Giant Cell Arteritis Subtypes: Data from the ARTESER Registry

Eugenio De Miguel¹, Jesús T. Sánchez-Costa², Javier Narvaez³, Miguel Ángel gonzalez-Gay⁴, Noemí Garrido-Puñal⁵, Paula V. Estrada-Alarcon⁶, Rafael B. Melero-González⁷, Elisa Fernández-Fernández⁸, María T. Silva-Diaz⁹, Joaquín M. Belzunegui¹⁰, Clara Moriano¹¹, Julio Sánchez¹², Judit Lluch¹³, Itziar Calvo¹⁴, Vicente Aldasoro¹⁵, Leticia León-Mateos¹⁶, Javier Loricera García¹⁷, Alberto Ruíz-Román⁵, Cristina Valero-Martínez¹⁸, Patricia Moya¹⁹, Marina Tortosa-Cabañas²⁰, Vanessa A. Navarro-Angeles⁶, Carles Galisteo²¹, Anne Riveros-Frutos²², Jose A. Román-Ivorra²³, Selene Labrada-Arrabal²⁴, Margarida Vasques-Rocha²⁵, Carlota L. Iñiguez-Ubiaga²⁶, María García-González²⁷ and Ricardo Blanco²⁸, ¹Hospital Universitario La Paz, Madrid, Spain, ²Spanish Society of Rheumatology, Madrid, Spain, ³Division of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, ⁴Research group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla; School of Medicine, Universidad de Cantabria, Santander, Spain. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, ⁵Hospital Universitario Virgen del Rocío, Sevilla, Spain, ⁶Hospital de Sant Joan Despí Moisès Broggi. Sant Joan Despí, Barcelona, Spain, ⁷Complejo Hospitalario Universitario de Vigo, Vigo, Spain, ⁸Rheumatology department, La Paz University Hospital, Madrid, Spain, ⁹Complejo Hospitalario Universitario de La Coruña, Coruña, Spain, ¹⁰Hospital Universitario Donostia, Donostia-San Sebasti, Spain, ¹¹Hospital Universitario de León, León, Spain, ¹²Hospital Universitario 12 de Octubre, Madrid, Spain, ¹³Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain, ¹⁴Basurto University Hospital, Bilbao, Spain, ¹⁵Complejo Hospitalario de Navarra, Pamplona, Spain, ¹⁶Hospital Clínico San Carlos. Madrid. Spain, Madrid, Spain, ¹⁷Hospital Universitario Marqués de Valdecilla, Santander, Spain, ¹⁸Hospital Universitario de La Princesa, Madrid, Spain, ¹⁹Hospital Sant Pau, Barcelona, Spain, ²⁰Hospital Universitario Ramón y Cajal, Madrid, Spain, ²¹Hospital Universitari Parc Tauli, Saadell, Spain, ²²Hospital Germans Trias i Pujol, Badalona, Spain, ²³Hospital Universitari i Politècnic La Fe, Valencia, Spain, ²⁴Hospital del Mar, Barcelona, Spain, ²⁵Hospital Universitario Araba, Vitoria-Gasteiz, Spain, ²⁶Hospital Universitario Lucus Augusti, Lugo, Spain, ²⁷Hospital Universitario de Canarias, La Laguna, Spain, ²⁸Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Meeting: ACR Convergence 2021

Keywords: classification criteria, giant cell arteritis, Imaging, Ultrasound, Vasculitis

Session Information

Date: Monday, November 8, 2021

Session Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster I: Giant Cell Arteritis & Polymyalgia Rheumatica (1391–1419)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: Giant cell arteritis (GCA) is the most common systemic vasculitis over 50 years of age. Classically, GCA was assimilated with the involvement of the temporal arteries and a biopsy of these arteries (TAB) was used for its diagnosis. Although the risk of developing aortic aneurysms and large vessel involvement in this disease was well known, the study of the large vessels was not included in the standard diagnosis process. Nowadays, with the incorporation of imaging techniques, the diagnosis of GCA extracranial forms is more and more frequent. The objective of this study was to determine the frequency of cranial and extracranial vessel involvement in our population with GCA.

