ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 816

Development of Thoracic Aortic Aneurysms in Patients with Polymyalgia Rheumatica: Underdiagnosed Giant Cell Arteritis?

Nicolas Martin Marin Zucaro1, Marina Scolnik2, Florencia Beatriz Mollerach3, Valeria Scaglioni2, Luciano Fernando Lo Giudice1, Jose Maximiliano Martinez P4, John Fredy Jaramillo Gallego1 and Enrique R Soriano5, 1Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Capital Federal, Argentina, 2Rheumatology Unit, Internal Medicine Service. Hospital Italiano Buenos Aires. Argentina, Buenos Aires, Argentina, 3Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 4Rheumatology, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 5Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, CABA, Argentina

Meeting: ACR/ARHP Annual Meeting 2018

Keywords:

Session Information

Date: Sunday, October 21, 2018

Title: Vasculitis Poster I: Non-ANCA-Associated and Related Disorders

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.

PMR with Thoracic aortic aneurysm

(n=50)

PMR without aneurism

(n=300)

P

Age at PMR diagnosis, media (SD)

75.3 (7.4)

75.0 (8.1)

0.84

Female, n (%, CI)

25 (50.0, 36.3-63.7)

239 (79.7, 74.7-83.9)

<0.001

Follow up after PMR diagnosis, years, median (IQR)

6.7 (4.1-10.4)

5.2 (2.7-7.5)

0.003

Arterial hypertension, n (%, CI)

36 (72.0, 57.9-82.8)

215 (71.7, 66.3-76.5)

0.96

Diabetes, n (%, CI)

4 (8.0, 2.9-15.7)

27 (9.0, 6.2-12.8)

0.82

Ever smoker, n (%, CI)

16 (32.0, 20.5-46.2)

79 (26.3, 21.6-31.6)

0.40

Dyslipidemia, n (%, CI)

18 (36.0, 23.8-50.2)

150 (50.0, 44.3-55.7)

0.07

Obesity, n (%, CI)

12 (24.0, 14.1-37.9)

93 (31.0, 25.9-36.5)

0.32

Cardiovascular event previous, n (%, CI)

8 (16.0, 8.1-29.1)

30 (10.0, 7.1-13.9)

0.21

Abdominal aortic aneurysm, n (%, CI)

1 (2.0, 0.3-13.2)

2 (0.7, 0.2-2.6)

0.34

Statin use, n (%, CI)

12 (24.0, 14.1-37.9)

128 (42.7, 37.1-48.4)

0.01

Aspirin use, n (%, CI)

12 (24.0, 14.1-37.9)

30 (10.0, 7.1-13.9)

0.21

Beta Blocker use, n (%, CI)

12 (24.0, 14.1-37.9)

77 (25.7, 21.0-30.9)

0.80

Erythrosedimentation rateat diagnosis, media (SD)

53.9 (21.9)

54.6 (24.0)

0.84

Hemoglobin at diagnosis, media (SD)

12.3 (1.5)

12.2 (1.3)

0.84

Shoulder girdle pain at diagnosis, n (%, CI)

49 (98.0, 86.8-99.7)

282 (94.0, 90.6-96.2)

0.25

Pelvic girdle pain, n (%, CI)

38 (76.0, 62.1-85.9)

231 (77.0, 71.9-81.4)

0.88

Arthritis at diagnosis, n (%, CI)

6 (12.0, 5.4-24.4)

24 (8.0, 5.4-11.7)

0.35

Initial corticosteroid dose, meprednisone/d, media (SD)

10.2 (5.7)

9.3 (4.2)

0.21

Months with corticosteroid treatment, median (IQR)

22.8 (17.3-46.2)

19.5 (14.2-32.7)

0.02

Recurrences while corticosteroid tapering, n (%, CI)

21 (42.0, 29.1-56.1)

105 (35.0, 29.8-40.6)

0.34

More than one recurrence, n (%, CI)

8 (16.0, 8.1-29.1)

73 (24.3, 19.8-29.5)

0.19

Relapses after finishing corticosteroids, n (%, CI)

7 (14.0, 6.7-26.8)

33 (11.0, 7.9-15.1)

0.54

Methotrexate use, n (%, CI)

4 (8.0, 2.9-19.7)

16 (5.3, 3.3-8.5)

0.45

Disclosure: N. M. Marin Zucaro, None; M. Scolnik, None; F. B. Mollerach, None; V. Scaglioni, None; L. F. Lo Giudice, None; J. M. Martinez P, None; J. F. Jaramillo Gallego, None; E. R. Soriano, AbbVie, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer Inc, Roche, UCB, 2,AbbVie, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, 5,AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sandoz, UCB, 8.

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 9). https://acrabstracts.org/abstract/development-of-thoracic-aortic-aneurysms-in-patients-with-polymyalgia-rheumatica-underdiagnosed-giant-cell-arteritis/. Accessed .

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