Gonzalez-Gay Miguel A, Miranda-Filloy Jose A, Lopez-Diaz Maria J, Perez-Alvarez Roberto, Gonzalez-Juanatey Carlos, Sanchez-Andrade Amalia, Martin Javier, Llorca Javier
From Divisions of Rheumatology (MAG-G, JAM-F, MJL-D, AS-A) and Cardiology (CG-J), Hospital Xeral-Calde, Lugo; Division of Medicine (RP-A), Hospital Meixoeiro, Vigo; Instituto de Parasitologia y Biomedicina Lopez-Neyra (JM), CSIC, Granada; and Division of Preventive Medicine and Public Health (JL), School of Medicine, University of Cantabria, Santander, Spain.
Medicine (Baltimore). 2007 Mar;86(2):61-68. doi: 10.1097/md.0b013e31803d1764.
To continue our investigation of the epidemiology of giant cell arteritis (GCA) in southern Europe, we assessed the potential presence of trends, peaks, and fluctuations in the incidence of this vasculitis over a 25-year period in the Lugo region of northwestern Spain. We also sought to determine whether changes in the clinical spectrum of the disease existed. From 1981 to 2005, biopsy-proven GCA was diagnosed in 255 Lugo residents. The age- and sex-adjusted annual incidence rate was 10.13 (95% confidence interval [CI], 8.93-11.46) per 100,000 population aged 50 years and older. The mean age +/- SD at the time of diagnosis was 75.0 +/- 6.9 years. The annual incidence rate in women (10.23; 95% CI, 8.60-12.08) was slightly greater than that in men (9.92; 95% CI, 8.19-11.89) (p = 0.15). The annual incidence rate increased with advancing age up to a maximum of 23.16 (95% CI, 19.52-27.28) in the 70-79 year age-group. A progressive increase in the incidence was observed from 1981 through 2000 (p = 0.001). However, the age- and sex-adjusted incidence rate for biopsy-proven GCA in the Lugo region did not show peaks in the annual incidence of GCA. Likewise, we observed no seasonal pattern for the diagnosis of the disease. Visual ischemic manifestations and irreversible visual loss were observed in 57 (22.4%) and 32 (12.5%) of the 255 patients, respectively. A negative trend manifested by a progressive decline in the number of patients with visual ischemic manifestations (p = 0.021) or permanent visual loss (p = 0.018) was found over the 25-year period of study. The decline in the frequency of visual manifestations of GCA could not be attributed to a shorter delay to diagnosis, as no significant differences were observed when the delays to diagnosis in the 5 consecutive 5-year periods were compared. In conclusion, the current study confirms a progressive increase in the incidence of biopsy-proven GCA in northwestern Spain, and suggests that there has been a change in the clinical spectrum of the disease.
为继续我们对欧洲南部巨细胞动脉炎（GCA）流行病学的调查，我们评估了西班牙西北部卢戈地区在25年期间这种血管炎发病率的潜在趋势、峰值和波动情况。我们还试图确定该疾病的临床谱是否存在变化。1981年至2005年期间，255名卢戈居民被诊断为经活检证实的GCA。年龄和性别调整后的年发病率为每10万50岁及以上人群10.13（95%置信区间[CI]，8.93 - 11.46）。诊断时的平均年龄±标准差为75.0±6.9岁。女性的年发病率（10.23；95%CI，8.60 - 12.08）略高于男性（9.92；95%CI，8.19 - 11.89）（p = 0.15）。年发病率随年龄增长而增加，在70 - 79岁年龄组达到最高值23.16（95%CI，19.52 - 27.28）。1981年至2000年期间观察到发病率逐渐上升（p = 0.001）。然而，卢戈地区经活检证实的GCA的年龄和性别调整发病率未显示出GCA年发病率的峰值。同样，我们未观察到该疾病诊断的季节性模式。255例患者中，分别有57例（22.4%）和32例（12.5%）出现视觉缺血表现和不可逆性视力丧失。在25年的研究期间，发现有视觉缺血表现（p = 0.021）或永久性视力丧失（p = 0.018）的患者数量呈逐渐下降的负趋势。GCA视觉表现频率的下降不能归因于诊断延迟时间缩短，因为在连续5个5年期间比较诊断延迟时间时未观察到显著差异。总之，当前研究证实西班牙西北部经活检证实的GCA发病率逐渐上升，并表明该疾病的临床谱发生了变化。
