Background Immune and vascular ageing are proposed risk factors for giant cell arteritis (GCA). Data on the impact of age at diagnosis of GCA on the clinical presentation and course of the disease are scarce.
Methods Patients with GCA followed at referral centres within the Italian Society of Rheumatology Vasculitis Study Group were enrolled up to November 2021. Patients were grouped according to age at diagnosis: ≤64, 65–79 and ≥80 years old.
Results The study included 1004 patients, mean age 72.1±8.4, female 70.82%. Median follow-up duration was 49 (IQR 23–91) months. Patients in the oldest group (≥80 years) had significantly more cranial symptoms, ischaemic complications and risk for blindness compared with the groups 65–79 and ≤64 years (blindness: 36.98% vs 18.21% vs 6.19%; p<0.0001). Large-vessel-GCA was more frequent in the youngest group (65% of patients). Relapses occurred in 47% of patients. Age did not influence the time to first relapse, nor the number of relapses. Older age was negatively associated with the number of adjunctive immunosuppressants. Patients >65 years old had 2–3 fold increased risk for aortic aneurysm/dissection up to 60 months follow-up. Serious infections, but not other treatment-related complications (hypertension, diabetes, osteoporotic fractures), were significantly associated with older age. Mortality occurred in 5.8% of the population with age >65, cranial and systemic symptoms as independent risk factors.
Conclusions The highest risk of ischaemic complications, aneurysm development, serious infections and the possible undertreatment make of GCA a very challenging disease in the oldest patients.
- Giant Cell Arteritis
- Systemic vasculitis
- Outcome Assessment, Health Care
Data availability statement
Data are available on reasonable request. Study protocol and raw data are accessible on reasonable request.
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Handling editor Josef S Smolen
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Collaborators List of collaborators for the Italian Society of Rheumatology Vasculitis Study Group:-Alice Bartoletti (1. dipartimento di medicina interna e terapia medica, Università di Pavia, 2 Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia);-Giovanni Zanframundo (1. dipartimento di medicina interna e terapia medica, Università di Pavia, 2 Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia);-Elena Maria Baldissera (Unit of Immunology, Rheumatology, Allergy and Rare Diseases; IRCCS San Raffaele Hospital; Milan; Italy);-Chiara Asperti (Unit of Immunology, Rheumatology, Allergy and Rare Diseases; IRCCS San Raffaele Hospital; Milan; Italy);-Riccardo Bixio (Rheumatology Unit, Department of Medicine, University of Verona);-Gattamelata Angelica (Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy),-Giacomo Bagni (Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy).
Contributors All authors contributed to the development of the research project, collection of data and revision of the manuscript. All collaborators contributed to the collection of data and revision of the manuscript. SM
acted as guarantor accepting full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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