Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study

Objective.To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden.Methods.The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skåne region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skåne Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA:reference population) was also calculated.Results.There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95% CI 2.33–3.37), followed by venous thromboembolic diseases (2.36, 95% CI 1.61–3.40), severe infections (1.85, 95% CI 1.57–2.18), thyroid diseases (1.55, 95% CI 1.25–1.91), cerebrovascular accidents (1.40, 95% CI 1.12–1.74), and diabetes mellitus (1.29, 95% CI 1.05–1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95% CI 1.00–1.44).Conclusion.Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.

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165. INFECTIONS ARE ASSOCIATED WITH INCREASED RISK OF GIANT CELL ARTERITIS - A POPULATION-BASED CASE-CONTROL STUDY FROM SOUTHERN SWEDEN

Rheumatology ◽

10.1093/rheumatology/kez059.042 ◽

2019 ◽

Vol 58 (Supplement_2) ◽

Author(s):

Pavlos Stamatis ◽

Aleksandra Turkiewicz ◽

Martin Englund ◽

Göran Jönsson ◽

Jan-Åke Nilsson ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Southern Sweden ◽

Increased Risk ◽

Control Study

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Visual Complications in Patients with Biopsy-proven Giant Cell Arteritis: A Population-based Study

The Journal of Rheumatology ◽

10.3899/jrheum.151033 ◽

2016 ◽

Vol 43 (8) ◽

pp. 1559-1565 ◽

Cited By ~ 27

Author(s):

Muna Saleh ◽

Carl Turesson ◽

Martin Englund ◽

Peter A. Merkel ◽

Aladdin J. Mohammad

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Inflammatory Responses ◽

Temporal Artery ◽

Reference Population ◽

Population Based ◽

Population Based Study ◽

Protein Levels ◽

Reactive Protein ◽

Background Population

Objective.To study the clinical and laboratory characteristics of patients with biopsy-proven giant cell arteritis (GCA) with visual complications, and to evaluate the incidence rate of visual complications in GCA compared to the background population.Methods.Data from 840 patients with GCA in the county of Skåne, Sweden, diagnosed between 1997 and 2010, were used for this analysis. Cases with visual complications were identified from a diagnosis registry and confirmed by a review of medical records. The rate of visual complications in patients with GCA was compared with an age- and sex-matched reference population.Results.There were 85 patients (10%) who developed ≥ 1 visual complication after the onset of GCA. Of the patients, 18 (21%) developed unilateral or bilateral complete visual loss. The mean age at diagnosis was 78 years (± 7.3); 69% were women. Compared with patients without visual complications, those with visual complication had lower C-reactive protein levels at diagnosis and were less likely to have headache, fever, and palpable abnormal temporal artery. The use of β-adrenergic inhibitors was associated with visual complications. The incidence of visual complications among patients with GCA was 20.9/1000 person-years of followup compared to 6.9/1000 person-years in the reference population, resulting in a rate ratio of 3.0 (95% CI 2.3–3.8).Conclusion.Ten percent of patients with GCA developed visual complications, a rate substantially higher than that of the general population. Patients with GCA who had visual complications had lower inflammatory responses and were more likely to have been treated with β-adrenergic inhibitors compared with patients without visual complications.

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FRI0244 Venous Thromboembolic Events and Cerebrovascular Accident in Patients with Giant Cell Arteritis: A Population Based Retrospective Cohort Study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.1754 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 513.1-513

Author(s):

A. Lo Gullo ◽

M.J. Koster ◽

C. Crowson ◽

A. Makol ◽

S. Ytterberg ◽

...

