ReviewLarge-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years
Introduction
The 2012 International Chapel Hill Consensus Conference (CHCC2012) subdivides vasculitides based on a combination of features, including the type of vessel affected [1]. Thereby, primary vasculitides may be distinguished into large vessel vasculitis (LVV), medium vessel vasculitis and small vessel vasculitis [1]. Primary LVV, involving the aorta and its major branches, are represented by two major variants, i.e. Takayasu arteritis (TA) and giant cell arteritis (GCA). According to the CHCC2012, histopathologic features of TA and GCA are indistinguishable, and TA is usually considered to predominantly involve young individuals whereas GCA predominantly involve older individuals [[2], [3], [4], [5], [6]].Thus, the age at onset of LVV is commonly used to distinguish both diseases, TA occurring before 50 years and GCA after 50 years [[7], [8], [9]]. However, GCA incidence peaks at 70–79 years [2,10,11], and only very few GCA appear before 60 years. In contrast, peak age for TA onset is usually between 20 and 30 years and the disease less commonly occurs after 50 years [6,12]. Therefore, patients diagnosed with LVV between 50 and 60 years of age can be difficult to classify.
Treatment of active forms of LVV is based on glucocorticoids, but therapeutic regimens that could be used in case of relapsing or refractory disease may differ between TA and GCA. Tumor necrosis factor (TNF)-α blockers were constantly found to be ineffective in prospective trials in GCA [[13], [14], [15]], whereas they showed some efficacy in retrospective studies in TA [[16], [17], [18], [19]]. In contrast, tocilizumab, an anti-interleukin (IL)-6 receptor monoclonal antibody, was shown to be effective in GCA in a large prospective randomized trial [20], whereas data from a small prospective trial failed to achieve the primary endpoint in TA but tended to favour tocilizumab [21,22].
In the present study, we describe the clinical pictures and outcomes of LVV occurring between the ages 50 and 60 (LVV50–60) years, and compares them to LVV diagnosed after 60 years (LVV>60).
Section snippets
Patients
We conducted a nationwide retrospective multicenter study from January 2000 to February 2017, supported by the French Vasculitis Study Group (FVSG) and French Giant Cell Arteritis Study Group (GEFA), in 24 French and one Belgian departments of Internal Medicine and Rheumatology. Inclusion criteria for cases were: 1) patients with LVV as defined below, and 2) patients aged between 50 and 60 years (LVV50–60). This study was conducted in compliance with the Good Clinical Practice protocol and the
Results
We included 183 cases (LVV50–60) and 183 controls (LVV>60) in this case-control study.
Discussion
To better characterize the spectrum of LVV, especially after 50 years, we analyzed the presentation and outcome of LVV occurring between the ages 50 and 60 years (LVV50–60) compared to those occurring after 60 years (LVV>60). Using current classification criteria, LVV50–60 may be defined as GCA but lying at the interface with TA, while LVV>60 characterize the “classic” form of GCA. In the present study, we identified LVV50–60 as a subset of patients with more frequent peripheral limb ischemia
Authors contribution
Study conception and design: Delaval, Terrier.
Acquisition of data: Laure Delaval, Aurélie Daumas, Maxime Samson, Mikael Ebbo, Hubert De Boysson, Eric Liozon, Henry Dupuy, Mathieu Puyade, Daniel Blockmans, Ygal Benhamou, Karim Sacré, Alice Berezne, Hervé Devilliers, Grégory Pugnet, François Maurier, Thierry Zénone, Claire de Moreuil, François Lifermann, Laurent Arnaud, Olivier Espitia, Alban Deroux, Vincent Grobost, Estibaliz Lazaro, Christian Agard, Alexandre Balageas, Kevin Bouiller,
Disclosure statement
All authors have declared no conflicts of interest.
Funding support
None.
Acknowledgements
The authors would like to thank the following authors that included some patients in this study: Audrey Benyamine, Philippe Blanche, Pascal Cohen, Nathalie Costedoat-Chalumeau, Laetitia Coutte, Bertrand Dunogue, Stéphane Gayet, Brigitte Granel, Matthieu Groh, Jean Robert Harlé, Claire Le Jeunne, Jonathan London, Alfred Mahr, Nathalie Morel, Luc Mouthon, Thomas Papo, Romain Paule, Xavier Puéchal, Nicolas Schleinitz, Jean Sibila and Stéphane Vinzio.
