Background GCA is a chronic inflammatory disease involving large and medium-sized arteries. It is considered the most frequent primary vasculitis with higher incidence in women. Mean age of onset in different cohorts ranges between 72-74 years. Former studies have observed certain differences in GCA clinical spectrum depending on age at disease presentation and gender. Particularly polymyalgia rheumatica has been found to be more frequent in women and in patients younger than 70 years.
Objectives The purpose of this study was to evaluate differences in initial clinical manifestations, ischemic complications and clinical course according to age at onset and gender in a prospectively followed cohort of patients with biopsy-proven giant cell arteritis.
Methods Between 1995 and 2005, 170 patients were diagnosed with biopsy proven GCA at our institution. Among them, 94 patients were selected according to the following criteria: prospective treatment by the authors according to uniform criteria, prospective periodic screening for aneurysm, prospective recording of GCA presentation, ischemic complications, relapses, glucocorticosteroid doses, and follow-up duration of at least 4 years. Based on the mean ± standard deviation (SD) of age at disease onset, patients were classified in 3 groups: age equal or below 67 years (mean -1SD) (early onset, n=16), age between 68 and 80 years (n=57), and age equal or older than 81 (mean+1SD) (late onset, n=21). Although retrospective in design, the study was performed on a prospectively followed cohort. Chi-square test, ANOVA test and Kaplan-Meyer survival analysis/log-rank test were used for statistical comparison.
Results Mean age (±SD) at diagnosis w as 74±7 years (58-89). Patients with early onset GCA (≤67 years) presented more frequently fever (p=0.002), and had higher erythrocyte sedimentation rate (0.039) than patients >68 years. In contrast, late onset GCA (≥81 years) was characterized by higher prevalence of severe ischemic complications in the form of amaurosis fugax (6% for ≤67 years vs 9% for 68-80 vs 29% for ≥81 years, p=0.046) and blindness (6% for ≤67 years vs 7% for 68-80 vs 33% for ≥81 years, p=0.006). During follow-up, late onset GCA patients relapsed less frequently (p=0.027). Concerning to gender, we found no differences in the initial clinical presentation between men and women but men developed more frequently aortic aneurysm during follow-up (p=0.003).
Conclusions Age at onset and gender are associated with differences in clinical presentation and outcome in patients with GCA.
Narvaez J, Nolla-Sole JM, Valverde-Garcia J, Roig-Escofet D. Sex differences in temporal arteritis and polymyalgia rheumatica. J Rheumatol. 2002;29(2):321-5.
Lopez-Diaz MJ, Llorca J, Gonzalez-Juanatey C, Pena-Sagredo JL, Martin J, Gonzalez-Gay MA. Implication of the age in the clinical spectrum of giant cell arteritis. Clin Exp Rheumatol. 2008;26(3 Suppl 49):S16-22.
Nir-Paz R, Gross A, Chajek-Shaul T. Sex differences in giant cell arteritis. J Rheumatol. 2002;29(6):1219-23.
Disclosure of Interest None Declared