Keyword(s):

Cohort Study ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Retrospective Cohort Study ◽

Cerebrovascular Accident ◽

Retrospective Cohort ◽

Population Based ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

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Hospitalized Infections in Giant Cell Arteritis — A Population-based Retrospective Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.140124 ◽

2014 ◽

Vol 41 (12) ◽

pp. 2447-2451 ◽

Cited By ~ 8

Author(s):

Prabhu D. Udayakumar ◽

Arun K. Chandran ◽

Cynthia S. Crowson ◽

Kenneth J. Warrington ◽

Eric L. Matteson

Keyword(s):

Urinary Tract ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Rate Ratio ◽

Statistical Significance ◽

Population Based ◽

Hospitalization Rate ◽

Soft Tissue Infections ◽

Increased Risk ◽

Tract Infections

Objective.To assess the occurrence of infections requiring or acquired during hospitalization in patients with giant cell arteritis (GCA).Methods.We retrospectively reviewed a population-based incidence cohort of patients with GCA diagnosed between 1950 and 2009 and compared this cohort with a non-GCA one matched for age, sex, and calendar year from the same population.Results.We identified 245 patients in the GCA cohort and 245 patients in the non-GCA cohort. Seventy-four GCA subjects (134 episodes) and 79 non-GCA (153 episodes) had infections requiring or acquired during hospitalization [rate ratio (RR) 0.94; 95% CI 0.74, 1.18]. Sixty-seven subjects (107 episodes) in the GCA cohort and 63 subjects (110 episodes) in non-GCA cohort required hospitalization secondary to an infection (RR 1.04; CI 0.80, 1.36). Pneumonia, urinary tract infections (UTI), skin and soft tissue infections accounted for the majority of infections requiring hospitalization and had similar occurrence in both cohorts. UTI accounted for the majority of infections requiring hospitalization in the first 6 months after GCA incidence (RR 3.93; CI 0.85, 56.52). No difference between the 2 cohorts was noted in overall infections acquired during hospitalization (RR 0.68; CI 0.41, 1.08).Conclusion.There is no overall increased risk of infections requiring or acquired during hospitalization in patients with GCA who are taking glucocorticoid therapy. There may be an increased risk of infections requiring hospitalization, especially of the urinary tract, in the first 6 months after GCA incidence, although this did not achieve statistical significance in our study.

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Trajectory of Healthcare Resources Utilization in Giant Cell Arteritis – A Population-Based Study

The Journal of Rheumatology ◽

10.3899/jrheum.201131 ◽

2021 ◽

pp. jrheum.201131

Author(s):

Aladdin J. Mohammad ◽

Aleksandra Turkiewicz ◽

Pavlos Stamatis ◽

Carl Turesson ◽

Martin Englund ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Health Care Services ◽

Hospital Admissions ◽

Relative Rate ◽

Reference Population ◽

Population Based ◽

Drop Out ◽

One Year ◽

Diagnosis Date

Objective To estimate the healthcare resource utilization (HRU) in patients with giant cell arteritis (GCA) compared with the general population in southern Sweden. Methods The study sample comprised 653 GCA patients along with ten age-, sex-, and residency-area-matched reference subjects per patient. Data on public and private healthcare consultations and hospitalizations were extracted from the Skåne Healthcare Register. We assessed trajectories of primary and specialist healthcare visit, as well as hospital admissions, and inpatient days from three years before through five years after the date of GCA diagnosis for patients and matched references. HRU was analysed using generalized estimating equations adjusted for sex, age at the index year, calendar year of diagnosis, education, income, marital status, place of birth, and Charlson comorbidity index. Inverse probability weighting was used to account for drop-out during study. Results GCA patients had higher rate of healthcare visits than the references from the year before GCA diagnosis up to four years after diagnosis with the largest relative (rate ratio [95% CI]: 1.85 [1.68, 2.05]) and absolute (mean difference [95% CI]: 10.2 [8.1, 12.3] visits per-person) differences in the year of diagnosis. Similar trajectories were observed for primary and specialist healthcare visits. For hospital admissions and inpatient days, the differences disappeared one year after diagnosis date. Conclusion Patients with GCA utilized health care services at a significantly higher rate than a reference population. The increased utilization among Swedish patients with GCA was evident one year before and prolonged up to four years after diagnosis date.

