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.
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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