Giant cell arteritis survival doubled in the past 2 decades

LONDON – The survival of patients with giant cell arteritis has more than doubled in the past 20 years, according to the results of a population-based study presented at the European Congress of Rheumatology.

Comparing two cohorts of patients with giant cell arteritis (GCA) – one diagnosed between 1997 and 2004 and the other between 2005 and 2012 – researchers supported by Arthritis Research Canada found that the adjusted relative risks for death over the two time periods were 3.62 (95% confidence interval, 3.04-4.32) and 1.41 (95% CI, 1.15-1.74), respectively, when compared against individuals in the general population.

“The risk of death from GCA over time has decreased,” noted the principal study investigator Dr. J. Antonio Aviña-Zubieta in an interview ahead of the congress. 

“We were not expecting such high mortality in the earlier GCA cohort [almost five times the general population]. GCA is a disease of older individuals, therefore the background risk for the individuals without GCA is already high, making it difficult to find statistically significant differences. In addition, we were not expecting such a dramatic improvement in the recent cohort, where the risk of death is approaching the baseline risk of the general population,” he observed.

Dr. Aviña-Zubieta, who is at the department of medicine at the University of British Columbia in Vancouver, and a scientist at Arthritis Research Canada, noted that improved mortality also was seen in individuals without GCA over the two time periods, but this was not as dramatic as in the GCA cohorts. “This suggests that at least some of the improvement in the GCA cohort is likely related to better care in general.” 

Improved survival over time has been noted recently in several rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis, and Dr. Aviña-Zubieta’s research group wondered if the same might be true in systemic vasculitis. 

“Given that GCA is the most frequent adult systemic vasculitis, we decided to test this question. Furthermore, given that our cohort is a population-based study, we thought that our result could be generalizable to the general population,” he said.

The study, which was funded by the Canadian Institutes of Health Research, involved obtaining data from an administrative health database on all newly diagnosed cases of GCA (n = 1,009) occurring between 1997 and 2012 in British Columbia, Canada. Cases were each matched by age, gender, and time of entry into the database to 10 non-GCA cases as controls (n = 10,009).

The mean age of participants in the GCA and non-GCA groups was 76 years, and 73% of participants in each group were female. As expected, individuals with GCA were more likely than those without the disease to have preexisting diseases such as hypertension (48.5% vs. 43.5%, P = .001), chronic obstructive pulmonary disease (15% vs. 11.4%, P less than .001), or angina (11.6% vs. 7%, P less than .001); to be taking medications; and to use health care resources to a greater extent. 

The definition used to define a case of GCA was quite strict according to Lindsay Belvedere, a research assistant at Arthritis Research Canada and a Master in Public Health student at Brigham Young University in Provo, Utah, who presented the study’s findings. Cases were required to have one ICD-9 or ICD-10 code for GCA given to them by a rheumatologist or after hospitalization or two ICD-9 or ICD-10 codes given on two separate occasions by a nonrheumatologist physician, and also they had to have received at least one prescription for glucocorticoids.

“This definition has been used in previous studies and been found to have a positive predictive value of 91%,” she observed. “To further increase the specificity of our case definition we excluded those who, following their diagnosis for GCA, received a diagnosis for another type of inflammatory arthritis such as psoriatic arthritis.” In addition, to ensure only incident cases were included in the cohort, patients with a GCA diagnosis prior to 1996 were also excluded from the dataset.

The early (1997-2004) versus the late (2005-2012) GCA cohort was found to have “considerably higher” mortality, with 373.7 versus 87.5 cases per 1,000 person-years. By comparison, there was a much smaller improvement in mortality during the two periods in the non-GCA cohort (75.9 vs. 48.6 cases per 1,000 person-years).

“These findings suggest that health care in general has improved, but more so in individuals with a serious disease such as GCA,” Dr. Aviña-Zubieta observed. Whether this is related to patients being diagnosed earlier, different treatment approaches, better management of complications, or better strategies to prevent complications remains to be tested, he said.

What is certain is that, “in a publicly funded health care system, this is good news.” Dr. Aviña-Zubieta additionally commented: “We need to find out what were the cause-specific outcomes which have improved – for example, cardiovascular disease, infections, or perhaps cancer – and which ones did not, so we can plan how to tackle them.”

Histologic pattern on biopsy linked to survival

Also at the meeting, Dr. Pierluigi Macchioni of Arcispedale S. Maria Nuova – IRCCS in Reggio Emilia, Italy, presented separate data on the survival of patients with GCA over a 26-year period in Italy. He shared the findings of a study that indicated the histologic pattern on temporal artery biopsy (TAB) was correlated with survival.

