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Early menopause, low body mass index, and smoking are independent risk factors for developing giant cell arteritis

¹ Department of Rheumatology, Sahlgrenska University Hospital, Göteborg, Sweden
² Centre for Bone Research at the Sahlgrenska Academy, Department of Geriatrics, Sahlgrenska University Hospital
³ Department of Pathology, Sahlgrenska University Hospital
⁴ Department of Pathology, Sahlgrenska University Hospital
⁵ Department of Rheumatology, Sahlgrenska University Hospital

Correspondence to:
Correspondence to:
Dr Claes Nordborg
Department of Pathology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden; claes.nordborg{at}pathology.gu.se

Objective: To assess female sex hormone related variables in a group of women with biopsy positive giant cell arteritis and a control group.

Methods: 49 women with biopsy positive giant cell arteritis, aged 50 to 69 years at the time of diagnosis, answered a questionnaire on hormonal and reproductive factors. The same questions were answered by a large population of women from the same geographical area in connection with routine mammograms. The results were tested statistically, using logistic regression analysis of each variable adjusted for age, and a multivariate logistic regression analysis including age and the variables which differed significantly between giant cell arteritis and controls.

Results: From the multivariate logistic regression analysis, three independent variables were associated with an increased risk of having giant cell arteritis: smoking and being an ex-smoker (odds ratio (OR) = 6.324 (95% confidence interval (CI), 3.503 to 11.418), p<0.0001); body mass index (a reduction of 1.0 kg/m² increased the risk by 10% (OR = 0.898 (0.846 to 0.952), p = 0.0003); and menopause before the age of 43 (OR = 3.521 (1.717 to 7.220), p = 0.0006).

Conclusions: There was a significant association between hormonal and reproduction related factors and the risk of developing giant cell arteritis in women given the diagnosis before the age of 70. The results suggest a possible role of oestrogen deficiency in the pathogenesis of giant cell arteritis. To confirm the results, an extended study will be needed, including women older than 70.

Abbreviations: ACTH, adrenocorticotropic hormone; BMI, body mass index; GCA, giant cell arteritis; HLA, human leucocyte antigen; HPA, hypothalamic-pituitary-adrenal; HPG, hypothalamic-pituitary-gonadal; HRT, hormone replacement therapy

Keywords: giant cell arteritis; menopause; smoking; body mass index; breast feeding

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