References (50)
- et al.
Diagnostic and classification criteria of Takayasu arteritis
J Autoimmun
(2014 Feb 1) - et al.
Extra-cranial giant cell arteritis and Takayasu arteritis: how similar are they?
Semin Arthritis Rheum
(2015 Jun) - et al.
Biotherapies in large vessel vasculitis
Autoimmun Rev
(2016 Jun 1) - et al.
Takayasu arteritis
Presse Medicale Paris
(2006 May) - et al.
Classification of large vessel vasculitis: can we separate giant cell arteritis from Takayasu arteritis? Presse Medicale Paris Fr 1983
(2017 Aug) Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu's arteriopathy
J Am Coll Cardiol
(1988 Oct)- et al.
Large-vessel involvement and aortic dilation in giant-cell arteritis. A multicenter study of 549 patients
Autoimmun Rev
(2018 Apr) - et al.
Impact of cranial and axillary/subclavian artery involvement by color duplex sonography on response to treatment in giant cell arteritis
J Vasc Surg
(2015 May) Aortic and extracranial large vessel giant cell arteritis: a review of 72 cases with histopathologic documentation
Semin Arthritis Rheum
(1995 Jun)- et al.
Spectrum of aortic disease in the Giant cell arteritis population
Am J Cardiol
(2018 Feb 15)
Giant-cell arteritis: do we treat patients with large-vessel involvement differently?
Am J Med
Biological treatments in giant cell arteritis & Takayasu arteritis
Eur J Intern Med
Efficacy of tocilizumab in Takayasu arteritis: multicenter retrospective study of 46 patients
J Autoimmun
Revised international Chapel Hill Consensus Conference Nomenclature of Vasculitides
Arthritis Rheum
Epidemiology of giant cell arteritis and polymyalgia rheumatica
Arthritis Care Res
Prevalence, incidence, and disease characteristics of Takayasu arteritis by ethnic background: data from a large, population-based cohort resident in southern Norway
Arthritis Care Res
Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, north African, and black patients
Medicine (Baltimore)
Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity
Circulation
The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis
Arthritis Rheum
The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis
Arthritis Rheum
Epidemiologic and immunogenetic aspects of polymyalgia rheumatica and giant cell arteritis in northern Italy
Arthritis Rheum
Trends in incidence and clinical presentation of temporal arteritis in olmsted county, Minnesota, 1950–1985
Arthritis Rheum
Takayasu's arteritis: a study of 104 Italian patients
Arthritis Care Res
Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial
Ann Intern Med
Adalimumab for steroid sparing in patients with giant-cell arteritis: results of a multicentre randomised controlled trial
Ann Rheum Dis
Cited by (15)
EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ
2024, Annals of Thoracic SurgeryImpact of age at diagnosis in polymyalgia rheumatica: A retrospective cohort study of 218 patients
2020, Autoimmunity ReviewsCitation Excerpt :Primarily, we examined a relatively large sample of patients with isolated PMR (218 in total). The exclusion of patients with associated GCA at diagnosis precludes age-dependent presentations of GCA [9] confounding the data. In addition, multiple outcomes pertaining to disease severity (relapse likelihood and timing, maximal and cumulative doses of glucocorticoids, need for glucocorticoid-sparing agents, and total duration of glucocorticoid treatment) were recorded, to allow for the possibility that more aggressive treatment of younger patients masked a more severe presentation of the disease.
An overview of the perspectives on experimental models and new therapeutic targets in giant cell arteritis
2020, Autoimmunity ReviewsCitation Excerpt :The temporal artery involvement can be studied by color duplex sonography, with an estimated sensitivity and specificity of hypoechoic halo for the diagnosis of GCA of 68% and 81%, respectively, compared to positive temporal artery biopsy [4]. Additionally, large-vessel vasculitis is increasingly recognized, with aortitis diagnosed in 40 to 80% of patients and aortic aneurysms diagnosed in up to 20% of patients at 5 years and up to 35% at 10 years [5–14]. The incidence of aortic aneurysms and/or dissection, which are dreaded complications of aortitis, ranges from 2.8 to 18.9/1000 person-years [7,15–17].
EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ
2024, European Journal of Cardio-thoracic Surgery
- 1
for the French Vasculitis Study Group and the French Giant Cell Arteritis Study Group (GEFA).