Infections are Associated With Increased Risk of Giant Cell Arteritis: A Population-based Case-control Study from Southern Sweden

Objective To investigate the association between infections and the subsequent development of giant cell arteritis (GCA) in a large population-based cohort from a defined geographic area in Sweden. Methods Patients diagnosed with biopsy-confirmed GCA between 2000 and 2016 were identified through the database of the Department of Pathology in Skåne, the southernmost region of Sweden. For each GCA case, 10 controls matched for age, sex, and area of residence were randomly selected from the general population. Using the Skåne Healthcare Register, we identified all infection events prior to patients’ date of GCA diagnosis and controls’ index date. With infection as exposure, a conditional logistic regression model was employed to estimate the OR for developing GCA. The types of infections contracted nearest in time to the GCA diagnosis/index date were identified. Results A total of 1005 patients with biopsy-confirmed GCA (71% female) and 10,050 controls were included in the analysis. Infections were more common among patients subsequently diagnosed with GCA compared to controls (51% vs 41%, OR 1.78, 95% CI 1.53–2.07). Acute upper respiratory tract infection (OR 1.77, 95% CI 1.47–2.14), influenza and pneumonia (OR 1.72, 95 % CI 1.35–2.19), and unspecified infections (OR 5.35, 95 % CI 3.46–8.28) were associated with GCA. Neither skin nor gastrointestinal infections showed a correlation. Conclusion Infections, especially those of the respiratory tract, were associated with subsequent development of biopsy-confirmed GCA. Our findings support the hypothesis that a range of infections may trigger GCA.

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Cardiovascular drug treatment, statins and biopsy-confirmed giant cell arteritis: a population-based case–control study

RMD Open ◽

10.1136/rmdopen-2020-001285 ◽

2020 ◽

Vol 6 (2) ◽

pp. e001285

Author(s):

Aleksandra Turkiewicz ◽

Pavlos Stamatis ◽

Aladdin J Mohammad

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Lower Risk ◽

Index Date ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Cardiovascular Drug ◽

Increased Risk ◽

Control Study

ObjectiveTo determine whether exposure to cardiovascular medications and statins is associated with increased risk of giant cell arteritis (GCA).DesignThe population-based case–control study comprised a cohort of patients with biopsy-confirmed GCA linked to the Swedish Prescribed Drug Register to identify all exposure to drugs prior to diagnosis of GCA. Ten controls per GCA case, matched for age, sex and residential area, were included. Using corresponding Anatomical Therapeutic Chemical codes, ACE inhibitors, angiotensin II receptor blockers, beta-blocking agents, calcium antagonists, diuretics, statins and cardiac therapy drugs were investigated from July 1, 2005 to the diagnosis/index date. A conditional logistic regression model was fitted adjusted for income, education level and marital status. We repeated the analyses including only new drug users excluding those with any prescription during the year from July 1, 2005 to July 1, 2006.Results574 cases (29% men) of diagnosed GCA and 5740 controls (29% men) were included. The mean age at diagnosis is 75 years (SD 8). Of the GCA cases, 71% had at least one dispensation of a cardiovascular drug prior to the index date, compared to 74% of controls. The ORs for the association of target drug exposure with GCA were <1 for most drugs, but close to 1 in the analysis of new users. Statins were consistently associated with lower risk of GCA, OR 0.74 (95% CI 0.61 to 0.90).ConclusionStatins may be associated with lower risk of incident biopsy-confirmed GCA. No association was evident for other studied drugs.

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Malignancies in Giant Cell Arteritis: A Population-based Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.190236 ◽

2019 ◽

Vol 47 (3) ◽

pp. 400-406 ◽

Cited By ~ 2

Author(s):

Pavlos Stamatis ◽

Carl Turesson ◽

Minna Willim ◽

Jan-Åke Nilsson ◽

Martin Englund ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Population Based ◽

