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Evaluation of damage in giant cell arteritis

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Kermani TA1, Sreih AG2, Cuthbertson D3, Carette S4, Hoffman GS5, Khalidi NA6, Koening CL7, Langford CA5, McAlear CA2, Monach PA8, Moreland L9, Pagnoux C4, Seo P10, Warrington KJ11, Ytterberg SR11, Merkel PA12; Vasculitis Clinical Research Consortium. Rheumatology (Oxford). 2018 Feb 1;57(2):322-328. doi: 10.1093/rheumatology/kex397.

Abstract

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1 Division of Rheumatology, University of California Los Angeles, Los Angeles, CA.

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

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

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

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

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

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, Mayo Clinic College of Medicine, Rochester, MN.

12 Division of Rheumatology and Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

OBJECTIVES: To evaluate damage and variables associated with damage in GCA.

METHODS: Patients with GCA enrolled in a prospective, multicentre, longitudinal study were included. Per-protocol assessments were made with the Vasculitis Damage Index and the Large-Vessel Vasculitis Index of Damage.

RESULTS: The study included 204 patients: 156 women (76%), mean age at diagnosis 71.3 years (s.d. 8.3), mean follow-up of 3.5 years (s.d. 1.9). One or more damage item was present in 54% at baseline and 79% at the last follow-up on the Vasculitis Damage Index, and 60% at baseline and 82% at the last follow-up on the Large-Vessel Vasculitis Index of Damage. The most frequently observed damage items were large-artery complications (29% cohort) and ocular (22%). Among 117 patients with new damage, most new items were ocular (63 patients), cardiac/vascular (48) and musculoskeletal (34). Of these, treatment-associated items were frequently observed, including cataracts (46 patients), osteoporosis (22) and weight gain (22). Disease-associated new damage included ischaemic optic neuropathy (3 patients), limb claudication (13), arterial occlusions (10) and damage requiring vascular intervention (10). In univariate analysis, the risk of damage increased 22% for every additional year of disease duration [odds ratio (OR) 1.22 (95% CI 1.04, 1.45)]. In 94 patients enrolled within ⩽90 days of diagnosis of GCA, the risk of new damage at the last follow-up decreased 30% for each additional relapse [OR 0.70 (95% CI 0.51, 0.97)].

CONCLUSIONS: Large-artery complications and ocular manifestations are the most commonly occurring items of damage in GCA. Most new damage is associated with treatment. These findings emphasize the cumulative burden of disease in GCA.