Extension of Extracranial Vessel Involvement in Patients with Giant Cell Arteritis

Monica Calderón Goercke¹, Javier Loricera², Diana Prieto Peña¹, Francisco Javier Narváez³, Elena Aurrecoechea⁴, Ignacio Villa-Blanco⁵, Santos Castañeda⁶, Catalina Gómez-Arango⁷, Antonio Mera⁸, Eva Perez Pampín⁸, Vicente Aldasoro⁹, Noelia Álvarez-Rivas¹⁰, Nagore Fernandez-Llanio Cornella¹¹, Maria Concepcion Alvarez de Buergo¹², Luisa Marena Rojas Vargas¹³, Francisca Sivera¹⁴, Eva Galindez-Agirregoikoa¹⁵, Roser Solans¹⁶, Susana Romero-Yuste¹⁷, Norberto Ortego Centeno¹⁸, Marcelino Revenga Martínez¹⁹, Rafael Melero²⁰, Eva Salgado-Pérez²¹, Sabela Fernández²², José Luis Martín-Varillas²³, Isabel Martínez-Rodríguez²⁴, Ignacio Banzo²⁴, Vanesa Calvo-Río²³, Belén Atienza-Mateo²³, Natalia Palmou-Fontana²³, Carmen González-Vela²⁵, José Luis Hernández², Miguel Angel González-Gay²³ and Ricardo Blanco²³, ¹Rheumatology, Rheumatology. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ³Rheumatology Department, Hospital de Bellvitge. Barcelona. Spain, L’Hospitalet de Llobregat, Spain, ⁴Rheumatology, Hospital de Sierrallana. Torrelavega. Spain, Torrelavega, Spain, ⁵Hospital de Sierrallana. Torrelavega. Spain, Torrelavega, Spain, ⁶Rheumatology, Rheumatology Department, Hospital Universitario la Princesa, IIS-Princesa, Madrid, Spain, ⁷Hospital Alto Deba, Mondragón. Spain, Mondragón, Spain, ⁸Rheumatology Division. Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain, ⁹Hospital Alto Deba. Mondragón. Spain, Mondragon, Spain, ¹⁰Hospital Universitario Lucus Augusti, Lugo. Spain, Lugo, Spain, ¹¹Rheumatology Section. Hospital Arnau de Vilanova, Valencia, Spain, ¹²Rheumatology, Hospital Río Carrión. Palencia. Spain, Palencia, Spain, ¹³Rheumatology Department, Hospital General La Mancha Centro, Alcázar de San Juan, Spain, ¹⁴Rheumatology, Hospital General Universitario de Elda. Comunidad Valenciana. Spain, Elda, Spain, ¹⁵Rheumatology Division, Hospital Universitario de Basurto, Bilbao, Spain, ¹⁶Autoimmune Systemic Diseases Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Autonomous University of Barcelona, Spain, Barcelona, Spain, ¹⁷Hospital de Pontevedra. Spain, Pontevedra, Spain, ¹⁸Medicine Department, Hospital Universitario San Cecilio. Granada. Spain, Granada, Spain, ¹⁹Hospital Universitario Ramón y Cajal. Madrid. Spain, Madrid, Spain, ²⁰Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo. Spain, Vigo, Spain, ²¹Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense. Spain, Ourense, Spain, ²²Rheumatology, Hospital Universitario San Agustín, Avilés. Spain, Avilés, Spain, ²³Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²⁴Nuclear Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²⁵Pathology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: giant cell arteritis, imaging techniques and tocilizumab

Session Information

Date: Tuesday, October 23, 2018

Title: Vasculitis Poster III: Immunosuppressive Therapy in Giant Cell Arteritis and Polymyalgia Rheumatica

Session Type: ACR Poster Session C

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

Background/Purpose: Giant cell arteritis (GCA) is a large vessel vasculitis with a predisposition for the cranial branches of the external carotid artery. However, aorta and / or its main branches may also be involved (1-4). In a series of patients with GCA who presented extracranial vessel involvement, our aim was to assess a) the vascular territories most frequently affected and b) correlation of a major extension of extracranial vascular involvement with a more severe clinical and analytical features.

Methods: Multicenter study of 68 patients with GCA who presented a compromise of extracranial vessels confirmed by PET/CT. Visual analysis of vascular uptake was performed on supra-aortic trunks (SAT), aortic arch (AA), thoracic aorta (TA), abdominal aorta (AA), iliac arteries (IA), lower limb arteries (LLA), and upper limb arteries (ULA).

