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Rheumatology (Oxford). 2018 Dec 4. doi: 10.1093/rheumatology/key325. [Epub ahead of print]

Survival predictors in biopsy-proven giant cell arteritis: a northern Italian population-based study.

Author information

1
Rheumatology Unit, Department of Specialistic Medicine, and Pathology Unit, Department of Oncology and Advanced Technology, Azienda USL-IRCCS di Reggio Emilia.
2
Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia.
3
Interinstitutional Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia (Local Health Authority), Reggio Emilia, Italy.

Abstract

Objective:

To evaluate the influence of disease-related findings and treatment outcomes on survival in a population-based cohort of Northern Italian patients with GCA.

Methods:

A total of 281 patients with incident temporal artery biopsy (TAB)-proven GCA, diagnosed over a 26-year period (1986-2012) and living in the Reggio Emilia area, were retrospectively evaluated. We analysed clinical, imaging and laboratory findings at diagnosis, pathological patterns of TAB, CS treatment and therapeutic outcomes, and traditional cardiovascular risk factors as factors predictive of survival.

Results:

Univariate analysis showed that increased mortality was associated with large vessel involvement at diagnosis [hazard ratio (HR) 5.84], while reduced mortality was associated with female sex (HR 0.66), PMR (HR 0.54), higher haemoglobin levels (HR 0.84) at diagnosis, long-term remission (HR 0.47) and inflammation limited to adventitia or to the adventitial vasa vasorum (HR 0.48) at TAB examination. Multivariate analysis confirmed the association between increased mortality and large vessel involvement (HR 5.14) at diagnosis, between reduced mortality and PMR (HR 0.57) at diagnosis and adventitial inflammation (HR 0.31) at TAB.

Conclusion:

PMR at diagnosis and inflammation limited to the adventitia at TAB appear to identify subsets of patients with more benign disease, while large vessel involvement at diagnosis is associated with reduced survival.

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