Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Severe and Opportunistic Infections during Giant Cell Arteritis Course: A Case-Control Study.
Narvaez1, Javier, Vives1, Laura López, Estrada2, Paula, Castillo1, Nuria del, Robustillo1, Montserrat, Nolla1, Joan Miquel
To assess the incidence of severe and opportunistic infections in GCA patients as compared to age- and sex-matched, population based randomly selected controls.
Case-control study including 140 cases with GCA diagnosed in 1 center from 1986 to 2008. Patients were diagnosed with GCA if they had a positive temporal artery biopsy (TAB) or, in cases with negative biopsy or no biopsy, if they fulfilled the 1990 ACR criteria for the classification of GCA and had a prompt and persistent response to glucocorticoid (GC) treatment. The end-point of patient follow-up was the date of the last clinic visit or the date of death. For each GCA patient, 2 subjects without GCA of the same sex and similar age an time of follow-up were randomly selected from the population of patients attended in our outpatient clinic due to osteoporosis, osteoarthritis or gout. Severe infection was recorded as any bacterial infection leading to hospitalization.
The series included 94 women and 46 men with a mean age at time of diagnosis of 75 ± 7 years (range, 56 to 92). TAB was positive in 112 (80 %) patients. The median duration of follow-up after diagnosis was 36.6 months (range, 12.5 to 180).
All patients were treated with GCs and responded rapidly (mean initial dosage of prednisone: 50.1 ± 13.7 mg/day). The dosage was later reduced according to the treating physicians' judgment.
During follow-up, severe and/or opportunistic infections were recorded in 17.9% (25/140) of GCA patients compared to 3.5% (10/280) in the control group (odds ratio (OR) = 5.87, 95% confidence interval (CI): 2.73, 12.61).
Among GCA patients, opportunistic infections occurred in 5.7% (8/140) of the patients (including 1 case of tuberculosis, 6 cases of herpes zoster and 2 cases of candidiasis) compared to 1.4% (4/280) in the control group (OR = 4.18, 95% CI: 1.23, 14.14). Several bacterial infections occurred in 13.6% (19/140) of the cases compared to 2.14% (6/280) in the non-GCA subjects (OR = 7.17; 95% CI: 1.79, 18.4).
Interestingly, the incidence of tuberculosis (TB) in our GCA patients, in whom prophylaxis with isoniazid was not regularly administered, was 181/100,000 patient-years (1 case in 550 patient-years of follow-up). During the same period (19902008) the pooled annual incidence of TB infection in the general population of Spain ranged from 23 to 30 cases/100,000 individuals. This data reflects that the incidence of TB in GCA patients receiving GC is at least 6 times higher than in the general population.
Only one of the GCA patients died due to pulmonary TB complicated with upper gastrointestinal bleeding. The overall mortality was similar in cases and controls (p>0.05).
Logistic regression models identified the cumulative dose of prednisone (OR=6.19, 95% CI: 1.61, 23.71; p=0.007) and the presence of large-artery complication (aortic involvement and/or large-artery stenosis) (OR=11.35, 95% CI: 2.24, 57.33; p=0.003) as significant predictors of severe/opportunistic infections.
The incidence of severe and opportunistic infections is increased in GCA. This increased risk is mostly influenced by GC therapy. We found a 6-fold increased risk of TB infection in patients diagnosed with GCA.
To cite this abstract, please use the following information:
Narvaez, Javier, Vives, Laura López, Estrada, Paula, Castillo, Nuria del, Robustillo, Montserrat, Nolla, Joan Miquel; Severe and Opportunistic Infections during Giant Cell Arteritis Course: A Case-Control Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1310