“In a previous study, we have demonstrated that in GCA the histologic spectrum is broad and the histologic differences appear to have specific clinical correlates,” Dr. Macchioni said. So the aim of the study was to see if these differences might be linked to patient survival.

Dr. Macchioni and associates identified 280 patients with incident TAB-positive GCA diagnosed between 1986 and 2012 who were from an area of Northern Italy and had complete clinical, laboratory, and survival data available. The mean age at disease onset was 74 years.

Patients were divided into groups based on the histologic pattern seen on TAB: the majority had transmural inflammation (TMI), with 8.6% having small-vessel vasculitis, 5% inflammation limited to adventitia (ILA), and 4.6% vasa vasorum vasculitis (VVV).

Over the course of the 26-year follow-up, 159 (56.8%) died, with a median survival time from disease onset of around 8.4 years. Two histologic types were associated with a reduced overall mortality when compared with the most common TMI histologic type: The hazard ratios for death were 0.12 for the VVV and 0.38 for the ILA histologic types.

“The histological spectrum of inflammatory lesions in TAB-positive GCA has a correlation with survival,” Dr. Macchioni said. Furthermore, “the presence of arterial wall calcification at TAB has an impact on the survival of GCA patients.” Indeed, comparing those with those without arterial wall calcification the risk for death was doubled (HR, 2.05).

rhnews@frontlinemedcom.com

LONDON – The survival of patients with giant cell arteritis has more than doubled in the past 20 years, according to the results of a population-based study presented at the European Congress of Rheumatology.

Comparing two cohorts of patients with giant cell arteritis (GCA) – one diagnosed between 1997 and 2004 and the other between 2005 and 2012 – researchers supported by Arthritis Research Canada found that the adjusted relative risks for death over the two time periods were 3.62 (95% confidence interval, 3.04-4.32) and 1.41 (95% CI, 1.15-1.74), respectively, when compared against individuals in the general population.

“The risk of death from GCA over time has decreased,” noted the principal study investigator Dr. J. Antonio Aviña-Zubieta in an interview ahead of the congress. 

“We were not expecting such high mortality in the earlier GCA cohort [almost five times the general population]. GCA is a disease of older individuals, therefore the background risk for the individuals without GCA is already high, making it difficult to find statistically significant differences. In addition, we were not expecting such a dramatic improvement in the recent cohort, where the risk of death is approaching the baseline risk of the general population,” he observed.

Dr. Aviña-Zubieta, who is at the department of medicine at the University of British Columbia in Vancouver, and a scientist at Arthritis Research Canada, noted that improved mortality also was seen in individuals without GCA over the two time periods, but this was not as dramatic as in the GCA cohorts. “This suggests that at least some of the improvement in the GCA cohort is likely related to better care in general.” 

Improved survival over time has been noted recently in several rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis, and Dr. Aviña-Zubieta’s research group wondered if the same might be true in systemic vasculitis. 

“Given that GCA is the most frequent adult systemic vasculitis, we decided to test this question. Furthermore, given that our cohort is a population-based study, we thought that our result could be generalizable to the general population,” he said.

The study, which was funded by the Canadian Institutes of Health Research, involved obtaining data from an administrative health database on all newly diagnosed cases of GCA (n = 1,009) occurring between 1997 and 2012 in British Columbia, Canada. Cases were each matched by age, gender, and time of entry into the database to 10 non-GCA cases as controls (n = 10,009).

The mean age of participants in the GCA and non-GCA groups was 76 years, and 73% of participants in each group were female. As expected, individuals with GCA were more likely than those without the disease to have preexisting diseases such as hypertension (48.5% vs. 43.5%, P = .001), chronic obstructive pulmonary disease (15% vs. 11.4%, P less than .001), or angina (11.6% vs. 7%, P less than .001); to be taking medications; and to use health care resources to a greater extent. 

The definition used to define a case of GCA was quite strict according to Lindsay Belvedere, a research assistant at Arthritis Research Canada and a Master in Public Health student at Brigham Young University in Provo, Utah, who presented the study’s findings. Cases were required to have one ICD-9 or ICD-10 code for GCA given to them by a rheumatologist or after hospitalization or two ICD-9 or ICD-10 codes given on two separate occasions by a nonrheumatologist physician, and also they had to have received at least one prescription for glucocorticoids.

