, Nagoya City University Hospital, Nagoya, Japan, 12Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 13Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan, 14The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan, 15Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan, 16Division of Epidemiology and Pharmacoepidemiology of Rheumatic Diseases, Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan, 17First Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan, 18Sakakibara Heart Institute, Tokyo, Japan

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , , ,

Session Information

Date: Sunday, November 5, 2017

Session Title: Vasculitis Poster I: Large Vessel Vasculitis

Session Type: ACR Poster Session A

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

Background/Purpose: Giant cell arteritis (GCA) often affects aorta or its branches, but it is unclear whether the large-vessel (LV) lesions are associated with treatment outcomes. The objective of this study was to evaluate clinical features of GCA with LV lesions and their associations with treatment outcomes in Japanese patients with GCA.

Methods: From a retrospective, multi-center, nationwide registry of GCA and Takayasu arteritis (TAK), we selected 137 newly diagnosed GCA patients who were treated with glucocorticoids (GCs) and 4 relapsed patients who were treated with GCs between 2007 and 2014. Differential diagnosis of GCA and elderly-onset TAK was made by the discretion of the site investigators, while 110 out of the 141 patients satisfied the ACR classification criteria for GCA. The primary outcomes were achievement of remission (disappearance of clinical symptoms with normal C-reactive protein) and remission at low dose GCs (prednisolone (PSL) ≤7.5mg/day).

Results: Imaging examinations were performed in 100 of the 141 GCA, and 69 of them had LV lesions. Stenosis and aneurysm of the aorta or its branches were detected in 18 (26%) and 9 (13%) of the 69 GCA patients, respectively. On the other hand, inflammatory lesion of arterial wall was detected in 51 (74%) patients with enhanced CT, MRI or PET-CT. Of the 69 GCA patients with LV lesions, 34 had inflammatory lesions in left subclavian artery (a.), 29 in right subclavian a., 29 in left carotid a., 23 in right carotid a., 21 in ascending thoracic aorta, 31 in aortic arch, 32 in descending thoracic aorta, and 35 in abdominal aorta. We compared GCA patients with LV lesions by imaging (LVL group, n=69) and the others (non-LVL group, n=72) for clinical features and treatment response. Headache, abnormal temporal artery, jaw claudication, visual disturbance, and musculoskeletal manifestations were observed in 39%, 39%, 25%, 12% and 52% of the LVL group and in 81%, 75%, 47%, 38% and 65% of the non-LVL group. Initial PSL doses (mean ± standard deviation) were 0.78 ± 0.21 and 0.75 ± 0.25 mg/kg/day, and concomitant immunosuppressive drugs were used in 48% and 33% throughout observational period of two years, for the LVL group and the non-LVL group, respectively. Remission was achieved in 94% and 96% of the LVL group and the non-LVL group, and relapse-free survival rates were not significantly different between the two groups. The log-rank test showed cumulative rate of remission at low dose GCs was significantly lower in the LVL group compared to the non-LVL group.

Conclusion: LV lesions in Japanese patients with GCA were mostly limited to inflammation of arterial wall without stenosis or aneurysm formation, but were associated with poorer treatment outcomes.

Disclosure: T. Sugihara, Takeda Pharmaceutical Co. Ltd., Mitsubishi-Tanabe Pharma Co., Chugai Pharmaceutical Co., Ltd., Ayumi Pharmaceutical Co., Ltd., UCB Japan Co. Ltd, Astellas Pharma Inc., Janssen Pharmaceutical K.K., Pfizer Japan Inc., and Bristol Myers Squibb K.K, 5; H. Hasegawa, None; H. Uchida, None; H. Yoshifuji, None; Y. Nakaoka, Chugai, Takeda, 2,Chugai, Daiichi Sankyo, MSD, Kowa, 8,Chugai, 5; Y. Watanabe, None; E. Amiya, None; M. Konishi, None; Y. Katsumata, Chugai Pharmaceutical Co., Ltd., Astellas Pharma Inc., Takeda Pharmaceutical Company Limited., Bayer Yakuhin, Ltd., AYUMI Pharmaceutical Corporation, 5; Y. Komagata, None; T. Naniwa, Chugai, Eisai, Tanabe-Chugai, Eisai, Tanabe-Mitsubishi, Ono, Teijin, Chugai, Eisai, Tanabe-Mitsubishi, Ono, Teijin, Daiichi-Sankyo, 2,Chugai, Eisai, Tanabe-Mitsubishi, Ono, Teijin, Pfizer, Janssen, Abbvie, Astellas, 5; T. Okazaki, None; Y. Tanaka, Mitsubishi-Tanabe, Takeda, Daiichi-Sankyo, Chugai, Bristol-Myers, MSD, Astellas, Abbvie, Eisai, 2,Abbvie, Chugai, Daiichi-Sankyo, Bristol-Myers, Mitsubishi-Tanabe, Astellas, Takeda, Pfizer, Teijin, Asahi-kasei, YL Biologics, Sanofi, Janssen, Eli Lilly, GlaxoSmithKline, 8; T. Takeuchi, Astra Zeneca K.K., Eli Lilly Japan K.K., Novartis Pharma K.K., Mitsubishi Tanabe Pharma Co., Abbivie GK, Nipponkayaku Co.Ltd, Janssen Pharmaceutical K.K., Astellas Pharma Inc,.Taiho Pharmaceutical Co., Ltd.,, 5,AbbVie GK., Bristol–Myers K.K., Chugai Pharmaceutical Co,. Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., and Astellas Pharma Inc, and Diaichi Sankyo Co.,Ltd., 8; M. Harigai, Eisai Ltd, Takeda Ltd, Teijin, 2,Eli Lilly and Company, BMS, Chugai, Janssen, 5; Y. Arimura, None; M. Isobe, None.

To cite this abstract in AMA style:

Sugihara T, Hasegawa H, Uchida H, Yoshifuji H, Nakaoka Y, Watanabe Y, Amiya E, Konishi M, Katsumata Y, Komagata Y, Naniwa T, Okazaki T, Tanaka Y, Takeuchi T, Harigai M, Arimura Y, Isobe M. Characteristics and Treatment Outcomes of Giant Cell Arteritis with Large-Vessel Lesions in a Nationwide, Retrospective Cohort Study in Japan [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/characteristics-and-treatment-outcomes-of-giant-cell-arteritis-with-large-vessel-lesions-in-a-nationwide-retrospective-cohort-study-in-japan/. Accessed November 13, 2019.

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