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Publications

Journal Article Ahead of print

PubMed: 41728983 DOI: 10.1002/art.70101

Prognosis and long term outcome of stenotic large vessel involvement in giant cell arteritis.

Arthritis Rheumatol

Authors: Georgina Maalouf, Bérangère Arnould, Olivier Espitia, Hubert Deboysson, Maxime Samson, Arnaud Hot, Eric Liozon, Simon Parreau, Christian Lavigne, Valentin Lacombe, Jean-Francois Alexandra, Thomas Thibault, Laurent Chiche, Julien Gaudric, Alban Redheuil, Matheus Vieira, Matthieu Groh, Cécile-Audrey Durel, Thibaud Chazal, Chloé Comarmond, Nadine Magy-Bertrand, Stéphane Vinzio, Lionel Martzolff, Pierre Lozac'h, Rodérau Outh, Jérémy Clément, Pierre Duffau, Anael Dumont, Sebastien Humbert, Constance Guillaud, Azeddine Dellal, Grégory Pugnet, Valérie Devauchelle-Pensec, Patrice Cacoub, Lucie Biard, David Saadoun

Affiliations

  • Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Département de Médecine Interne et immunologie Clinique, F-75013, Paris , France , Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire ( CEREMAIA) ; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD) ; CIC Biotherapy ; INSERM 959, Groupe Hospitalier Pitié Salpetriere, AP-HP, Paris, France.
  • Department of Internal Medicine, CHU Rouen, Rouen, France.
  • Department of Vascular Medicine, CHU Nantes, Nantes, France.
  • Department of Internal Medicine, CHU Caen, Caen, France.
  • Internal medecine and systemic disease unit, CHU Dijon, Dijon, Burgundy, France.
  • Department of Internal Medicine, Hopital Edouard-Herriot, Lyon, France.
  • Department of Internal Medicine, CHU Limoges, Limoges, France.
  • Department of Internal Medicine, Hopital Dupuytren, Limoges, France.
  • Médecine interne et polyvalente, CH du Haut-Anjou, Chateau-Gontier ; Médecine interne, CHU d'Angers.
  • Department de Médecine interne-Immunologie clinique, CHU d'Angers, Angers, France, Centre National de Référence Maladies Autoimmunes Systémiques Rares CeRAINOM-Angers.
  • Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Department of Vascular and Interventional radiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Department of Internal Medicine, Hôpital Foch, Suresnes, France.
  • Department of Internal Medicine, Hôpital Fondation Adolphe-de-Rothschild, Paris, France.
  • Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Department of Internal Medicine, CHRU Jean-Minjoz, Besançon, France.
  • Department of Internal Medicine, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France.
  • Department of Internal Medicine, Groupe Hospitalier Région Mulhouse et Sud Alsace, Hôpital Emile-Muller, Mulhouse, France.
  • Department of Internal Medicine, CH Le Mans, Le Mans, France.
  • Department of Internal Medicine, CHU Grabiel-Montpied, Clermont-Ferrand, France.
  • Department of Internal Medicine, CH de Blois, Blois, France.
  • Department of Internal Medicine, CHU de Bordeaux, Bordeaux, France.
  • Department of Internal medicine, Centre Hospitalier Louis Pasteur, Dole, France.
  • Department of Internal Medicine, Hôpital Henri-Mondor, Créteil, France.
  • Department of Rheumatology, GHJ Le Raincy-Montfermeil, Montfermeil, France.
  • Department of Internal Medicine and Clinical Immunology, CHU Rangueil, Toulouse, France.
  • Department of Rheumatology, Hôpital de La Cavale-Blanche, Brest, France.
  • Department of Biostatistics, Hopital Saint Louis, Paris.

Abstract

OBJECTIVES

Large vessel-vasculitis (LVV) account for up to 70% of patients with giant cell arteritis (GCA). Stenotic involvement in GCA-LVV remains largely unknown. The purpose of this study was to assess the long-term outcome and prognosis of GCA with stenotic LVV.

METHODS

Retrospective multicenter study of 3,149 patients with GCA, including 198 (6.3%) with stenotic LVV. Hierarchical clustering on principal components (HCPC) was performed on baseline arterial localizations and logistic regression assessed factors associated with vascular complications.

RESULTS

Stenotic LVV affected mostly the subclavian artery (63%), the carotid artery ( 58%) , vertebral artery(37%), axillary artery(33%), followed by the femoral artery (30%) and mesenteric arteries (13%). Stroke (31%) was the main complication followed by limb ischemia (21%), myocardial infarction (4%) and mesenteric ischemia (2%). Cumulative incidence of vascular complications was 13.1% (95% CI: 8.9%-18.3%), 17.3% (95% CI: 12.3%-22.9%) and 19.5% (95% CI:14.3%-25.4%), at 1, 5 and 10 years respectively. Hierarchical clustering analysis identified 3 clusters among which cluster 1 (n=123; 62%) included older patients with more arteritic anterior ischemic optic neuropathy (p=0.04), vertebral artery stenosis and a higher mortality rate (p<0.044). In multivariate analysis, age at diagnosis [hazard ratio (HR): 1.06 (95% CI 1.03-1.10), p = 0.0004] and vertebral involvement [hazard ratio (HR): 1.87 (95% CI 1.03-3.40), p=0.039] were significantly associated with higher risk of vascular complication.

CONCLUSION

Stenotic LVV account for less than 10% of GCA and is associated with poor vascular prognosis.

MeSH

Cells, Arthritis, Arteries, Arteritis, Rheumatic Diseases, Giant Cells, Cluster Analysis, Vertebral Artery, Giant Cell Arteritis, Ischemia, Prognosis