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POS0803 TRENDS IN THE INCIDENCE OF GIANT CELL ARTERITIS ACROSS SEVEN DECADES AND CHANGES IN DIAGNOSTIC MODALITIES: A POPULATION-BASED STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1415 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 654.1-654

Author(s):

T. Garvey ◽

C. S. Crowson ◽

M. Koster ◽

K. J. Warrington

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Population Based ◽

Incidence Rates ◽

Large Vessel ◽

Vessel Imaging ◽

Group 3 ◽

Group 2 ◽

Diagnostic Modalities ◽

Incident Cases

Background:Diagnostic methods for giant cell arteritis (GCA) have evolved over recent decades, and large vessel imaging plays an increasing role in disease detection.Objectives:This study aims to estimate the incidence of GCA over the past 10 years in a population and compare it to preceding incidence estimates. It also explores trends in the diagnostic modalities used to identify GCA.Methods:A pre-existing population-based cohort of patients diagnosed with GCA between 1950 and 2009 was extended with incident cases from 2010 to 2019. The diagnosis of GCA was confirmed by review of medical records of patients with ICD9/10 codes for GCA between 1/1/2010 and 12/31/2019. Incident cases that met either one of the following sets of inclusion criteria were added to the cohort: one, American College of Rheumatology 1990 GCA classification criteria; or two, patients aged ≥50 years with elevation of erythrocyte sedimentation rate or C-reactive protein and radiographic evidence of large vessel vasculitis attributed to GCA. Incident cases were classified into one of three groups: group 1, temporal artery biopsy (TAB) positive; group 2, TAB negative or not done with positive large-vessel imaging; or group 3, clinical diagnosis of GCA.Results:The study cohort included 305 patients diagnosed with GCA from 1950 until 2019. Fifty-five incident cases were diagnosed between 2010 and 2019; 37 females (67%) and 18 males (33%). The age and sex adjusted incidence rates (95% CI) per 100,000 between 2010 and 2019 for females, males, and the total population were 13.0 (8.8, 17.3), 8.6 (4.6, 12.7), and 10.8 (8.0, 13.7), respectively. The corresponding incidence rates from 2000-2009 were 28.0 (21.0, 35.1), 10.2 (5.0, 15.5), and 20.5 (15.9, 25.1), respectively. This represents a significant decline in the incidence rates in females (p<0.001) and the total group (p<0.001) between the 2000-2009 and 2010-2019 cohorts but no change in males (p=0.64). Of the 55 patients diagnosed between 2010 and 2019, there were 37 (67%) in group 1, 10 (18%) in group 2, and 8 (15%) in group 3. In contrast, of the 250 patients diagnosed between 1950 and 2009 there were 209 (84%) in group 1, 4 (2%) in group 2, and 37 (15%) in group 3. There was a significant difference between the 1950-2009 and 2010-2019 cohorts in the composition of these groups (p<0.001).Conclusion:In this population-based cohort of patients with GCA diagnosed over a 70-year period, the incidence of GCA has declined in recent years. The total decline is driven by a decline in females but not in males. The reasons for this are unclear but should be followed over time and investigated in other population-based cohorts. There has also been a shift in the diagnostic modalities for GCA. In recent years, there are fewer TAB positive patients, and more patients diagnosed with large vessel imaging. This is the first population-based incidence cohort demonstrating a trend towards increased use of large vessel imaging for the diagnosis of GCA.References:[1]Chandran AK, et al. Incidence of Giant Cell Arteritis in Olmsted County, Minnesota, over a 60-year period 1950-2009. Scand J Rheumatol. 2015;44(3):215-218.[2]Gonzalez-Gay MA, et al. Giant cell arteritis: is the clinical spectrum of the disease changing? BMC Geriatr. 2019; Jul 29;19(1):200.[3]Rubenstein E, et al. Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: a systemic literature review and meta-analysis. Rheumatology (Oxford). 2020 May 1:59(5):1011-1020.Figure 1.Trends in the incidence of GCA in Olmsted County by sex (1950-2019).Acknowledgements:This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health (NIH) under Award Number R01 AG034676, and CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.Disclosure of Interests:Thomas Garvey: None declared, Cynthia S. Crowson: None declared, Matthew Koster: None declared, Kenneth J Warrington Grant/research support from: Clinical research support from Eli Lilly and Kiniksa

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Coeliac disease and invasive pneumococcal disease: a population-based cohort study

Epidemiology and Infection ◽

10.1017/s0950268816003204 ◽

2017 ◽

Vol 145 (6) ◽

pp. 1203-1209 ◽

Cited By ~ 9

Author(s):

A. RÖCKERT TJERNBERG ◽

J. BONNEDAHL ◽

M. INGHAMMAR ◽

A. EGESTEN ◽

G. KAHLMETER ◽

...