“This definition has been used in previous studies and been found to have a positive predictive value of 91%,” she observed. “To further increase the specificity of our case definition we excluded those who, following their diagnosis for GCA, received a diagnosis for another type of inflammatory arthritis such as psoriatic arthritis.” In addition, to ensure only incident cases were included in the cohort, patients with a GCA diagnosis prior to 1996 were also excluded from the dataset.

The early (1997-2004) versus the late (2005-2012) GCA cohort was found to have “considerably higher” mortality, with 373.7 versus 87.5 cases per 1,000 person-years. By comparison, there was a much smaller improvement in mortality during the two periods in the non-GCA cohort (75.9 vs. 48.6 cases per 1,000 person-years).

“These findings suggest that health care in general has improved, but more so in individuals with a serious disease such as GCA,” Dr. Aviña-Zubieta observed. Whether this is related to patients being diagnosed earlier, different treatment approaches, better management of complications, or better strategies to prevent complications remains to be tested, he said.

What is certain is that, “in a publicly funded health care system, this is good news.” Dr. Aviña-Zubieta additionally commented: “We need to find out what were the cause-specific outcomes which have improved – for example, cardiovascular disease, infections, or perhaps cancer – and which ones did not, so we can plan how to tackle them.”

Histologic pattern on biopsy linked to survival

Also at the meeting, Dr. Pierluigi Macchioni of Arcispedale S. Maria Nuova – IRCCS in Reggio Emilia, Italy, presented separate data on the survival of patients with GCA over a 26-year period in Italy. He shared the findings of a study that indicated the histologic pattern on temporal artery biopsy (TAB) was correlated with survival.

“In a previous study, we have demonstrated that in GCA the histologic spectrum is broad and the histologic differences appear to have specific clinical correlates,” Dr. Macchioni said. So the aim of the study was to see if these differences might be linked to patient survival.

Dr. Macchioni and associates identified 280 patients with incident TAB-positive GCA diagnosed between 1986 and 2012 who were from an area of Northern Italy and had complete clinical, laboratory, and survival data available. The mean age at disease onset was 74 years.

Patients were divided into groups based on the histologic pattern seen on TAB: the majority had transmural inflammation (TMI), with 8.6% having small-vessel vasculitis, 5% inflammation limited to adventitia (ILA), and 4.6% vasa vasorum vasculitis (VVV).

Over the course of the 26-year follow-up, 159 (56.8%) died, with a median survival time from disease onset of around 8.4 years. Two histologic types were associated with a reduced overall mortality when compared with the most common TMI histologic type: The hazard ratios for death were 0.12 for the VVV and 0.38 for the ILA histologic types.

“The histological spectrum of inflammatory lesions in TAB-positive GCA has a correlation with survival,” Dr. Macchioni said. Furthermore, “the presence of arterial wall calcification at TAB has an impact on the survival of GCA patients.” Indeed, comparing those with those without arterial wall calcification the risk for death was doubled (HR, 2.05).

rhnews@frontlinemedcom.com

LONDON – The survival of patients with giant cell arteritis has more than doubled in the past 20 years, according to the results of a population-based study presented at the European Congress of Rheumatology.

Comparing two cohorts of patients with giant cell arteritis (GCA) – one diagnosed between 1997 and 2004 and the other between 2005 and 2012 – researchers supported by Arthritis Research Canada found that the adjusted relative risks for death over the two time periods were 3.62 (95% confidence interval, 3.04-4.32) and 1.41 (95% CI, 1.15-1.74), respectively, when compared against individuals in the general population.

“The risk of death from GCA over time has decreased,” noted the principal study investigator Dr. J. Antonio Aviña-Zubieta in an interview ahead of the congress. 

“We were not expecting such high mortality in the earlier GCA cohort [almost five times the general population]. GCA is a disease of older individuals, therefore the background risk for the individuals without GCA is already high, making it difficult to find statistically significant differences. In addition, we were not expecting such a dramatic improvement in the recent cohort, where the risk of death is approaching the baseline risk of the general population,” he observed.

Dr. Aviña-Zubieta, who is at the department of medicine at the University of British Columbia in Vancouver, and a scientist at Arthritis Research Canada, noted that improved mortality also was seen in individuals without GCA over the two time periods, but this was not as dramatic as in the GCA cohorts. “This suggests that at least some of the improvement in the GCA cohort is likely related to better care in general.” 

Improved survival over time has been noted recently in several rheumatic diseases, such as systemic lupus erythematosus and rheumatoid arthritis, and Dr. Aviña-Zubieta’s research group wondered if the same might be true in systemic vasculitis. 

