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.


Treatment with Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Antagonists (ARA) Is Associated with Higher Frequency of Ischemic Complications but Better Response to Therapy in Patients with Giant-Cell Arteritis (GCA).

Alba3,  Marco A., Garcia-Martinez1,  Ana, Espigol-Frigole3,  Georgina, Tavera2,  Itziar, Butjosa3,  Montserrat, Prieto-Gonzalez5,  Sergio, Hernandez-Rodriguez4,  Jose

Emergency Department, Hospital Clinic, Barcelona, Spain
Systemic Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
Systemic Autoimmune Diseases. Hospital Clinic, Barcelona, Spain
Systemic Autoimmune Diseases. Hospital Clininc, Barcelona, Spain
Systemic Autoimmune Diseases.Hospital Clinic, Barcelona, Spain

Background:

GCA is a chronic inflammatory disease involving large and medium-sized arteries. Involvement of cranial arteries is particularly symptomatic. About 15–20% of patients develop cranial ischemic events derived from occlusion of involved vessels. Previous studies have shown that angiotensin receptor 1 is expressed in vascular lesions from patients with GCA (Ophthalmology 2009; 116: 990–6). Angiotensin II is an important mediator of angiogenesis and vascular remodelling.

Purpose:

To investigate whether ACEI or ARB therapy is related to vascular complications or response to glucocorticoid therapy in patients with GCA.

Methods:

Between 1995 and 2005, 160 patients were diagnosed with biopsy proven GCA at our institution. Among them patients with the following criteria were selected: prospective treatment and follow-up by the authors according to uniform criteria, prospective recording of GCA-related complications, relapses and glucocorticosteroid doses, and a follow-up duration of at least 3 years. Eighty-four patients fulfilled the selection criteria and were eligible for this study. Although retrospective in design, the study was performed on a prospectively followed cohort. Fisher exact test and Kaplan-Meyer survival analysis/log-rank test were used for statistical comparison.

Results:

Eighteen patients (21%) were receiving ACEI (12 patients) or ARB (6 patients) at the time of diagnosis. GCA-related complications (amaurosis fugax, diplopia, anterior ischemic optic neuritis, transient ischemic attack or stroke) occurred in 18 (21%) of patients at disease presentation. Ischemic complications occurred in 5 (27.8%) of patients receiving ACEI or ARB compared to 5 (7.6%) of those not receiving these therapies (p = 0.033). The proportion of patients who relapsed at least once was lower among those receiving ACEI or ARB (54% vs 75%, p = 0.06). Patients with multiple relapses were significantly less frequent among the ACEI/ARB treated group (p = 0.03). Patients receiving ACEI/ARB tended to achieve a maintenance prednisone dose < 10 mg/day earlier than patients not receiving these therapies (71 vs 82 weeks, p =0.07).

Conclusions:

Previous ACEI/ARB use is associated with higher frequency of ischemic complications at the time of GCA diagnosis but is associated with better response to glucocorticoid treatment. These preliminary data suggest that ACEI/ARB effects on angiogenesis or vascular remodelling nay be relevant to patients with GCA.

Supported by SAF 08/04328 and MaratoTV3.

To cite this abstract, please use the following information:
Alba, Marco A., Garcia-Martinez, Ana, Espigol-Frigole, Georgina, Tavera, Itziar, Butjosa, Montserrat, Prieto-Gonzalez, Sergio, et al; Treatment with Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Antagonists (ARA) Is Associated with Higher Frequency of Ischemic Complications but Better Response to Therapy in Patients with Giant-Cell Arteritis (GCA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1314
DOI: 10.1002/art.29080

Abstract Supplement

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