Methods: ARTESER is a multicenter observational retrospective study promoted by the Spanish Society of Rheumatology with 26 participating centers and in which patients diagnosed with GCA between June 1 2013 and March 29 2019 were included. The gold standard for the diagnosis of the disease was the opinion of the responsible physician according to the clinical, analytical, imaging and TAB data available. This analysis includes the data collected from TAB and imaging (ultrasound, PET, and MRI/CT-angiography) as support to classify the patient as having a cranial and/or extracranial GCA subtype.

Results: 1675 patients with GCA were included. Mean age ± SD was 76.9 ± 8.1 years and gender distribution was 1178 (70.3%) women and 497 (29.7%) men. From the data collected, it was found that 1091 patients had cranial involvement, 331 extracranial involvement and 170 patients had mixed involvement (cranial and extracranial). The Figure 1 shows how the frequency of extracranial involvement has increased in recent years, coinciding with the increase of the use of imaging tests in diagnosis. The Figure 2 shows how the ultrasound diagnosis increased from 25.8% in 2013 to 52.9% in 2019, and PET increased from 12.3% in 2013 to 19.6% in 2019. TAB was performed in the 46.3% of the patients and contributed to the diagnosis of cranial forms. Since imaging tests were not performed in all patients, and that the increase in their use is directly related with the increase in the diagnosis of forms with extracranial large vessel involvement, it is likely that the frequency of large vessel GCA increases by the next years. As a limitation, it should be noted that the subtype of vascular involvement was not detailed in 253 patients.

Conclusion: The forms with cranial involvement are the most frequent in GCA. The diagnosis of large vessel GCA has increased in recent years in direct relation to the increase in the diagnostic use of imaging tests. The diagnosis of extracranial vessel involvement it is likely to increase in the coming years.

Evolution of GCA subtypes cranial and extracranial along the time

GCA: Temporal evolution of diagnostic tests

Disclosures: E. De Miguel, Roche, 6, 12, Paid instructor, Abbvie, 2, 5, 6, Novartis, 2, 5, 6, 12, Paid instructor, Pfizer, 2, 5, 6, MSD, 6, BMS, 6, UCB, 6, Grunental, 6, Janssen, 6, 12, Paid instructor, Sanofi, 6, Galapagos, 2; J. Sánchez-Costa, None; J. Narvaez, None; M. gonzalez-Gay, None; N. Garrido-Puñal, None; P. Estrada-Alarcon, None; R. Melero-González, None; E. Fernández-Fernández, None; M. Silva-Diaz, None; J. Belzunegui, None; C. Moriano, None; J. Sánchez, None; J. Lluch, None; I. Calvo, None; V. Aldasoro, None; L. León-Mateos, None; J. Loricera García, None; A. Ruíz-Román, None; C. Valero-Martínez, None; P. Moya, None; M. Tortosa-Cabañas, None; V. Navarro-Angeles, None; C. Galisteo, None; A. Riveros-Frutos, None; J. Román-Ivorra, None; S. Labrada-Arrabal, None; M. Vasques-Rocha, None; C. Iñiguez-Ubiaga, None; M. García-González, None; R. Blanco, Brystol Myers Squibb, 6.

To cite this abstract in AMA style:

De Miguel E, Sánchez-Costa J, Narvaez J, gonzalez-Gay M, Garrido-Puñal N, Estrada-Alarcon P, Melero-González R, Fernández-Fernández E, Silva-Diaz M, Belzunegui J, Moriano C, Sánchez J, Lluch J, Calvo I, Aldasoro V, León-Mateos L, Loricera García J, Ruíz-Román A, Valero-Martínez C, Moya P, Tortosa-Cabañas M, Navarro-Angeles V, Galisteo C, Riveros-Frutos A, Román-Ivorra J, Labrada-Arrabal S, Vasques-Rocha M, Iñiguez-Ubiaga C, García-González M, Blanco R. Giant Cell Arteritis Subtypes: Data from the ARTESER Registry [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10). https://acrabstracts.org/abstract/giant-cell-arteritis-subtypes-data-from-the-arteser-registry/. Accessed May 19, 2022.

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