POS0721 DIFFERENT PATTERNS OF VASCULAR ULTRASOUND ARE ASSOCIATED WITH DIFFERENT ISCHEMIC COMPLICATIONS IN PATIENTS WITH GIANT CELL ARTERITIS

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 648
• Main Authors: J Molina Collada, G Torres Ortiz, Castrejon, I, Monjo, I, Fernández-Fernández, E, Alvaro-Gracia, J M, De Miguel, E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Acute coronary syndromes; Arteries; Arteriosclerosis; Arteritis; Biopsy; C-reactive protein; Cardiovascular diseases; Colitis; Diagnosis; Embolism; Erythrocyte sedimentation rate; Hemoglobin; Histology; Inflammation; Ischemia; Jaw; Lung diseases; Optic neuropathy; Polymyalgia rheumatica; Pulmonary artery; Pulmonary embolisms; Risk factors; Skull; Stroke; Ultrasonic imaging; Ultrasound; Vascular diseases; Vein & artery diseases
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.2375

BackgroundPatients with giant cell arteritis (GCA) can present ischemic complications (IC). Recognizing patients at risk of IC may help to improve GCA long-term outcomes. However, previous studies have failed to identify consistent risk factors for IC in this population, being mainly low systemic inflammation or atherosclerotic risk factors the main findings in some cohorts.ObjectivesOur objective is to determine if a specific pattern of vascular inflammation by ultrasound (US) is associated with different types of IC in patients with GCA.MethodsA retrospective observational study of patients referred to the US fast track clinics of two academic centres with GCA clinical confirmation over a 4-years period. All patients underwent baseline US of cranial and extracranial arteries (carotid, subclavian and axillary) at the time of referral, and were classified in two categories; cranial or large vessel (LV)-GCA, according to US findings. IC was defined as the occurrence of acute anterior ischemic optic neuropathy (AION) or non-AION (including stroke, acute coronary syndrome, pulmonary embolism or peripheral artery disease) within 3 months after diagnosis, and after excluding other potentially implicated causes. Chi-squared and analysis of variance were performed to explore the association between clinical or US variables with the occurrence of different types of IC.ResultsA total of 42 (22.9%) patients over 188 patients with GCA clinical confirmation evaluated at our clinics had an IC within 3 months after diagnosis, 24 (12.8%) an AION and 19 (10.1%) a non-AION IC (10 stroke, 5 acute coronary syndrome, 4 peripheral artery disease, 2 pulmonary embolism and one case of ischemic colitis). Patient characteristics according to IC type are shown in Table 1. Patients with AION showed more frequently findings of US cranial involvement (100%) versus patients with non-AION IC (63.2%) and without IC (79.3%), p=0.009. In contrast, patients with non-AION IC presented more frequently signs of US LV-GCA (63.2%) versus patients with AION (25%) and without IC (55.2%), p=0.014).ConclusionDifferent patterns of vascular US involvement are associated with different IC in GCA patients. Predominantly cranial-GCA patients have more frequently AION, while predominantly LV-GCA patients have more frequently non-AION IC, as stroke, acute coronary syndrome, pulmonary embolism or peripheral artery disease.Table 1.Characteristics of patients according to the type of IC.Total n=188No ischemic complications n=145 (77.1%)AION n=24 (12.8%)Non-AION IC n=19 (10.1%)pDemographicsAge, mean (SD)78.2 (8.5)77.7 (8.9)81.1 (5.8)78.6 (8.5)0.183Female, n (%)88 (46.8%)69 (47.6%)10 (41.7%)9 (47.4%)0.864Clinical variablesHeadache, n (%)147 (78.2%)115 (79.3%)18 (75%)14 (73.7%)0.788Jaw claudication, n (%)47 (25%)37 (25.5%)6 (25%)4 (21.1%)0.915Constitutional symptoms, n (%)100 (53.2%)81 (55.9%)10 (41.7%)9 (47.4%)0.376Fever, n (%)29 (15.4%)25 (17.2%)0 (0%)4 (21.1%)0.074SCORE CVR, mean (SD)21.8 (14.7)20.9 (14.8)25.5 (13)24 (15.4)0.275LaboratoryCRP (mg/L), mean (SD)36.4 (54.3)40.3 (57.6)26.3 (48.8)20.1 (24.6)0.194ESR (mm/h), mean (SD)58.1 (34.2)56.1 (35.1)73.7 (25.8)54.4 (32.5)0.072Haemoglobin (g/dL), mean (SD)13.4 (11)13.8 (12.5)12 (1.8)12 (2)0.658Platelets 109/L, mean (SD)326.5 (128.1)334.7 (126)297.1 (151.4)302.6 (108.1)0.288HistologyTemporal artery biopsy positive n=50, n (%)21 (42%)15 (39.5%)6 (75%)0 (0%)0.037USPositive US, n (%)183 (97.3%)140 (96.6%)24 (100%)19 (100%)0.467Positive cranial ACG US, n (%)151 (80.3%)115 (79.3%)24 (100%)12 (63.2%)0.009Isolated positive cranial ACG US, n (%)85 (45.2%)60 (41.4%)18 (75%)7 (36.8%)0.007Positive LV-GCA US, n (%)98 (52.1%)80 (55.2%)6 (25%)12 (63.2%)0.014Isolated positive LV-ACG US, n (%)32 (17%)25 (17.2%)0 (0%)7 (36.8%)0.006AION: acute anterior ischemic optic neuropathy; PMR: polymyalgia rheumatica; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; CVR: cardiovascular risk; SD: standard deviation.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.