Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Semin Arthritis Rheum. 2022 Aug;55:152017. doi: 10.1016/j.semarthrit.2022.152017. Epub 2022 Apr 28.
To determine the prevalence and predictors of subclinical giant cell arteritis (GCA) in patients with newly diagnosed polymyalgia rheumatica (PMR).
PubMed, Embase, and Web of Science Core Collection were systematically searched (date of last search July 14, 2021) for any published information on any consecutively recruited cohort reporting the prevalence of GCA in steroid-naïve patients with PMR without cranial or ischemic symptoms. We combined prevalences across populations in a random-effect meta-analysis. Potential predictors of subclinical GCA were identified by mixed-effect logistic regression using individual patient data (IPD) from cohorts screened with PET/(CT).
We included 13 cohorts with 566 patients from studies published between 1965 to 2020. Subclinical GCA was diagnosed by temporal artery biopsy in three studies, ultrasound in three studies, and PET/(CT) in seven studies. The pooled prevalence of subclinical GCA across all studies was 23% (95% CI 14%-36%, I=84%) for any screening method and 29% in the studies using PET/(CT) (95% CI 13%-53%, I=85%) (n=266 patients). For seven cohorts we obtained IPD for 243 patients screened with PET/(CT). Inflammatory back pain (OR 2.73, 1.32-5.64), absence of lower limb pain (OR 2.35, 1.05-5.26), female sex (OR 2.31, 1.17-4.58), temperature >37° (OR 1.83, 0.90-3.71), weight loss (OR 1.83, 0.96-3.51), thrombocyte count (OR 1.51, 1.05-2.18), and haemoglobin level (OR 0.80, 0.64-1.00) were most strongly associated with subclinical GCA in the univariable analysis but not C-reactive protein (OR 1.00, 1.00-1.01) or erythrocyte sedimentation rate (OR 1.01, 1.00-1.02). A prediction model calculated from these variables had an area under the curve of 0.66 (95% CI 0.55-0.75).
More than a quarter of patients with PMR may have subclinical GCA. The prediction model from the most extensive IPD set has only modest diagnostic accuracy. Hence, a paradigm shift in the assessment of PMR patients in favour of implementing imaging studies should be discussed.
确定新诊断的巨细胞动脉炎（GCA）患者中亚临床巨细胞动脉炎（GCA）的患病率和预测因素。
系统检索了 PubMed、Embase 和 Web of Science 核心合集（最后一次检索日期为 2021 年 7 月 14 日），以获取任何关于连续招募队列的已发表信息，这些队列报告了无颅或缺血症状的类固醇初治巨细胞动脉炎患者中 GCA 的患病率。我们通过使用正电子发射断层扫描（PET）/计算机断层扫描（CT）筛选的队列中的个体患者数据（IPD），使用混合效应逻辑回归识别亚临床 GCA 的潜在预测因素。
我们纳入了 1965 年至 2020 年期间发表的 13 项队列研究，共 566 名患者。3 项研究通过颞动脉活检、3 项研究通过超声、7 项研究通过 PET/CT 诊断亚临床 GCA。所有研究中，任何筛查方法的亚临床 GCA 患病率为 23%（95%CI 14%-36%，I=84%），使用 PET/CT 的研究为 29%（95%CI 13%-53%，I=85%）（n=266 名患者）。对于 7 项队列，我们获得了 243 名接受 PET/CT 筛查患者的 IPD。炎症性背痛（OR 2.73，1.32-5.64）、下肢疼痛缺失（OR 2.35，1.05-5.26）、女性（OR 2.31，1.17-4.58）、体温>37°（OR 1.83，0.90-3.71）、体重减轻（OR 1.83，0.96-3.51）、血小板计数（OR 1.51，1.05-2.18）和血红蛋白水平（OR 0.80，0.64-1.00）在单变量分析中与亚临床 GCA 最密切相关，但 C 反应蛋白（OR 1.00，1.00-1.01）或红细胞沉降率（OR 1.01，1.00-1.02）无关。从这些变量计算的预测模型的曲线下面积为 0.66（95%CI 0.55-0.75）。
超过四分之一的巨细胞动脉炎患者可能存在亚临床 GCA。来自最大 IPD 集的预测模型仅具有适度的诊断准确性。因此，应该讨论评估 PMR 患者的范式转变，支持实施影像学研究。
