Background/Purpose:
This study aimed to 1)
catalogue damage in a longitudinal cohort of patients with giant cell arteritis (GCA) and 2) evaluate predictors of damage in GCA. 

   Methods:
Patients with GCA enrolled
in a prospective, multicenter, longitudinal study were included. Periodic
assessment included a standardized
protocol with the Vasculitis Damage Index (VDI) and the Large-Vessel
Vasculitis Index of Damage (LVVID). Univariate
analyses were used to evaluate predictors of any damage at last follow-up and
accrual of new damage during follow-up.

   Results: The study included 204 patients with GCA:
156 women (76%); mean age at diagnosis = 71.3±8.3 years; median (25^th,
75^th quartiles) time from diagnosis to entry in the cohort was 3.7
(1.0, 16.5) months. Mean (±SD) duration of follow-up for the cohort was 3.5
(±1.9) years.

At least 1 damage
item was present on VDI in 54% of patients at baseline and 79% at last
follow-up. For LVVID, at least 1 damage item was present in 60% at baseline and
82% at last follow-up. At least 1 damage item was recorded in 46/114 (40%) of
patients diagnosed ≤180 days prior to study entry on VDI compared to
64/87 (74%) with disease duration >180 days (p<0.0001). Similarly, 55/116
(47%) of patients diagnosed ≤180 days prior to study entry had at least 1
item by LVVID compared to 68/87 (78%) with disease duration >180 days
(p<0.0001).

At last follow-up,
at least 1 new item of damage was
noted in 55% patients on VDI and 60% on LVVID. The median number of new damage
items accrued was 1 (0-8) on VDI and 1 (0-8) on LVVID. The majority of the new
damage items were cataracts (40%), hypertension (20%), osteoporosis (20%), new
limb claudication/arterial occlusion/infarction (29%) and damage requiring
vascular intervention (angioplasty, stent, bypass, 9%). Organ systems with
damage at baseline and last follow-up are in the Table.

Only disease
duration was associated with presence of any damage item at last follow-up (OR
1.22; 95% CI l 1.04, 1.44). Age at diagnosis, sex, any
relapse, number of relapses, highest Birmingham Vasculitis Activity Score
(BVAS) or highest Physician Global Assessment (PGA) were not associated
with presence of damage.

Predictors of
accrual of new damage were evaluated in
94 patients with newly-diagnosed GCA (enrolled within 90 days of GCA diagnosis)
with mean (±SD) duration of follow-up 3.1 (±1.7) years. Age,
sex, any relapse, number of relapses, highest BVAS, or highest PGA were
not associated with new damage during follow-up. 

  
Conclusion: Damage from vasculitis or
its treatment is present in 40-50% of patients with GCA within 6 months of
diagnosis, and, in >75% during follow-up. Most of the new damage accrued
during follow-up is treatment-associated; however, significant
disease-associated damage, especially from peripheral arterial manifestations
also occurs. These results emphasize the cumulative burden of disease
associated with GCA even after initial diagnosis and treatment.