de Mornac Donatienne, Espitia Olivier, Néel Antoine, Connault Jérôme, Masseau Agathe, Espitia-Thibault Alexandra, Artifoni Mathieu, Achille Aurélie, Wahbi Anaïs, Lacou Mathieu, Durant Cécile, Pottier Pierre, Perrin François, Graveleau Julie, Hamidou Mohamed, Hardouin Jean-Benoit, Agard Christian
Department of Internal Medicine, Nantes University Hospital, Nantes, France.
Department of Internal Medicine, CHU Nantes, 1 Place Alexis Ricordeau, Nantes, 44093, France.
Ther Adv Musculoskelet Dis. 2021 May 18;13:1759720X211009029. doi: 10.1177/1759720X211009029. eCollection 2021.
Giant cell arteritis (GCA) is the most common systemic vasculitis. Relapses are frequent. The aim of this study was to identify relapse risk factors in patients with GCA with complete large-vessel imaging at diagnosis.
Patients with GCA followed in our institution between April 1998 and April 2018 were included retrospectively. We included only patients who had undergone large vascular imaging investigations at diagnosis by computed tomography (CT)-scan and/or positron emission tomography (PET)-scan and/or angio-magnetic resonance imaging (MRI). Clinical, biological, and radiological data were collected. Relapse was defined as the reappearance of GCA symptoms, with concomitant increase in inflammatory markers, requiring treatment adjustment. Relapsing patients (R) and non-relapsing patients (NR) were compared. Relapse and multiple relapses (>2) risk factors were identified in multivariable Cox analyses.
This study included 254 patients (73.2% women), with a median age of 72 years at diagnosis and a median follow up of 32.5 months. At diagnosis, 160 patients (63%) had an inflammatory large-vessel involvement on imaging, 46.1% (117 patients) relapsed at least once, and 21.3% (54 patients) had multiple relapses. The median delay of first relapse after diagnosis was 9 months. The second relapse delay was 21.5 months. NR patients had more stroke at diagnosis than R ( = 0.03) and the brachiocephalic trunk was involved more frequently on CT-scan ( = 0.046), as carotids ( = 0.02) in R patients. Multivariate Cox model identified male gender [hazard ratio (HR): 0.51, confidence interval (CI) (0.27-0.96), = 0.04] as a relapse protective factor, and peripheral musculoskeletal manifestations [HR: 1.74 (1.03-2.94), = 0.004] as a relapse risk factor. Peripheral musculoskeletal manifestations [HR: 2.78 (1.23-6.28), = 0.014], negative temporal artery biopsy [HR: 2.29 (1.18-4.45), = 0.015], large-vessel involvement like upper limb ischemia [HR: 8.84 (2.48-31.56), = 0.001] and inflammation of arm arteries on CT-scan [HR: 2.39 (1.02-5.58), = 0.04] at diagnosis were risk factors of multiple relapses.
Male gender was a protective factor for GCA relapse and peripheral musculoskeletal manifestations appeared as a relapsing risk factor. Moreover, this study identified a particular clinical phenotype of multi-relapsing patients with GCA, characterized by peripheral musculoskeletal manifestations, negative temporal artery biopsy, and large-vessel involvement with upper limb ischemia or inflammation of arm arteries.
46.1% of patients with GCA relapse, and 21.3% undergo multiple relapses;Male gender appears as a protective factor for relapsing in GCA;Peripheral musculoskeletal manifestations are a relapse and multiple relapses risk factor;A negative temporal artery biopsy is predictive of multiple relapses;Large-vessel involvement is predictive of multiple relapses.
巨细胞动脉炎（GCA）是最常见的系统性血管炎，复发频繁。本研究旨在确定诊断时进行了完整大血管成像的GCA患者的复发危险因素。
回顾性纳入1998年4月至2018年4月在我们机构随访的GCA患者。我们仅纳入了在诊断时通过计算机断层扫描（CT）、正电子发射断层扫描（PET）和/或血管磁共振成像（MRI）进行了大血管成像检查的患者。收集临床、生物学和放射学数据。复发定义为GCA症状再次出现，同时炎症标志物增加，需要调整治疗。比较复发患者（R）和未复发患者（NR）。在多变量Cox分析中确定复发和多次复发（>2次）的危险因素。
本研究纳入254例患者（73.2%为女性），诊断时中位年龄72岁，中位随访32.5个月。诊断时，160例患者（63%）影像学显示有炎症性大血管受累，46.1%（117例患者）至少复发一次，21.3%（54例患者）多次复发。诊断后首次复发的中位延迟时间为9个月。第二次复发延迟时间为21.5个月。NR患者诊断时中风发生率高于R患者（P = 0.03），R患者CT扫描显示头臂干受累更频繁（P = 0.046），颈动脉受累情况类似（P = 0.02）。多变量Cox模型确定男性性别[风险比（HR）：0.51，置信区间（CI）（0.27 - 0.96），P = 0.04]为复发保护因素，外周肌肉骨骼表现[HR：1.74（1.03 - 2.94），P = 0.004]为复发危险因素。外周肌肉骨骼表现[HR：2.78（1.23 - 6.28），P = 0.014]、颞动脉活检阴性[HR：2.29（1.18 - 4.45），P = 0.015]、诊断时如上肢缺血等大血管受累[HR：8.8（2.48 - 31.56），P = 0.001]以及CT扫描显示臂动脉炎症[HR：2.39（1.02 - 5.58），P = 0.04]是多次复发的危险因素。
男性性别是GCA复发的保护因素，外周肌肉骨骼表现是复发危险因素。此外，本研究确定了GCA多次复发患者的一种特殊临床表型，其特征为外周肌肉骨骼表现、颞动脉活检阴性以及伴有上肢缺血或臂动脉炎症的大血管受累。
46.1%的GCA患者复发，21.3%多次复发；男性性别是GCA复发的保护因素；外周肌肉骨骼表现是复发和多次复发的危险因素；颞动脉活检阴性可预测多次复发；大血管受累可预测多次复发。
