Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) are close-related entities. Imaging studies have suggested that subclinical inflammation of the large arteries is frequent in patients with apparently isolated PMR. Our objective was to compare characteristics of PMR patients who developed a thoracic aortic aneurysm (TAA) during follow-up with those who did not, in order to identify clinical features that may predict aortic involvement in clinical PMR patients.
Methods: All electronic medical records of PMR patients diagnosed after year 2000 (fulfilling ACR 2012 criteria) from a university hospital-based health management organization (HMO) were reviewed. Patients with a previous diagnosis of aortic aneurysm, those who developed clinical GCA or other rheumatic disease after PMR diagnosis and those lost in follow-up or without appropriate thoracic images after diagnosis, were excluded. A case-control study (PMR-TAA versus PMR without TAA) was performed and patients’ characteristics were compared. A multivariate logistic regression analysis was performed to identify risk factors for TAA.
Results: 350 PMR patients were included (724 were excluded for the reasons mentioned in methods) and 50 (14.3%, 95% CI 10.9-18.4) developed a TAA during a median follow up of 5.4 years (IQR 2.9-7.9). 18 TAA were located at the aortic root and 32 at ascendant aorta, with a medium size at diagnosis of 4.3 cm (SD 0.33). No ruptures or dissections occurred but 5 patients (10 %, 95% CI 4.2-22.1) required surgery. Patients’ characteristics are shown in Table 1. Traditional cardiovascular risk factors and clinical characteristics of PMR were similar across groups, except for less statins use and longer treatment with steroids in PMR-TAA group. In the multivariate logistic regression analysis, being a male (OR 4,4, CI 2.3-8.6, p <0.001) and months of corticosterioid treatment, (OR 1.02, 95% CI 1.01-1.03, p 0.01) were associated with an increased risk of TAA. Statins use seemed to be protective, although did not reach statistical significance (OR: 0.48, 95% CI 0.23-1.002; p=0.051).
Conclusion: 14.3 % of apparently isolated PMR developed a thoracic aortic aneurysm. Screening with thoracic images in PMR male patients and those PMR patients requiring a prolonged corticosteroid use may be advisable.
Table1. Demographic characteristics in PMR patients with and without thoracic aortic aneurysm.
To cite this abstract in AMA style:Marin Zucaro NM, Scolnik M, Mollerach FB, Scaglioni V, Lo Giudice LF, Martinez P JM, Jaramillo Gallego JF, Soriano ER. Development of Thoracic Aortic Aneurysms in Patients with Polymyalgia Rheumatica: Underdiagnosed Giant Cell Arteritis? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/development-of-thoracic-aortic-aneurysms-in-patients-with-polymyalgia-rheumatica-underdiagnosed-giant-cell-arteritis/. Accessed December 10, 2019.
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