Results: We evaluated 68 patients with GCA (51w/17m) with a mean age of 68.0±8.3 years. The vascular territories affected were: TA (n=58, 85.29%), SAT (n=38, 55.88%), AA (n=28, 41.18%), AA (n=18, 26.47%), LLA (n=17, 25%), IA (n=13, 19.12%) and ULA (n=6, 8.82%). We considered 3 groups according to the number of vascular territories affected: a) 1 or 2 territories, b) 3 or 4 territories and c) 5 or more territories and made a comparative study between this groups. In patients with ³5 vascular territories affected, we observed a higher baseline ESR, and the most frequent systemic manifestations were polymyalgia rheumatica and constitutional symptoms with statistical significance (TABLE). Distribution of categorical variables was compared by the Pearson Chi-squared test. Quantitative variables were analyzed using the ANOVA test.

Conclusion: In patients with GCA the involvement of TA is very frequent, followed by the SAT and the AA. Regarding the laboratory findings, patients with higher levels of ESR presented a major extension of extracranial vascular involment, as well as presenting PMR and/or constitutional symptoms was also related to more affection of extracranial territories.

	NUMBER OF VASCULAR TERRITORIES AFFECTED			p
ACUTE PHASE REACTANTS	1-2	3-4	³5
CRP, mg/dL mean (SD)	3.1 ± 1.0	5.4 ± 1.8	7.3 ± 3.2	0.315
ESR, mm/1^st hour, mean (SD)	36.8 ± 5.3	44.4 ± 6.2	74.5 ± 13.0	0.031
Hemoglobin, g/dL, mean (SD)	12.4 ± 0.2	12.0 ± 0.4	11.6 ± 0.5	0.438
SYSTEMIC MANIFESTATIONS
Constitutional syndrome, n (%)	6 (17.1)	6 (22.2)	5 (83.3)	0.002
PMR, n (%)	28 (52.9)	23 (85.2)	4 (66.7)	0.03
ISCHEMIC MANIFESTATIONS
Headache, n (%)	11 (31.4)	10 (37)	2 (33.3)	0.898
Jaw claudication, n (%)	1 (2.9)	3 (11.1)	1 (16.7)	0.307
Visual involvement, n (%)	2 (5.7)	2 (7.4)	–	0.783

Disclosure: M. Calderón Goercke, None; J. Loricera, None; D. Prieto Peña, None; F. J. Narváez, None; E. Aurrecoechea, None; I. Villa-Blanco, None; S. Castañeda, None; C. Gómez-Arango, None; A. Mera, None; E. Perez Pampín, None; V. Aldasoro, None; N. Álvarez-Rivas, None; N. Fernandez-Llanio Cornella, None; M. C. Alvarez de Buergo, None; L. M. Rojas Vargas, None; F. Sivera, None; E. Galindez-Agirregoikoa, None; R. Solans, None; S. Romero-Yuste, None; N. Ortego Centeno, None; M. Revenga Martínez, None; R. Melero, None; E. Salgado-Pérez, None; S. Fernández, None; J. L. Martín-Varillas, None; I. Martínez-Rodríguez, None; I. Banzo, None; V. Calvo-Río, None; B. Atienza-Mateo, None; N. Palmou-Fontana, None; C. González-Vela, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Calderón Goercke M, Loricera J, Prieto Peña D, Narváez FJ, Aurrecoechea E, Villa-Blanco I, Castañeda S, Gómez-Arango C, Mera A, Perez Pampín E, Aldasoro V, Álvarez-Rivas N, Fernandez-Llanio Cornella N, Alvarez de Buergo MC, Rojas Vargas LM, Sivera F, Galindez-Agirregoikoa E, Solans R, Romero-Yuste S, Ortego Centeno N, Revenga Martínez M, Melero R, Salgado-Pérez E, Fernández S, Martín-Varillas JL, Martínez-Rodríguez I, Banzo I, Calvo-Río V, Atienza-Mateo B, Palmou-Fontana N, González-Vela C, Hernández JL, González-Gay MA, Blanco R. Extension of Extracranial Vessel Involvement in Patients with Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/extension-of-extracranial-vessel-involvement-in-patients-with-giant-cell-arteritis/. Accessed .

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