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Show Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Authors: J. Anthony Chacko MD,1 Muhammad Z. Chauhan MD,1 Raghu Ramakrishnaiah MD,2 Paul H. Phillips MD,1 Joseph G. Chacko MD1 Affiliations: 1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA 2Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Financial Disclosures • The Authors have no financial interests to disclose Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Introduction • GCA is a systemic autoimmune disease • Incidence: 18-29 cases in 100,000 people ≥ 50 years old1 • Symptoms: headache, scalp tenderness, jaw claudication, vision loss2 • Aortic aneurysm and/or carotid stenosis has been described in GCA patients3 1 Burg LC, Karakostas P, Behning C, Brossart P, Kermani TA, Schäfer VS. Ther Adv Musculoskelet Dis. 2023;15:1759720X221149963. 2 Robson JC, Kiran A, Maskell J, et al. Ann Rheum Dis 2015;74(1):129-35. 3 Nuenninghoff DM, Hunder GG, Christianson TJ, et al. Arthritis Rheum 2003;48(12):3522-31. Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Introduction Figure 1A: Distribution of potential regions of arterial involvement in GCA patients Figure 1B: Aortic aneurysms by anatomical location Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Purpose • Evaluate risk of aortic and carotid complications in GCA patients, with a focus on those with visual symptoms • Evaluate need of screening for aortic structural disease (ASD) in GCA patients Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Methods • Analyzed the TriNetX© Diamond Network from 2014-2020 • Group 1: GCA ≥ 50 years old with TAB within 2 weeks of diagnosis • Group 2: GCA + TAB within 2 weeks + 3-month history of a visual symptom • Control: tension-type headache without necrotizing vasculopathy • Excluded: Hx GCA or aortic aneurysm, DVT/PE, cerebral infarction, MI, or necrotizing vasculopathy Copyright © 2019 TriNetX • 125 Cambridgepark Drive, Suite 500 • Cambridge, MA 02140 USA Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Methods • Primary Outcomes: • Thoracic aortic aneurysms • Thoracoabdominal aortic aneurysms • Abdominal aortic aneurysms • Carotid artery stenosis • Calculate absolute risk, relative risk (RR) and adjusted hazard ratio (aHR) for aortic aneurysms and carotid artery stenosis at a 5-year time window Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Results Before Matching: GCA + TAB [Group 1] (n = 13,278) and Control (n = 813,672) After Matching: Age, Sex, Ethnicity, Substance Abuse, BMI, T2DM, HTN, HPLD, Socioeconomic indices GCA + TAB [Group 1] (n = 13,277) and Control (n = 13,277) Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Results For GCA + TAB (Group 1) compared to controls: • Increased risk of ANY aortic aneurysm (thoracic, thoracoabdominal, and abdominal) • 5-years: 1.83% versus 1.19% (aHR: 1.51, 95% CI: 1.23-1.84, p < 0.0001) • Increased risk of thoracic aortic aneurysms (aHR: 1.85, 95% CI: 1.38-2.49) • No difference for thoracoabdominal aortic aneurysms (aHR: 1.08, 95% CI: 0.46-2.56) • No difference for abdominal aortic aneurysms (aHR: 1.25, 95% CI: 0.98-1.6) Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Results For GCA + TAB (Group 1) compared to controls: • Increased risk of carotid artery stenosis • 5-years: 5.89% versus 4.13% (RR: 1.43, 95% CI: 1.28-1.59, p < 0.0001) • aHR: 1.56, 95% CI: 1.38-1.74 Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Results Before Matching: GCA + TAB + Visual Symptom [Group 2] (n = 1,268) and Control (n = 813,672) After Matching: Age, Sex, Ethnicity, Substance Abuse, BMI, T2DM, HTN, HPLD, Socioeconomic indices GCA + TAB + Visual Symptom [Group 2] (n = 1,268) and Control (n = 1,268) Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Results For GCA + TAB + Visual Symptom (Group 2) compared to controls: • Elevated risk of ANY aortic aneurysm: 2.51% versus 1.21% (aHR: 2.15, 95% CI: 1.16-3.98) • Increased risk of thoracic aortic aneurysms (aHR: 2.79, 95% CI: 1.30-5.95) • Elevated risk of carotid stenosis: 6.67% versus 4.13% (aHR: 1.50, 95% CI: 1.05-2.12) Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Results aHR = 1.51 aHR = 1.85 aHR = 1.56 aHR = 2.15 aHR = 2.79 aHR = 1.50 Forest plot of adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CI) for development of any aortic aneurysm, thoracic aortic aneurysm, or carotid artery stenosis in the GCA + TAB and GCA + TAB + Vision Symptom (Sx) cohorts compared to controls at 5-years Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Discussion • GCA patients ≥ 50, 3+ prescriptions for prednisolone within 6 months • 9908 GCA patients and 98,204 controls • For thoracic AA, the RR was 4.97 and 7.39 at 5 and 10-years, respectively. • Median time to thoracic AA: 7.5 years • For PAD, the RR was 1.58 and 1.60 at 5- and 10-years, respectively. Therkildsen P, de Thurah A, Nielsen BD, et al. Rheumatology (Oxford). 2022;61(7):2931-2941. doi:10.1093/rheumatology/keab871. Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Limitations • Retrospective design • Selection and information bias • Severity or duration of visual symptoms • TAB confirmed • 5-year design Aortic and Carotid Complications in Patients with Giant Cell Arteritis with and without Visual Symptoms Conclusion • Patients with GCA, especially with visual symptoms, are at increased risk of thoracic aortic aneurysms and carotid stenosis. • Therefore, consider CTA chest and carotid duplex in our GCA patients. |
