Background/Purpose: In GCA, cranial artery involvement is particularly frequent and underlies the classical manifestations and complications of the disease. Symptomatic pericarditis has been occasionally described as part of the presenting symptoms. However, the frequency of imaging-detected pericardial involvement has not been systematically evaluated. The aim of our study was to assess the prevalence of pericardial involvement detected by CTA in patients with newly diagnosed GCA, as well as the potential relationship with pericardial symptoms, GCA manifestations, laboratory data, or the presence of large-vessel vasculitis (LVV). The outcome of pericardial involvement with GC treatment was also analyzed.

Methods: From July 2007 to January 2015, 63 patients diagnosed with biopsy-proven GCA at our institution were subjected to CTA according to a defined protocol as part of a prospective study assessing LVV [Prieto-González S et al; Ann Rheum Dis 2012]. These patients were treatment-naïve or had received GC for ≤ 3 days. A follow-up CTA was scheduled to evaluate the outcome of imaging-detected lesions with GC treatment. Post-hoc assessment of CTA images was performed in order to detect pericardial abnormalities including pericardial thickening (thickness of the pericardial membrane of at least 4mm) and/or pericardial effusion (presence of liquid between the pericardial membrane and the heart). Specific GCA symptoms and laboratory features, as well as classical pericardial manifestation were recorded.

Results: Among the 63 patients included, 45 were women and 18 men, aged 78 years (range 56-92). At the time of GCA diagnosis, pericardial involvement was present in 18 patients (29%), consisting of thickening (4-7mm) in 8 patients (13%) and effusion (4-18mm) in 10 (16%). Forty-six patients completed the follow-up CTA assessment after a median follow-up of 16 months (range 12-135). At the second imaging, 8 of them (17%) still had pericardial involvement: thickening in 5 (11%) and effusion in 3 (6%). All patients were asymptomatic regarding classical pericarditis symptoms. No relationship was observed between the presence of pericardial involvement and GCA manifestations, laboratory data or the detection of LVV.

Conclusion:  In our series, about one third of patients with newly diagnosed GCA have pericardial involvement, consisting of a subclinical mild to moderate pericardial thickening or effusion that improves during the follow-up with GC treatment. Supported by SAF14/57708-R.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pericardial-involvement-in-biopsy-proven-giant-cell-arteritis-gca-patients-detected-by-ct-angiography-cta-prevalence-at-diagnosis-and-outcome-with-glucocorticoid-gc-treatment/