Upper Gastrointestinal Tract ◽

Tract Cancer ◽

Gastrointestinal Tract Cancer ◽

Background Population ◽

Increased Risk ◽

Upper Gastrointestinal

ObjectiveTo investigate the risk of cancer in patients with biopsy-proven giant cell arteritis (GCA) from a defined population in southern Sweden.Methods.The study cohort consisted of 830 patients (mean age at GCA diagnosis was 75.3 yrs, 74% women) diagnosed with biopsy-proven GCA between 1997 and 2010. Temporal artery biopsy results were retrieved from a regional database and reviewed to ascertain GCA diagnosis. The cohort was linked to the Swedish Cancer Registry. The patients were followed from GCA diagnosis until death or December 31, 2013. Incident malignancies registered after GCA diagnosis were studied. Based on data on the first malignancy in each organ system, age- and sex-standardized incidence ratios (SIR) with 95% CI were calculated compared to the background population.Results.One hundred seven patients (13%) were diagnosed with a total of 118 new malignancies after the onset of GCA. The overall risk for cancer after the GCA diagnosis was not increased (SIR 0.98, 95% CI 0.81–1.17). However, there was an increased risk for myeloid leukemia (2.31, 95% CI 1.06–4.39) and a reduced risk for breast cancer (0.33, 95% CI 0.12–0.72) and upper gastrointestinal tract cancer (0.16, 95% 0.004–0.91). Rates of other site-specific cancers were not different from expected.Conclusion.In this Swedish population-based cohort of GCA, the overall risk for cancer was not increased compared to the background population. However, there was an increased risk for leukemia and a decreased risk for breast and upper gastrointestinal tract cancer.

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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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Survival and prognostic factor analyses in malignant giant cell tumour of bone

10.21203/rs.2.12960/v4 ◽

2020 ◽

Author(s):

Jin Zhang ◽

Xin Wang ◽

Feng Lin ◽

Guijun Xu ◽

Haixiao Wu ◽

...

Keyword(s):

Giant Cell ◽

Cox Regression ◽

Giant Cell Tumour ◽

Large Population ◽

Survival Rates ◽

Population Based ◽

Cell Tumour ◽

Rank Test ◽

Seer Database ◽

Increased Risk

Abstract Background: The characteristics and survival of patients with malignant giant cell tumour of bone (GCTB) have not been investigated thoroughly due to the rarity of the disease. We evaluated these factors in a large cohort in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database.Methods: Data from patients who were diagnosed with malignant GCTB from 1975 to 2016 were extracted from the SEER database. The overall survival (OS) was calculated by Kaplan–Meier analysis, and intergroup differences were tested by the log-rank test. Univariate and multivariate Cox proportional hazard regression analyses were conducted to identify the independent survival factors.Results: A total of 325 patients with malignant GCTB were included. The overall 1-, 5-, and 10-year survival rates were 94.3% (95% CI: 91.7-96.8), 82.3% (95% CI: 77.9-86.6), and 80.1% (95% CI: 75.4-84.7), respectively. A potential non-linear J-shaped dose–response relationship between the age or diagnosis year and survival were found. Multivariate Cox regression showed poor survival in patients with age from 35 to 60 years (hazard ratio (HR) =9.99, 95% CI: 1.34-74.80, P=0.025), age older than 60 years (HR=62.03, 95% CI: 7.94-484.38, P<0.001), with stage T2 disease (HR=4.85, 95% CI: 1.52-15.47, P=0.008), with stage T3 disease (HR=6.09, 95% CI: 1.03-36.23, P=0.047), and with distant tumours (HR=2.76, 95% CI: 1.14-6.65, P=0.024), and extraskeletal sites (HR=3.33, 95% CI: 1.02-10.85, P=0.046).Conclusions: This large population-based series described the clinical characteristics of malignant GCTB. Patients with stage T2/3disease, distant disease and extra-skeletal sites had more odds to be with worse survival. The elder age than 34 years had a gradually increased risk for survival.

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Mortality among Patients with Giant Cell Arteritis: A Large-scale Population-based Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.190927 ◽

2019 ◽

Vol 47 (9) ◽

pp. 1385-1391 ◽

Cited By ~ 1

Author(s):

Niv Ben-Shabat ◽

Shmuel Tiosano ◽

Ora Shovman ◽

Doron Comaneshter ◽

Yehuda Shoenfeld ◽

...

