We know that patients with GCA have a higher mortality rate than their age-matched counterparts. Variables associated with mortality include concurrent diabetes, high doses of prednisone, and more comorbidities. Administrative data from British Columbia has shown that GCA patients have more comorbidities and take more medications at baseline than their age-matched counterparts.
On Friday at EULAR, Lindsay Belvedere from Vancouver presented data on mortality trends in patients with GCA. Using administrative data from British Columbia, her group identified incident cases of GCA from 1997-2012 along with non-GCA controls matched for sex, age and entry. They divided GCA cases into two groups (1997-2004 and 2005-2012) and calculated mortality rates and hazard ratios in each group, and adjusted for potential confounders.
The adjusted HR in the early group was 4.58 compared to 1.46 in the later group, suggesting that we have been successful in reducing mortality in patients with GCA over time. The reasons for this are likely multiple and include better management of comorbidities, earlier identification and treatment of GCA, and lower cumulative doses of prednisone.
The bottom line – this data is a testament that we are getting better at treating patients with GCA! On another note, we should be proud of Lindsay, who received a trainee award for this paper.
During the same session, Pierluigi Macchioni from Italy presented a study looking at biopsy patterns of patients with biopsy-proven GCA and their correlation to mortality. They reviewed 280 patients with incident temporal artery biopsy-positive GCA diagnosed between 1986 and 2012, and divided them into four categories including:
Transmural inflammation (TMI)
Inflammation limited to adventitia (ILA)
Vaso vasorum vasculitis (VVV)
Small vessel vasculitis (SVV)
Patients were further sub-classified based on severity of inflammation (none, mild, moderate and severe). When compared to age-matched controls, there was no difference in overall survival of patients with GCA.
However, in a subgroup analysis, there was a significantly higher mortality associated with GCA in those patients with TMI (regardless of degree of inflammation) compared to those with SVV. Patients with arterial wall calcification had double the mortality compared to those without calcification. There was no correlation with lab parameters or steroid dose. The most common causes of death were CV disease, neoplasms, infections and lung disease.
Based on this data, we may need to consider more aggressive monitoring or comorbidity management in patients with transmural inflammation.
Dr. Jamal is a Clinical Associate Professor at the University of British Columbia and an active staff physician at Vancouver Coastal Health. Her interests include diagnosis and prognosis of early inflammatory arthritis, and timely assessment and access to care for patients with rheumatoid arthritis.View Full Bio