Department of Internal Medicine, Division of Autoimmune and Rheumatic diseases, University of Minnesota, Minneapolis, Minnesota, USA
Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.
RMD Open. 2024 Feb 8;10(1):e003775. doi: 10.1136/rmdopen-2023-003775.
To evaluate the incidence and outcomes of large artery (LA) involvement among patients with giant cell arteritis (GCA) and to compare LA involvement to non-GCA patients.
The study included Olmsted County, Minnesota, USA residents with incident GCA between 1950 and 2016 with follow-up through 31 December 2020, death or migration. A population-based age-matched/sex-matched comparator cohort without GCA was assembled. LA involvement included aortic aneurysm, dissection, stenosis in the aorta or its main branches diagnosed within 1 year prior to GCA or anytime afterwards. Cumulative incidence of LA involvement was estimated; Cox models were used.
The GCA cohort included 289 patients (77% females, 81% temporal artery biopsy positive), 106 with LA involvement.Reported cumulative incidences of LA involvement in GCA at 15 years were 14.8%, 30.2% and 49.2% for 1950-1974, 1975-1999 and 2000-2016, respectively (HR 3.48, 95% CI 1.67 to 7.27 for 2000-2016 vs 1950-1974).GCA patients had higher risk for LA involvement compared with non-GCA (HR 3.22, 95% CI 1.83 to 5.68 adjusted for age, sex, comorbidities). Thoracic aortic aneurysms were increased in GCA versus non GCA (HR 13.46, 95% CI 1.78 to 101.98) but not abdominal (HR 1.08, 95% CI 0.33 to 3.55).All-cause mortality in GCA patients improved over time (HR 0.62, 95% CI 0.41 to 0.93 in 2000-2016 vs 1950-1974) but remained significantly elevated in those with LA involvement (HR 1.89, 95% CI 1.39 to 2.56).
LA involvement in GCA has increased over time. Patients with GCA have higher incidences of LA involvement compared with non-GCA including thoracic but not abdominal aneurysms. Mortality is increased in patients with GCA and LA involvement highlighting the need for continued surveillance.
评估巨细胞动脉炎（GCA）患者大动脉（LA）受累的发生率和结局，并将 LA 受累与非 GCA 患者进行比较。
本研究纳入了 1950 年至 2016 年间美国明尼苏达州奥姆斯特德县发病的 GCA 患者，并随访至 2020 年 12 月 31 日，随访终点为死亡或迁移。组建了一个基于人群的年龄匹配/性别匹配的无 GCA 对照组。LA 受累包括在 GCA 发病前 1 年内或之后任何时间诊断的主动脉瘤、夹层、主动脉或其主要分支狭窄。估计 LA 受累的累积发生率；使用 Cox 模型。
GCA 队列包括 289 名患者（77%为女性，81%颞动脉活检阳性），106 名患者有 LA 受累。报告的 1950-1974 年、1975-1999 年和 2000-2016 年 GCA 患者 15 年 LA 受累的累积发生率分别为 14.8%、30.2%和 49.2%（2000-2016 年与 1950-1974 年相比，HR 3.48，95%CI 1.67 至 7.27）。与非 GCA 患者相比，GCA 患者发生 LA 受累的风险更高（HR 3.22，95%CI 1.83 至 5.68，年龄、性别、合并症校正后）。与非 GCA 患者相比，GCA 患者的胸主动脉瘤发生率增加（HR 13.46，95%CI 1.78 至 101.98），但腹主动脉瘤发生率无增加（HR 1.08，95%CI 0.33 至 3.55）。GCA 患者的全因死亡率随时间改善（2000-2016 年与 1950-1974 年相比，HR 0.62，95%CI 0.41 至 0.93），但 LA 受累患者的死亡率仍显著升高（HR 1.89，95%CI 1.39 至 2.56）。
GCA 患者的 LA 受累随时间增加。与非 GCA 患者相比，GCA 患者的 LA 受累发生率更高，包括胸主动脉瘤，但不包括腹主动脉瘤。GCA 合并 LA 受累患者的死亡率增加，强调需要持续监测。
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