Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Association of Cardiovascular Disease Risk Factors with Ischaemic Manifestations of Giant Cell Arteritis
Vicente, Esther F., Casado, Amparo, Garcia-Arias, María J., Lopez-Bote, Juan P., Humbria, Alicia, Garcia-Vadillo, Jesús A., Castaneda, Santos
To describe the prevalence of classical cardiovascular disease risk factors (CVDRF) and the clinical characteristics of a population of giant cell arteritis (GCA) at diagnosis, and to analyse the association of the CVDRF with the ischaemic manifestations of the disease.
Cross-sectional study including 58 patients with biopsy-proven GCA (age at diagnosis: 74.2±7.2 yrs; 86.2% women). Demographic, clinical, analytical (hemoglobin, ESR and biochemistry), arterial ischaemic manifestations, CVDRF [smoking, hypercholesterolemia, diabetes mellitus (DM) and hypertension (HT)] and therapy with immunosupressants (IS) and corticosteroids (CS) were collected. Anemia was defined as Hb<11 g/dl and elevated ESR if >40 mm/h. Arterial ischaemic manifestations were classified as moderate (jaw claudication, "amaurosis fugax", transient visual loss [TVL] and diplopia) and severe (blindness, stroke, ischaemic heart disease [IHD] and peripheral arteriopathy). Statistical analysis: continuous variables are expressed as mean±SD and categorical as number of cases and percentage (%). The factors associated with the ischaemic manifestations of GCA were evaluated using the Student's t test, the Fischer exact test or the Pearson's c2 test. Statistical significance was assumed for p< 0.05 two-tail tests (Stata, v 10.0).
Follow-up time from diagnosis was 5.5±4.7 yrs. Clinical characteristics: 33 patients (58.9%) headache, 29 (50.8%) polymyalgia rheumatica (PMR) and 20 (37%) pathologic temporal artery examination. Anemia was detected in 25 patients (43%) and elevated ESR in 56 (98.2%). CVDRF were found in 44 patients (75.8%): HT (62.5%), hypercholesterolemia (55.2%), DM (14%) and smoking (5 active [9.6%] & 28 previous [53.8%]). Ischaemic manifestations occurred in 29 patients (50%): 20 jaw claudication (35.1%), 5 "amaurosis fugax" (8.6%), 6 TVL (10.3%), 6 blindness (10.3%), 1 stroke, 1 peripheral arteriopathy and 1 IHD. None had diplopia. Seven patients were classified as severe (12.1%) and 22 as moderate (37.9%). Among severe cases, 4 associated jaw claudication. Bivariate analysis by gender showed an older age at diagnosis in women (p=0.004). HT was associated with higher initial dose of CS (p=0.017) and active smoking with TVL (p=0.044). Multivariate analysis identified HT (p=0.016) and hypercholesterolemia (p=0.018) as the factors associated with moderate ischaemic manifestations. Age at diagnosis and initial CS dose were the only factors associated with blindness (p=0.018 & p=0.028, respectively).
Clinical characteristics of our series are close to previous descriptions by other authors. Jaw claudication and visual impairment are the most frequent ischaemic manifestations in our patients. Our study suggests that classical CVDRF could be associated with some ischaemic manifestations in GCA.
To cite this abstract, please use the following information:
Vicente, Esther F., Casado, Amparo, Garcia-Arias, María J., Lopez-Bote, Juan P., Humbria, Alicia, Garcia-Vadillo, Jesús A., et al; Association of Cardiovascular Disease Risk Factors with Ischaemic Manifestations of Giant Cell Arteritis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1879