Hubert de Boysson1, Aurélie Daumas2, Mathieu Vautier3, Jean-Jacques Parienti4, Eric Liozon5, Marc Lambert6, Maxime Samson7, Mikael Ebbo2, Anael Dumont8, Audrey Sultan8, Bernard Bonnotte7, Alain Manrique9, Boris Bienvenu8, David Saadoun10, Achille Aouba11. 1. Department of Internal Medicine, Caen University Hospital, Caen, France; University of Normandy, Caen, France. Electronic address: deboysson-h@chu-caen.fr. 2. Department of Internal Medicine and Therapeutics, Timone Hospital, Marseille, France. 3. AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, Paris, France. 4. Biostatistics and Clinical Research Unit, Caen University Hospital, France. 5. Department of Internal Medicine and Clinical Immunology, Limoges University Hospital, Limoges, France. 6. Department of Internal Medicine, Lille University Hospital, Lille, France. 7. Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France. 8. Department of Internal Medicine, Caen University Hospital, Caen, France. 9. Department of Nuclear Medicine, Caen University Hospital, Caen, France. 10. AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department, France; INSERM, Paris, France; CNRS, Paris, France. 11. Department of Internal Medicine, Caen University Hospital, Caen, France; University of Normandy, Caen, France.
Abstract
OBJECTIVES: Large-vessel involvement (LVI) can occur in giant-cell arteritis (GCA) and may represent a distinct disease subgroup with a higher risk for aortic dilation. This study aimed to better characterize the presentation and evolution of LVI in patients with GCA. PATIENTS AND METHODS: A retrospective multicenter study enrolled 248 GCA patients with LVI and 301 GCA patients without LVI on imaging. Factors associated with aortic dilation were identified in a multivariable model. RESULTS: The patients with LVI were younger (p<0.0001), more likely to be women (p=0.01), and showed fewer cephalic symptoms (p<0.0001) and polymyalgia rheumatica (p=0.001) but more extracranial vascular symptoms (p=0.05) than the patients without LVI. Glucocorticoids (GC) management did not differ between the two groups, but the GC discontinuation rate was lower in the patients with LVI (p=0.0003). Repeated aortic imaging procedures were performed at 19months [range: 5-162months] and 17months [range: 6-168months] after diagnosis in 154 patients with LVI and 123 patients without LVI, respectively, of whom 21% and 7%, respectively, presented new aortic dilations (p=0.0008). In the patients with LVI, aortic dilation occurred on an aorta segment shown to be inflammatory on previous imaging in 94% of patients. In the multivariate analysis, LVI was the strongest predictor of aortic dilation (hazard ratio: 3.16 [range: 1.34-7.48], p=0.009). CONCLUSIONS: LVI represents a distinct disease pattern of GCA with an increased risk of aortic dilation. Control of the aortic morphology during follow-up is required.
OBJECTIVES: Large-vessel involvement (LVI) can occur in giant-cell arteritis (GCA) and may represent a distinct disease subgroup with a higher risk for aortic dilation. This study aimed to better characterize the presentation and evolution of LVI in patients with GCA. PATIENTS AND METHODS: A retrospective multicenter study enrolled 248 GCA patients with LVI and 301 GCA patients without LVI on imaging. Factors associated with aortic dilation were identified in a multivariable model. RESULTS: The patients with LVI were younger (p<0.0001), more likely to be women (p=0.01), and showed fewer cephalic symptoms (p<0.0001) and polymyalgia rheumatica (p=0.001) but more extracranial vascular symptoms (p=0.05) than the patients without LVI. Glucocorticoids (GC) management did not differ between the two groups, but the GC discontinuation rate was lower in the patients with LVI (p=0.0003). Repeated aortic imaging procedures were performed at 19months [range: 5-162months] and 17months [range: 6-168months] after diagnosis in 154 patients with LVI and 123 patients without LVI, respectively, of whom 21% and 7%, respectively, presented new aortic dilations (p=0.0008). In the patients with LVI, aortic dilation occurred on an aorta segment shown to be inflammatory on previous imaging in 94% of patients. In the multivariate analysis, LVI was the strongest predictor of aortic dilation (hazard ratio: 3.16 [range: 1.34-7.48], p=0.009). CONCLUSIONS:LVI represents a distinct disease pattern of GCA with an increased risk of aortic dilation. Control of the aortic morphology during follow-up is required.
Authors: Tanaz A Kermani; Sehriban Diab; Antoine G Sreih; David Cuthbertson; Renée Borchin; Simon Carette; Lindsy Forbess; Curry L Koening; Carol A McAlear; Paul A Monach; Larry Moreland; Christian Pagnoux; Philip Seo; Robert F Spiera; Kenneth J Warrington; Steven R Ytterberg; Carol A Langford; Peter A Merkel; Nader A Khalidi Journal: Semin Arthritis Rheum Date: 2018-05-09 Impact factor: 5.532