PT  - JOURNAL ARTICLE
AU  - Tanaz A Kermani
AU  - Kenneth J Warrington
AU  - Cynthia S Crowson
AU  - Steven R Ytterberg
AU  - Gene G Hunder
AU  - Sherine E Gabriel
AU  - Eric L Matteson
TI  - Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis
AID  - 10.1136/annrheumdis-2012-202408
DP  - 2013 Dec 01
TA  - Annals of the Rheumatic Diseases
PG  - 1989--1994
VI  - 72
IP  - 12
4099  - http://ard.bmj.com/content/72/12/1989.short
4100  - http://ard.bmj.com/content/72/12/1989.full
SO  - Ann Rheum Dis2013 Dec 01; 72
AB  - Objectives To evaluate incidence-trends and timing of large-vessel (LV) manifestations in patients with giant cell arteritis (GCA), and to examine the influence of LV manifestations on survival. Methods A population-based incident cohort of patients diagnosed with GCA between 1950 and 2004 was used. LV involvement was defined as large-artery stenosis or aortic aneurysm/dissection that developed in the 1 year before GCA diagnosis or at any time thereafter. Patients were followed up until death or 31 December 2009. Results The study included 204 patients, 80% women, mean age at diagnosis of GCA 76.0 years (±8.2 years). Median length of follow-up was 8.8 years. The cumulative incidence of any LV manifestation at 10 years was 24.9% for patients diagnosed with GCA between 1980 and 2004 compared with 8.3% for patients diagnosed with GCA between 1950 and 1979. The incidence of any LV event was high within the first year of GCA diagnosis. The incidence of aortic aneurysm/dissection increased 5 years after GCA diagnosis. Compared with the general population, survival was decreased in patients with an aortic aneurysm/dissection (standardized mortality ratio (SMR) 2.63; 95% CI 1.78 to 3.73) but not in patients with large-artery stenosis (SMR 1.44; 95% CI 0.87 to 2.25). Patients with GCA and aortic manifestations had a higher than expected number of deaths from cardiovascular and pulmonary causes than the general population. Among patients with GCA, aortic manifestations were associated with increased mortality (HR=3.4; 95% CI 2.2 to 5.4). Conclusions Vigilance and screening for aortic aneurysms should be considered in all patients 5 years after the incidence of GCA. Aortic aneurysm/dissection is associated with increased mortality in GCA.