Clinical phenotype and complications of large vessel giant cell arteritis: A systematic review and meta-analysis

Suellen Anne Lyne; Carlee Ruediger; Susan Lester; Gursimran Kaur; Lisa Stamp; Ernst Michael Shanahan; Catherine Louise Hill

doi:10.1016/j.jbspin.2023.105558

Clinical phenotype and complications of large vessel giant cell arteritis: A systematic review and meta-analysis

Joint Bone Spine. 2023 Jul;90(4):105558. doi: 10.1016/j.jbspin.2023.105558. Epub 2023 Feb 28.

Authors

Suellen Anne Lyne¹, Carlee Ruediger², Susan Lester², Gursimran Kaur³, Lisa Stamp⁴, Ernst Michael Shanahan⁵, Catherine Louise Hill⁶

Affiliations

¹ University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia; Rheumatology Department, Level 5 the Tower Block, The Queen Elizabeth Hospital, 28, Woodville road, Woodville 5011, South Australia, Australia; Rheumatology Department, Flinders Medical Centre, Flinders Drive, Bedford Park 5042, South Australia, Australia. Electronic address: Suellen.Lyne@adelaide.edu.au.
² University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia; Rheumatology Department, Level 5 the Tower Block, The Queen Elizabeth Hospital, 28, Woodville road, Woodville 5011, South Australia, Australia.
³ Rheumatology Department, Christchurch Hospital, 2, Riccarton avenue, Christchurch Central City, 4710 Christchurch, New Zealand.
⁴ Rheumatology Department, Christchurch Hospital, 2, Riccarton avenue, Christchurch Central City, 4710 Christchurch, New Zealand; University of Otago, Christchurch Hospital, 2, Riccarton avenue, Christchurch Central City, 4710 Christchurch, New Zealand.
⁵ Rheumatology Department, Flinders Medical Centre, Flinders Drive, Bedford Park 5042, South Australia, Australia; Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia.
⁶ University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia; Rheumatology Department, Level 5 the Tower Block, The Queen Elizabeth Hospital, 28, Woodville road, Woodville 5011, South Australia, Australia; Rheumatology Department, Royal Adelaide Hospital, Port Road, Adelaide 5000, South Australia, Australia.

PMID: 36858169
DOI: 10.1016/j.jbspin.2023.105558

Abstract

Background: Giant Cell Arteritis (GCA) is a heterogenous systemic granulomatous vasculitis involving the aorta and any of its major tributaries. Despite increased awareness of large vessel (LV) involvement, studies reporting incidence, clinical characteristics and complications of large-vessel GCA (LV-GCA) show conflicting results due to inconsistent disease definitions, differences in study methodologies and the broad spectrum of clinical presentations. The aim of this systematic literature review was to better define LV-GCA based on the available literature and identify distinguishing characteristics that may differentiate LV-GCA patients from those with limited cranial disease.

Methods: Published studies indexed in MEDLINE and EMBASE were searched from database inception to 7th May 2021. Studies were included if they presented cohort or cross-sectional data on a minimum of 25 patients with LV-GCA. Control groups were included if data was available on patients with limited cranial GCA (C-GCA). Data was quantitatively synthesised with application of a random effects meta-regression model, using Stata.

Results: The search yielded 3488 studies, of which 46 were included. Diagnostic criteria for LV-GCA differed between papers, but was typically dependent on imaging or histopathology. Patients with LV-GCA were generally younger at diagnosis compared to C-GCA patients (mean age difference -4.53 years), had longer delay to diagnosis (mean difference 3.03 months) and lower rates of positive temporal artery biopsy (OR: 0.52 [95% CI: 0.3, 0.91]). Fewer LV-GCA patients presented with cranial manifestations and only 53% met the 1990 ACR Classification Criteria for GCA. Vasculitis was detected most commonly in the thoracic aorta, followed by the subclavian, brachiocephalic trunk and axillary arteries. The mean cumulative prednisolone dose at 12-months was 6056.5mg for LV-GCA patients, relapse rates were similar between LV- and C-GCA patients, and 12% of deaths in LV-GCA patients could be directly attributed to an LV complication.

Conclusion: Patients with LV-GCA have distinct disease features when compared to C-GCA, and this has implications on diagnosis, treatment strategies and surveillance of long-term sequalae.

Keywords: Extra-cranial; Giant cell arteritis; Large vessel vasculitis; Meta-analysis; Systematic literature review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Giant Cell Arteritis* / complications
Giant Cell Arteritis* / diagnosis
Giant Cell Arteritis* / drug therapy
Humans
Phenotype