Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Semin Arthritis Rheum. 2021 Apr;51(2):360-366. doi: 10.1016/j.semarthrit.2021.01.007. Epub 2021 Jan 27.
The study investigated the development over time of the incidence, diagnostic imaging, and treatment of giant cell arteritis (GCA).
This nationwide, population-based cohort study was conducted in Denmark using medical and administrative registries. Incident GCA cases from 1996-2018 were defined as patients aged ≥50 years registered with a first-time GCA diagnosis and ≥3 prescriptions for glucocorticoids (GCs) within 6 months after diagnosis. We determined incidence rates of GCA, the proportion of patients still receiving GCs >2 years after diagnosis, the proportion of patients receiving temporal artery biopsies (TAB) and diagnostic imaging including ultrasound, positron emission tomography, magnetic resonance, and/or computed tomography angiography at the time of diagnosis.
We identified 9908 incident GCA cases. The incidence rates of GCA remained stable at 19-25 per 100,000 people aged >50 years from 1996-2018. The proportion of GCA patients receiving a TAB remained constant until 2016, after which it promptly declined from 70-80% to 29-39%. In contrast, the proportion of patients receiving diagnostic imaging increased from 2% to 66% from 2000-2018. The proportion of GCA patients remaining in GC treatment has steadily decreased from 1996-2016, but remains high at 64%, 40%, and 34% after 2, 5, and 10 years following the diagnosis, respectively. The cumulative GC dose has remained relatively stable.
Incidence rates of GCA have remained stable since 1996 despite increasing use of diagnostic imaging. There is a clear discrepancy between current international GCA treatment guidelines and the clinical practice up to 2018.
本研究旨在探讨巨细胞动脉炎（GCA）发病率、诊断性影像学检查和治疗方法随时间的变化情况。
本研究为基于人群的全国性队列研究，在丹麦开展，使用医疗和行政登记系统。1996 年至 2018 年间，确诊为 GCA 的年龄≥50 岁的患者被定义为首次确诊 GCA 并在诊断后 6 个月内至少开具 3 次糖皮质激素（GC）处方的患者。我们确定了 GCA 的发病率、诊断后仍接受 GC 治疗>2 年的患者比例、诊断时接受颞动脉活检（TAB）和诊断性影像学检查（包括超声、正电子发射断层扫描、磁共振成像和/或计算机断层血管造影）的患者比例。
我们共确定了 9908 例确诊的 GCA 患者。1996 年至 2018 年间，年龄>50 岁人群中 GCA 的发病率保持在 19-25/10 万之间，相对稳定。接受 TAB 检查的 GCA 患者比例直到 2016 年一直保持不变，此后迅速从 70-80%降至 29-39%。相比之下，2000 年至 2018 年期间，接受诊断性影像学检查的患者比例从 2%增加到 66%。诊断后 2、5 和 10 年，仍接受 GC 治疗的 GCA 患者比例分别持续下降（从 1996 年至 2016 年），但仍分别高达 64%、40%和 34%。GC 累积剂量相对稳定。
尽管诊断性影像学检查的应用日益广泛，但自 1996 年以来，GCA 的发病率保持稳定。目前的国际 GCA 治疗指南与 2018 年之前的临床实践之间存在明显差异。
