Session Information
Date: Sunday, November 13, 2016
Title: Vasculitis - Poster I: Large Vessel Vasculitis and Polymyalgia Rheumatica
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Malignancy associated vasculitis represents 2–5% of systemic vasculitides. While there have been reports of increased incidence of malignancy in patients with giant cell arteritis (GCA) no definite association has yet been established. Our objective was to determine the proportion patients with GCA and past/concurrent/subsequent malignancy.
Methods: We conducted a prospective longitudinal analysis of patients diagnosed with GCA from September 2011 to May 2016 at a single secondary/tertiary rheumatology centre. The proportion of patients with past, concurrent, and successive malignancy (diagnosed within 1 year of follow-up) was determined. Crude incidence rate (CIR) of malignancy in general population aged 50 years and above from the same geographical region in year 2011 and 2012 (final accessible reports based on complete yearly data) was acquired from Slovenian Cancer Registry for comparison.
Results: During the observation period 119 new GCA cases were identified (median age 73.8 (IQR 70.0–78.8) years, 71% female, 39.5% ever smokers). Ninety-eight (82.4%) patients fulfilled the 1990 ACR classification criteria for GCA; the remaining 17.6% had imaging evidence of large vessel vasculitis. Thirteen patients (10.9%) had past history of malignant disease; one of these patients had an active urinary bladder cancer at the time of GCA diagnosis. There was 1 death due to cancer during the follow-up. In 8 patients (6.7%) malignant disease was found concurrently with GCA (4/8) or within one year of follow-up (4/8) (Table 1). With respect to location of the 8 newly diagnosed malignancies, there were 3 cases (2.5%) of urinary bladder cancer (Table 2). CIR for malignancy in population aged 50 years and above of the same geographical region was 1.51%, with specific CIR for bladder cancer of 0.04%.
| Table 1. Age-stratified comparison of malignancy incidence rate in GCA patients vs. the general population. | |||||||
| Age group (years) |
No. of patients with malignancy |
No. of GCA patients with C/S malignancy |
Total No. of GCA patients |
Incidence rate (C+S) |
CIR for general population |
||
|
P |
C |
S |
|||||
| 50–59 |
1 |
1 |
0 |
1 |
7 |
14.3 % |
0.75 % |
| 60–69 |
2 |
1 |
2 |
3 |
35 |
8.6 % |
1.59 % |
| 70–79 |
6 |
0 |
2 |
2 |
55 |
3.6 % |
2.31 % |
| 80+ |
4 |
2 |
0 |
2 |
22 |
9.5 % |
2.56 % |
| Total (50+) |
13 |
4 |
4 |
8 |
119 |
6.7 % |
1.51 % |
| Legend: P – past; C – concurrent; S – successive; CIR – Crude Incidence Rate | |||||||
| Table 2. Location of malignancy and temporal relationship to GCA. | |||
| Location |
P |
C |
S |
| Renal |
1 |
0 |
0 |
| Bladder |
1 |
2 |
1 |
| Stomach |
0 |
1 |
1 |
| Colon |
3 |
0 |
0 |
| Ovarian/uterine |
3 |
0 |
0 |
| Haematologic |
1 |
1 |
0 |
| Breast |
2 |
0 |
1 |
| Prostatic |
1 |
0 |
0 |
| Melanoma |
1 |
0 |
1 |
| Total |
13 |
4 |
4 |
Conclusion: In our study, incidence rate of malignant disease was distinctly higher in GCA patients compared to general population for all age groups; ultimately, 6.7% of GCA patients were diagnosed with concurrent/successive malignant disease – compared to 1.5% of similarly aged general population. Additionally, we detected an increased incidence of urinary bladder cancer in our GCA cohort.
To cite this abstract in AMA style:
Jese R, Hocevar A, Rotar Z, Praprotnik S, Tomsic M. Giant Cell Arteritis and Malignancy – More Than Just a Coincidence? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/giant-cell-arteritis-and-malignancy-more-than-just-a-coincidence/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/giant-cell-arteritis-and-malignancy-more-than-just-a-coincidence/