Brief observation
Giant-Cell Arteritis: Do We Treat Patients with Large-Vessel Involvement Differently?

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Abstract

Purpose

We aimed to describe the initial treatment that was used in a common hospital-based practice in patients with giant-cell arteritis with and without large-vessel involvement at diagnosis as well as the outcomes in both groups.

Methods

This retrospective multi-center cohort included patients with giant-cell arteritis diagnosed between 2005 and 2015, all of whom had fluorodeoxyglucose (FDG) positron emission tomography combined with computed tomography (FDG-PET/CT) performed at giant-cell arteritis diagnosis and were followed up for ≥12 months. We compared the features, treatment, and outcomes of patients with large-vessel involvement demonstrated on FDG-PET/CT with those of patients with a negative PET/CT.

Results

Eighty patients (50 women, median age: 71 [53-87] years) were included, 40 of whom had large-vessel involvement demonstrated on FDG-PET/CT and 40 who did not. After a median 56-month follow-up time, 42 (53%) patients had discontinued glucocorticoid (GC) treatment. Patients with and without large-vessel involvement were indistinguishable in the initial median dose of prednisone (0.74 mg/kg vs 0.75 mg/kg, P = .56), overall GC duration (P = .77), GC discontinuation rate (P = .65), relapse rate (P = .50), frequency of GC-dependent disease requiring GC-sparing treatments (P = .62), and fatality rate (P = .06).

Conclusion

In the setting of tertiary hospital recruitment, large-vessel involvement at giant-cell arteritis diagnosis using a PET/CT study had no influence on the choice of initial GC dose and had no impact on outcomes. Prospective studies are required to confirm these findings.

Section snippets

Study Design and Patients

For this study, we used the cohort previously reported (which grew, up from 130 to 173 patients). Briefly, all patients had a diagnosis of giant-cell arteritis and underwent a PET/CT at diagnosis or during the follow-up.2 Patients were followed up between 2005 and 2015 in 3 West-French teaching hospitals and reference centers for giant-cell arteritis (Caen, Limoges, and Lille University Hospitals). To be included in this study, 1) patients had to fulfill at least 3 of the 5 American College

Patient Description

We included 80 patients (50 women/30 men, median age 71 [53-87] years) in the present study, including 40 who had large-vessel involvement at diagnosis and 40 who did not. Detailed clinical manifestations and biological parameters of included patients at diagnosis are shown in Table 1. A median of 4 [2-8] vascular territories were involved on positive PET/CT (detail in Table 2).

Therapeutic Strategies and Outcomes

The comparative treatment and outcomes of both groups are shown in Table 3. Although patients with and without

Discussion

In this study, we reported the results of a retrospective audit of the medical practices used in 3 tertiary care university centers regarding the empirical treatment of newly diagnosed giant-cell arteritis with and without large-vessel involvement. We observed that the detection of large-vessel involvement at diagnosis had no influence on the initial therapeutic strategy in the studied physician panel and the initial GC doses were not different between the groups. Furthermore, subgroup analysis

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Funding: None.

Conflict of Interest: None.

Authorship: All authors had access to the data and a role in writing the manuscript.

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