“Given that GCA is the most frequent adult systemic vasculitis, we decided to test this question. Furthermore, given that our cohort is a population-based study, we thought that our result could be generalizable to the general population,” he said.

The study, which was funded by the Canadian Institutes of Health Research, involved obtaining data from an administrative health database on all newly diagnosed cases of GCA (n = 1,009) occurring between 1997 and 2012 in British Columbia, Canada. Cases were each matched by age, gender, and time of entry into the database to 10 non-GCA cases as controls (n = 10,009).

The mean age of participants in the GCA and non-GCA groups was 76 years, and 73% of participants in each group were female. As expected, individuals with GCA were more likely than those without the disease to have preexisting diseases such as hypertension (48.5% vs. 43.5%, P = .001), chronic obstructive pulmonary disease (15% vs. 11.4%, P less than .001), or angina (11.6% vs. 7%, P less than .001); to be taking medications; and to use health care resources to a greater extent. 

The definition used to define a case of GCA was quite strict according to Lindsay Belvedere, a research assistant at Arthritis Research Canada and a Master in Public Health student at Brigham Young University in Provo, Utah, who presented the study’s findings. Cases were required to have one ICD-9 or ICD-10 code for GCA given to them by a rheumatologist or after hospitalization or two ICD-9 or ICD-10 codes given on two separate occasions by a nonrheumatologist physician, and also they had to have received at least one prescription for glucocorticoids.

“This definition has been used in previous studies and been found to have a positive predictive value of 91%,” she observed. “To further increase the specificity of our case definition we excluded those who, following their diagnosis for GCA, received a diagnosis for another type of inflammatory arthritis such as psoriatic arthritis.” In addition, to ensure only incident cases were included in the cohort, patients with a GCA diagnosis prior to 1996 were also excluded from the dataset.

The early (1997-2004) versus the late (2005-2012) GCA cohort was found to have “considerably higher” mortality, with 373.7 versus 87.5 cases per 1,000 person-years. By comparison, there was a much smaller improvement in mortality during the two periods in the non-GCA cohort (75.9 vs. 48.6 cases per 1,000 person-years).

“These findings suggest that health care in general has improved, but more so in individuals with a serious disease such as GCA,” Dr. Aviña-Zubieta observed. Whether this is related to patients being diagnosed earlier, different treatment approaches, better management of complications, or better strategies to prevent complications remains to be tested, he said.

What is certain is that, “in a publicly funded health care system, this is good news.” Dr. Aviña-Zubieta additionally commented: “We need to find out what were the cause-specific outcomes which have improved – for example, cardiovascular disease, infections, or perhaps cancer – and which ones did not, so we can plan how to tackle them.”

Histologic pattern on biopsy linked to survival

Also at the meeting, Dr. Pierluigi Macchioni of Arcispedale S. Maria Nuova – IRCCS in Reggio Emilia, Italy, presented separate data on the survival of patients with GCA over a 26-year period in Italy. He shared the findings of a study that indicated the histologic pattern on temporal artery biopsy (TAB) was correlated with survival.

“In a previous study, we have demonstrated that in GCA the histologic spectrum is broad and the histologic differences appear to have specific clinical correlates,” Dr. Macchioni said. So the aim of the study was to see if these differences might be linked to patient survival.

Dr. Macchioni and associates identified 280 patients with incident TAB-positive GCA diagnosed between 1986 and 2012 who were from an area of Northern Italy and had complete clinical, laboratory, and survival data available. The mean age at disease onset was 74 years.

Patients were divided into groups based on the histologic pattern seen on TAB: the majority had transmural inflammation (TMI), with 8.6% having small-vessel vasculitis, 5% inflammation limited to adventitia (ILA), and 4.6% vasa vasorum vasculitis (VVV).

Over the course of the 26-year follow-up, 159 (56.8%) died, with a median survival time from disease onset of around 8.4 years. Two histologic types were associated with a reduced overall mortality when compared with the most common TMI histologic type: The hazard ratios for death were 0.12 for the VVV and 0.38 for the ILA histologic types.

“The histological spectrum of inflammatory lesions in TAB-positive GCA has a correlation with survival,” Dr. Macchioni said. Furthermore, “the presence of arterial wall calcification at TAB has an impact on the survival of GCA patients.” Indeed, comparing those with those without arterial wall calcification the risk for death was doubled (HR, 2.05).

rhnews@frontlinemedcom.com