Background/Purpose: Giant-cell arteritis (GCA) is usually described in people of Northern-European ancestry, and little is known about outcomes in Black and Hispanic (B-His) patients. Using a large U.S. multi-center electronic-health-record network, we compared clinical management and 1-year outcomes between White and B-His adults with GCA.

Methods: We conducted a retrospective cohort study using the TriNet-X Global Collaborative Network. Adults (≥18 years) with an ICD-10 diagnosis of GCA were assigned to a White cohort or a B-His cohort based on electronic health records; individuals with mixed race/ethnicity were excluded. One-to-one propensity-score matching on age, sex, and 12 cardiovascular or metabolic comorbidities produced two balanced groups of 8323 patients each. Outcomes recorded 1–365 days after the index date were vision loss, stroke, myocardial infarction (MI), temporal-artery biopsy, CT angiography, prednisone use, tocilizumab use, death, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Risk ratios (RRs) with 95 % confidence intervals (CIs) and Kaplan–Meier log-rank tests were used for comparisons.

Results: After matching, baseline characteristics were well balanced (standardized differences < 0.05). Inflammatory activity was greater in B-His patients, whose mean CRP (24.5 mg/L vs 21.0 mg/L; p = 0.005) and ESR (40.1 mm/h vs 27.0 mm/h; p < 0.001) exceeded those of White patients. Temporal-artery biopsy was performed more often in B-His patients (22.6 % vs 17.8 %; RR 0.79, 0.74–0.84; p < 0.001), but vision-loss and CT-angiography frequencies were low (< 0.7 % and < 0.3 %, respectively) and did not differ. Prednisone exposure was equivalent in both groups (≈58 %), yet tocilizumab was prescribed nearly twice as often to White patients (5.1 % vs 2.8 %; RR 1.82, 1.56–2.13; p < 0.001). During follow-up period, stroke occurred in 3.5 % of B-His patients and 2.6 % of White patients (RR 0.74, 95 % CI 0.62–0.89; p = 0.002), while MI rates were similar (2.0 % vs 1.9 %). All-cause mortality, however, was higher in Whites (5.0 % vs 3.2 %; RR 1.53, 1.32–1.78; p < 0.001). Survival analysis confirmed lower stroke-free survival for B-His patients and lower overall survival for Whites.

Conclusion: In this large, propensity-matched real-world cohort, Black and Hispanic adults with GCA displayed higher inflammatory markers and greater stroke risk yet were less likely to receive tocilizumab than their White counterparts. Conversely, White patients had higher 1-year mortality despite comparable comorbidity burdens. These bidirectional disparities underscore the need for earlier recognition of vascular events in B-His patients and investigation into factors driving excess mortality among White patients. Tailored diagnostic vigilance and equitable access to advanced therapies are essential to optimize outcomes across racial and ethnic groups.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-differences-in-management-and-clinical-outcomes-of-giant-cell-arteritis-a-real-world-propensity-matched-study/