Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Few retrospective studies in giant cell arteritis (GCA) previously reported, separately, that 1) patients with diabetes had less positive temporal artery biopsies (TAB), 2) patients on angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) experienced fewer relapses and 3) patients on statins experienced the same frequency of clinical complications and relapses as non-exposed patients. This retrospective chart review study simultaneously investigated the impact of these 3 factors on a cohort of patients followed in 2 large North American centers.
Methods: Patient who were diagnosed with GCA were included in this study if they met the American College of Rheumatology’s (ACR) modified classification criteria (age >50 and ≥2 of the following: new onset headache, TA abnormality, ESR >40mm, abnormal TAB and large vessel vasculitis by angiogram or biopsy). Their demographics, presenting symptoms, TAB results, disease complications and outcomes (relapses, duration of glucocorticoid use) were compared between exposed (diabetes/ACE/ARB/statin) and non-exposed patients.
Results: Of 175 charts reviewed of consecutive patients with a diagnosis of GCA (between 1993-2015) seen in the 2 study centers, 137 met the ACR modified classification criteria. 70% were female and the mean (SD) age at diagnosis was 71 (8.9) years. 17 patients had preexisting diabetes (11 developed diabetes after diagnosis), 36 were using ACE-Is (14 more after), 26 were using ARBs (6 more after) and 52 were on statins (15 more after). TAB was less often positive in patients with diabetes (RR 0.24 [95% CI: 0.069-0.81], p < 0.02). The cumulative probability of flaring over time was higher in both patients with pre- and post-diagnosis diabetes when compared to non-diabetic patients (log-rank, p <0.03), with adjusted HRs of 0.25 [0.10-0.62] and 0.28 [0.095-0.84], respectively. There was a significant difference in the probability of successful discontinuation of prednisone for ACE-I therapy (log-rank, p <0.03), but a nonsignificant trend for ARB therapy when compared to non-exposed patients, with adjusted HRs of 0.44 [0.22-0.87] and 0.60 [0.30-1.2] respectively. Clinical complications (Table 1) and relapse rates (log-rank test, p > 0.80, adjusted HR 0.54 (0.24-1.2)) did not significantly differ between patients on statin therapy or not.
|Diabetes||Statin therapy||ACE-I therapy||ARB therapy|
|Positive temporal artery biopsy||0.24* 95% CI (0.069-0.81)||0.69||0.95||0.50|
|Headache||1.77||1.77* 95% CI (0.96-3.26)||1.2||1.09|
|Temporal artery tenderness||1.0||1.5||0.79||1.3|
|Upper limb claudication||0.48||0.30* 95% CI (0.081-1.1)||0.67||0.88|
|Lower limb claudication||0.00||0.22||0.79||0.11|
|Anterior ischemic optic neuropathy||2.3||1.16||1.4||0.88|
|Other large vessel manifestation||0.48||0.48* 95% CI (0.23-1.0)||1.06||0.69|
Table 1. Relative risk ratios of the presenting features of giant cell arteritis * p < 0.05
Conclusion: In this study, patients with GCA and diabetes appeared more likely to have a negative TAB, and to relapse. ACE-I therapy showed an independent association with success at discontinuing prednisone. Statin therapy did not alter the clinical presentation or course of GCA. These observed findings confirm most (but not all) of those from similar, yet separate studies which explored this topic.
To cite this abstract in AMA style:Ma J, Khalidi NA, Wierzbicki O, Al Qethami A, Carette S, Pagnoux C. Impact of Diabetes, Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Use, and Statin Use on Presentation and Outcomes in Patients with Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/impact-of-diabetes-angiotensin-converting-enzyme-inhibitor-or-angiotensin-ii-receptor-blocker-use-and-statin-use-on-presentation-and-outcomes-in-patients-with-giant-cell-arteritis/. Accessed May 27, 2019.
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