Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years
Objective To evaluate the incidence and outcomes of large artery (LA) involvement among patients with giant cell arteritis (GCA) and to compare LA involvement to non-GCA patients.Methods The study included Olmsted County, Minnesota, USA residents with incident GCA between 1950 and 2016 with follow-u...
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BMJ Publishing Group
2024-02-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/10/1/e003775.full |
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| author | Kenneth J Warrington Tanaz A Kermani Mohanad M Elfishawi Mahmut S Kaymakci Sara J Achenbach Cynthia S Crowson Cornelia M Weyand Matthew J Koster |
| author_facet | Kenneth J Warrington Tanaz A Kermani Mohanad M Elfishawi Mahmut S Kaymakci Sara J Achenbach Cynthia S Crowson Cornelia M Weyand Matthew J Koster |
| author_sort | Kenneth J Warrington |
| collection | DOAJ |
| description | Objective To evaluate the incidence and outcomes of large artery (LA) involvement among patients with giant cell arteritis (GCA) and to compare LA involvement to non-GCA patients.Methods The study included Olmsted County, Minnesota, USA residents with incident GCA between 1950 and 2016 with follow-up through 31 December 2020, death or migration. A population-based age-matched/sex-matched comparator cohort without GCA was assembled. LA involvement included aortic aneurysm, dissection, stenosis in the aorta or its main branches diagnosed within 1 year prior to GCA or anytime afterwards. Cumulative incidence of LA involvement was estimated; Cox models were used.Results The GCA cohort included 289 patients (77% females, 81% temporal artery biopsy positive), 106 with LA involvement.Reported cumulative incidences of LA involvement in GCA at 15 years were 14.8%, 30.2% and 49.2% for 1950–1974, 1975–1999 and 2000–2016, respectively (HR 3.48, 95% CI 1.67 to 7.27 for 2000–2016 vs 1950–1974).GCA patients had higher risk for LA involvement compared with non-GCA (HR 3.22, 95% CI 1.83 to 5.68 adjusted for age, sex, comorbidities). Thoracic aortic aneurysms were increased in GCA versus non GCA (HR 13.46, 95% CI 1.78 to 101.98) but not abdominal (HR 1.08, 95% CI 0.33 to 3.55).All-cause mortality in GCA patients improved over time (HR 0.62, 95% CI 0.41 to 0.93 in 2000–2016 vs 1950–1974) but remained significantly elevated in those with LA involvement (HR 1.89, 95% CI 1.39 to 2.56).Conclusions LA involvement in GCA has increased over time. Patients with GCA have higher incidences of LA involvement compared with non-GCA including thoracic but not abdominal aneurysms. Mortality is increased in patients with GCA and LA involvement highlighting the need for continued surveillance. |
| format | Article |
| id | doaj-art-b6eaaff5286e43538aef9073e39c0b29 |
| institution | DOAJ |
| issn | 2056-5933 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-b6eaaff5286e43538aef9073e39c0b292025-08-20T03:11:52ZengBMJ Publishing GroupRMD Open2056-59332024-02-0110110.1136/rmdopen-2023-003775Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 yearsKenneth J Warrington0Tanaz A Kermani1Mohanad M Elfishawi2Mahmut S Kaymakci3Sara J Achenbach4Cynthia S Crowson5Cornelia M Weyand6Matthew J Koster7Mayo Clinic, Rochester, Minnesota, USA46 Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USADepartment of Internal Medicine, Division of Autoimmune and Rheumatic diseases, University of Minnesota, Minneapolis, Minnesota, USARheumatology, Mayo Clinic, Rochester, Minnesota, USAHealth Sciences Research, Mayo Clinic, Rochester, Minnesota, USAHealth Sciences Research, Mayo, Rochester, Minnesota, USARheumatology, Mayo Clinic, Rochester, Minnesota, USARheumatology, Mayo Clinic, Rochester, Minnesota, USAObjective To evaluate the incidence and outcomes of large artery (LA) involvement among patients with giant cell arteritis (GCA) and to compare LA involvement to non-GCA patients.Methods The study included Olmsted County, Minnesota, USA residents with incident GCA between 1950 and 2016 with follow-up through 31 December 2020, death or migration. A population-based age-matched/sex-matched comparator cohort without GCA was assembled. LA involvement included aortic aneurysm, dissection, stenosis in the aorta or its main branches diagnosed within 1 year prior to GCA or anytime afterwards. Cumulative incidence of LA involvement was estimated; Cox models were used.Results The GCA cohort included 289 patients (77% females, 81% temporal artery biopsy positive), 106 with LA involvement.Reported cumulative incidences of LA involvement in GCA at 15 years were 14.8%, 30.2% and 49.2% for 1950–1974, 1975–1999 and 2000–2016, respectively (HR 3.48, 95% CI 1.67 to 7.27 for 2000–2016 vs 1950–1974).GCA patients had higher risk for LA involvement compared with non-GCA (HR 3.22, 95% CI 1.83 to 5.68 adjusted for age, sex, comorbidities). Thoracic aortic aneurysms were increased in GCA versus non GCA (HR 13.46, 95% CI 1.78 to 101.98) but not abdominal (HR 1.08, 95% CI 0.33 to 3.55).All-cause mortality in GCA patients improved over time (HR 0.62, 95% CI 0.41 to 0.93 in 2000–2016 vs 1950–1974) but remained significantly elevated in those with LA involvement (HR 1.89, 95% CI 1.39 to 2.56).Conclusions LA involvement in GCA has increased over time. Patients with GCA have higher incidences of LA involvement compared with non-GCA including thoracic but not abdominal aneurysms. Mortality is increased in patients with GCA and LA involvement highlighting the need for continued surveillance.https://rmdopen.bmj.com/content/10/1/e003775.full |
| spellingShingle | Kenneth J Warrington Tanaz A Kermani Mohanad M Elfishawi Mahmut S Kaymakci Sara J Achenbach Cynthia S Crowson Cornelia M Weyand Matthew J Koster Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years RMD Open |
| title | Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years |
| title_full | Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years |
| title_fullStr | Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years |
| title_full_unstemmed | Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years |
| title_short | Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years |
| title_sort | reappraisal of large artery involvement in giant cell arteritis a population based cohort over 70 years |
| url | https://rmdopen.bmj.com/content/10/1/e003775.full |
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