Prünte Mona Klara Ros, Naumann Anne, Christ Monika, Naumann Markus, Bayas Antonios
Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
Front Neurol. 2023 Jun 26;14:1188073. doi: 10.3389/fneur.2023.1188073. eCollection 2023.
Vertebral artery (VA) involvement in giant cell arteritis (GCA) has rarely been reported. We aimed to evaluate the prevalence, patients' characteristics, and immunotherapies used in patients with GCA and VA involvement at diagnosis and 1 year follow-up, retrospectively including patients being diagnosed between January 2011 and March 2021 in our department. Clinical features, laboratory data, VA imaging, immunotherapy, and 1 year follow-up data were analyzed. Baseline characteristics were compared to GCA patients without VA involvement. Among all 77 cases with GCA, 29 patients (37.7%) had VA involvement, as diagnosed by imaging and/or clinical signs and symptoms. Gender distribution and erythrocyte sedimentation rate (ESR) were significantly different in the groups with and without VA involvement, with more women being affected (38/48 patients, 79.2%) and a significantly higher median ESR in patients without VA involvement (62 vs. 46 mm/h; = 0.012). MRI and/or CT showed vertebrobasilar stroke at GCA diagnosis in 11 cases. 67/77 patients (87.0%) received high-dose intravenous glucocorticosteroids (GCs) at diagnosis, followed by oral tapering. Six patients were treated with methotrexate (MTX), one with rituximab, and five with tocilizumab (TCZ). 2/5 TCZ patients achieved clinical remission after 1 year, vertebrobasilar stroke within the first year occurred in 2/5 patients. Diagnosis of VA involvement might be underrecognized in GCA patients. VA imaging should be performed in elderly patients with vertebrobasilar stroke presenting with GCA symptoms, not to miss GCA as the etiology of stroke. Efficacy of immunotherapies in GCA with VA affection and long-term outcomes need to be investigated further.
椎动脉（VA）受累于巨细胞动脉炎（GCA）的情况鲜有报道。我们旨在评估GCA合并VA受累患者在诊断时及1年随访时的患病率、患者特征及使用的免疫疗法，回顾性纳入2011年1月至2021年3月在我科诊断的患者。分析了临床特征、实验室数据、VA影像学、免疫疗法及1年随访数据。将基线特征与无VA受累的GCA患者进行比较。在所有77例GCA患者中，29例（37.7%）有VA受累，通过影像学和/或临床体征及症状诊断。有和无VA受累的组间性别分布及红细胞沉降率（ESR）有显著差异，受累女性更多（38/48例患者，79.2%），无VA受累患者的ESR中位数显著更高（62对46 mm/h；P = 0.012）。MRI和/或CT显示11例患者在GCA诊断时有椎基底动脉卒中。67/77例患者（87.0%）在诊断时接受了大剂量静脉糖皮质激素（GCs）治疗，随后逐渐减量口服。6例患者接受甲氨蝶呤（MTX）治疗，1例接受利妥昔单抗治疗，5例接受托珠单抗（TCZ）治疗。2/5例TCZ治疗患者在1年后达到临床缓解，1年内2/5例患者发生椎基底动脉卒中。GCA患者中VA受累的诊断可能未得到充分认识。对于出现GCA症状的老年椎基底动脉卒中患者应进行VA影像学检查，以免漏诊GCA作为卒中的病因。GCA合并VA受累时免疫疗法的疗效及长期预后需进一步研究。