Keyword(s):

Cohort Study ◽

Coeliac Disease ◽

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

Cox Regression ◽

Statistical Significance ◽

Pneumococcal Vaccination ◽

Population Based ◽

Increased Risk ◽

Severe Infections

SUMMARYSevere infections are recognized complications of coeliac disease (CD). In the present study we aimed to examine whether individuals with CD are at increased risk of invasive pneumococcal disease (IPD). To do so, we performed a population-based cohort study including 29 012 individuals with biopsy-proven CD identified through biopsy reports from all pathology departments in Sweden. Each individual with CD was matched with up to five controls (n = 144 257). IPD events were identified through regional and national microbiological databases, including the National Surveillance System for Infectious Diseases. We used Cox regression analyses to estimate hazard ratios (HRs) for diagnosed IPD. A total of 207 individuals had a record of IPD whereas 45/29 012 had CD (0·15%) and 162/144 257 were controls (0·11%). This corresponded to a 46% increased risk for IPD [HR 1·46, 95% confidence interval (CI) 1·05–2·03]. The risk estimate was similar after adjustment for socioeconomic status, educational level and comorbidities, but then failed to attain statistical significance (adjusted HR 1·40, 95% CI 0·99–1·97). Nonetheless, our study shows a trend towards an increased risk for IPD in CD patients. The findings support results seen in earlier research and taking that into consideration individuals with CD may be considered for pneumococcal vaccination.

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The sensitivity of temporal artery biopsy in the detection of giant cell arteritis is independent of tissue length

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.055 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S28-S29

Author(s):

H J Hurley ◽

P Q Deb

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Average Length ◽

Statistical Significance ◽

Temporal Artery ◽

Temporal Artery Biopsy ◽

Temporal Arteries ◽

Biopsy Specimens ◽

Two Samples ◽

Left And Right

Abstract Introduction/Objective Giant cell arteritis (GCA) is the most common vasculitis of the elderly, and the most common primary systemic vasculitis overall, with an annual incidence of 200/million. The long term sequelae, namely vision loss and stroke, are permanent and devastating. While GCA is often treated empirically based on clinical presentation, panarteritis on temporal artery biopsy is required for diagnosis. However, these biopsies have the tendency to be falsely negative due to skip lesions, a common feature of GCA. Therefore, we set out to determine whether longer biopsy specimens were more sensitive in the detection of GCA. Methods/Case Report A census of temporal artery biopsies performed with the indication of clinical symptoms of GCA was taken at our institution. The patient age, sex, biopsy laterality, biopsy length, and pathological diagnosis were recorded for each cataloged sample. Statistical significance of difference in biopsy length was tested using an unpaired t-test in R 4.1.0. Results (if a Case Study enter NA) A total of 114 temporal artery specimens were biopsied from 94 different patients with the indication of GCA and assigned a definitive positive or negative diagnosis. Of the 94 patients, 54 were female and 40 were male. Of the total pathological specimens, 11 were positive and 103 were negative. The overall average length of biopsy specimens was 2.13 cm with a standard deviation of 0.65 cm. The average positive biopsy was 2.26 cm long, and the average negative was 2.12 cm, an insignificant difference (0.14 cm, t = 0.7, p = 0.43). In 25 patients, biopsies were taken from both the left and right temporal arteries. Of those patients, 2 were positive for GCA and the remaining 23 were negative. Interestingly, the biopsy result in every case was identical between the left and right samples; we found no instances of pathological evidence of GCA in only one of the two samples from the same patient. Conclusion According to data taken at our institution, there is no indication to lengthen the biopsy requirements from the existing 1.5 cm. However, we have demonstrated evidence that it may be unnecessary to biopsy both temporal arteries in a single patient. Larger studies would be required to confirm our findings.

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