Background/Purpose: Giant cell arteritis (GCA) is the most common vasculitis in North America and Western Europe. GCA is more likely to occur in women (1). However, there are scarce data on the epidemiology, clinical presentation, comorbidities, treatment and outcomes between men and women. Our aim was to assess the previous differential features between gender found in ARTESER registry.

Methods: ARTESER is a large Spanish multicenterepidemiological registry of GCA promoted by the Spanish Society of Rheumatology in which 26 national hospitals participated. Patients were included according to whether they met the 1990 ACR criteria, had a positive diagnostic test (biopsy or imaging test) or by the clinical judgement of the investigator. The recruitment period was between 2013 and 2019 and standardized data were included for all patients diagnosed with GCA in these centers. Differences between sexes were compared in a bivariate analysis.

Results: A total of 1675 patients with GCA were included, 1178 women and 497 men. The annual incidence of GCA was higher in the female group (10.07; 95%CI: 8.7-11.5) than in the male group (4.83; 95%CI: 3.8-5.9) with a similar mean age at diagnosis and symptom onset between the two groups of 76.9 and 76.7 years, respectively. Among the comorbidities presented at diagnosis, male had a higher presentation of diabetes mellitus, tobacco use, alcohol consumption, cardiovascular disease and neoplasms than female, in which only osteoporosis was more frequent. The results are shown in table 1. Clinical manifestations were divided into cranial, extracranial and general. Among the cranial manifestations, headache (79.9%), temporal (49.2%) and visual (36.1%) disturbances were the most frequent. Polymyalgia rheumatica was the predominant extracranial manifestation (41.8%) and asthenia the most general symptom reported (52.2%). Main data are shown in table 2. We analyzed the distribution according to sex and observed a higher frequency of headache (p=0.028), polymyalgia rheumatica (p=0.003) and asthenia (p=0.035) in the female group. In contrast, we found a higher frequency of dysphasia in the male group (p=0.013) and visual symptoms, with no statistically significant differences in the latter. In terms of laboratory findings, elevated glomerular sedimentation rate (ESR) (p=0.039) and platelet count (p< 0.001) were higher in female. Treatment and outcome data are shown in table 3. Regarding the use of glucocorticoids and related adverse effects no differences between the two groups were detected. The use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was more frequent in males (p=0.005), but no differences were found regarding tocilizumab administration. There were no differences in the number of relapses or disease remission. However, the proportion of deaths during follow-up was higher in women (13.8% vs. 6.6%, p< 0.001).

Conclusion: GCA was more frequent in females, with more than twice as many cases as males. Some of the classic manifestations, such as headache, polymyalgia rheumatica and asthenia, were more common in women. In addition, women had higher ESR and platelet levels than men. The use of csDMARDs was higher in the male group but mortality was increased in females.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sex-differences-in-giant-cell-arteritis-data-from-the-arteser-registry/