In patients with biopsy-proven giant cell arteritis (GCA), polymyalgia rheumatica (PMR) at diagnosis and inflammation limited to adventitia or vasa vasorum vasculitis identify subsets of individuals with more benign disease, whereas large-vessel involvement is associated with reduced survival, according to the results of a population-based retrospective study published in Rheumatology.
The investigators sought to evaluate the influence of treatment outcomes and disease-related findings on survival in a population-based cohort of patients with incident biopsy-proven GCA. A total of 281 patients with incident temporal artery biopsy (TAB)-proven GCA were finally entered in the inception study cohort. The researchers analyzed the following: clinical, imaging, and laboratory findings at GCA diagnosis; pathologic patterns of TAB; effect of traditional cardiovascular risk factors as predictors of survival; and corticosteroid treatment and therapeutic outcomes.
According to univariate analysis, increased mortality was significantly linked to large-vessel involvement at diagnosis (hazard ratio [HR], 5.84; 95% CI, 1.57-21.8; P =.009), whereas reduced mortality was significantly associated with female gender (HR, 0.66; 95% CI, 0.45-0.98; P =.040); PMR (HR, 0.54; 95% CI, 0.37-0.79; P =.002); long-term remission (HR, 0.47; 95% CI, 0.26-0.86; P =.015); higher hemoglobin levels at diagnosis (HR, 0.84; 95% CI, 0.74-0.96; P =.011); and inflammation limited to the adventitia or to the adventitial vasa vasorum at TAB examination (HR, 0.48; 95% CI, 0.24-0.97; P =.041).
Multivariate analysis demonstrated a significant association between increased mortality and large-vessel involvement at diagnosis (HR, 5.14; 95% CI, 0.37-0.86; P =.008), between reduced mortality and PMR at diagnosis (HR, 0.57; 95% CI, 0.37-0.86; P =.008), and between reduced mortality and advential inflammation at TAB (HR, 0.31; 95% CI, 0.14-0.70; P =.005).
The investigators concluded that long-term remission in patients with GCA is associated with reduced mortality, which suggests the efficacy of controlling inflammation in this population.
Macchioni P, Boiardi L, Muratore F, et al. Survival predictors in biopsy-proven giant cell arteritis: a northern Italian population-based study [published online December 4, 2018]. Rheumatology (Oxford). doi:10.1093/rheumatology/key325