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Arterial lesions in giant cell arteritis: A longitudinal study

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Kermani TA1, Diab S2, Sreih AG3, Cuthbertson D4, Borchin R4, Carette S5, Forbess L6, Koening CL7, McAlear CA3, Monach PA8, Moreland L9, Pagnoux C5, Seo P10, Spiera RF11, Warrington KJ12, Ytterberg SR12, Langford CA13, Merkel PA14, Khalidi NA2; Vasculitis Clinical Research Consortium. Semin Arthritis Rheum. 2018 May 9. pii: S0049-0172(18)30094-5. doi: 10.1016/j.semarthrit.2018.05.002. [Epub ahead of print]

Abstract

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1 Division of Rheumatology, University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540 Santa Monica, CA 90404. Electronic address: TKermani@mednet.ucla.edu.

2 Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada.

3 Division of Rheumatology, University of Pennsylvania, Philadelphia, PA.

4 Department of Biostatistics and Informatics, Department of Pediatrics, University of South Florida, Tampa, FL.

5 Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada.

6 Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA.

7 Division of Rheumatology, University of Utah, Salt Lake City, UT.

8 Section of Rheumatology, Boston University School of Medicine, Boston, MA.

9 Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA.

10 Division of Rheumatology, Johns Hopkins University, Baltimore, MD.

11 Division of Rheumatology, Hospital for Special Surgery, New York, NY.

12 Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN.

13 Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Lerner College of Medicine, Cleveland, OH.

14 Division of Rheumatology and the Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA.

Abstract

OBJECTIVES: To evaluate large-vessel (LV) abnormalities on serial imaging in patients with giant cell arteritis (GCA) and discern predictors of new lesions.

METHODS: Clinical and imaging data from patients with GCA (including subjects diagnosed by LV imaging) enrolled in a prospective, multicenter, longitudinal study and/or a randomized clinical trial were included. New arterial lesions were defined as a lesion in a previously unaffected artery.

RESULTS: The study included 187 patients with GCA, 146 (78%) female, mean (±SD) age at diagnosis 68.5 ± 8.5 years; 39% diagnosed by LV imaging. At least one arterial lesion was present in 123 (66%) on the first study. The most frequently affected arteries were subclavian (42%), axillary (32%), and thoracic aorta (20%). In 106 patients (57%) with serial imaging, new arterial lesions were noted in 41 patients (39%), all of whom had a baseline abnormality, over a mean (±SD) follow-up of 4.39 (2.22) years. New abnormalities were observed in 33% patients by year 2; clinical features of active disease were present at only 50% of these cases. There were no differences in age, sex, temporal artery biopsy positivity, or disease activity in patients with or without new lesions.

CONCLUSIONS: In this cohort of patients with GCA, LV abnormalities on first imaging were common. Development of new arterial lesions occurred in patients with arterial abnormalities at first imaging, often in the absence of symptoms of active disease. Arterial imaging should be considered in all patients with GCA at diagnosis and serial imaging at least in patients with baseline abnormalities.