Keyword(s):

Cohort Study ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Median Survival ◽

Mortality Risk ◽

Large Scale ◽

Large Population ◽

Population Based ◽

Medical Database ◽

Age And Sex

Objective.Studies regarding mortality among patients with giant cell arteritis (GCA) have yielded conflicting results. Thus in this large population-based study we aimed to examine whether GCA is associated with increased mortality, and if so, the effect of age at diagnosis and sex on the association.Methods.We used the medical database of Clalit Health Services for this retrospective cohort study. Followup was from January 1, 2002, and continued until death or end of followup on September 1, 2018. Incident GCA patients were compared with age- and sex-matched controls. Estimated median survival times were calculated using the Kaplan-Meier method. HR for all-cause mortality were obtained by the Cox proportional hazard model, adjusted for sociodemographic variables and cardiovascular risk factors.Results.The study included 7294 patients with GCA and 33,688 controls. The mean age at start of followup was 72.1 ± 9.9 years with 69.2% females. Estimated median survival time was 13.1 years (95% CI 12.6–13.5) in patients with GCA compared with 14.4 years (95% CI 14.1–14.6) in controls (p < 0.001). The multivariate analysis demonstrated increased mortality risk in the first 2 years after diagnosis (HR 1.14, 95% CI 1.04–1.25) and > 10 years after diagnosis (HR 1.14, 95% CI 1.02–1.3). The mortality risk was higher in patients diagnosed at ≤ 70 years of age [HR 1.5 (95% CI 1.14–1.99) 0–2 yrs; HR 1.38 (95% CI 1.1–1.7) > 10 yrs].Conclusion.Patients with GCA have a minor decrease in longterm survival compared to age- and sex-matched controls. The seen difference is due to excess mortality in the first 2 years, and > 10 years after diagnosis. Patients diagnosed ≤ 70 years of age are at greater risk.

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The Safety of Delayed Versus Immediate Antibiotic Prescribing for Upper Respiratory Tract Infections

Clinical Infectious Diseases ◽

10.1093/cid/ciaa890 ◽

2020 ◽

Cited By ~ 1

Author(s):

Tjeerd Pieter van Staa ◽

Victoria Palin ◽

Benjamin Brown ◽

William Welfare ◽

Yan Li ◽

...

Keyword(s):

Respiratory Tract ◽

Hospital Admission ◽

Respiratory Tract Infections ◽

Population Based ◽

Upper Respiratory Tract Infections ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Increased Risk ◽

Upper Respiratory ◽

Tract Infections

Abstract Background This study aimed to evaluate the clinical safety of delayed antibiotic prescribing for upper respiratory tract infections (URTIs), which is recommended in treatment guidelines for less severe cases. Methods Two population-based cohort studies used the English Clinical Practice Research Databank and Welsh Secure Anonymized Information Linkage, containing electronic health records from primary care linked to hospital admission records. Patients with URTI and prescriptions of amoxicillin, clarithromycin, doxycycline, erythromycin, or phenoxymethylpenicillin were identified. Patients were stratified according to delayed and immediate prescribing relative to URTI diagnosis. Outcome of interest was infection-related hospital admission after 30 days. Results The population included 1.82 million patients with an URTI and antibiotic prescription; 91.7% had an antibiotic at URTI diagnosis date (immediate) and 8.3% had URTI diagnosis in 1–30 days before (delayed). Delayed antibiotic prescribing was associated with a 52% increased risk of infection-related hospital admissions (adjusted hazard ratio, 1.52; 95% confidence interval, 1.43–1.62). The probability of delayed antibiotic prescribing was unrelated to predicted risks of hospital admission. Analyses of the number needed to harm showed considerable variability across different patient groups (median with delayed antibiotic prescribing, 1357; 2.5% percentile, 295; 97.5% percentile, 3366). Conclusions This is the first large population-based study examining the safety of delayed antibiotic prescribing. Waiting to treat URTI was associated with increased risk of hospital admission, although delayed antibiotic prescribing was used similarly between high- and low-risk patients. There is a need to better target delayed antibiotic prescribing to URTI patients with lower risks of complications.

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Evaluation of swabbing methods for estimating the prevalence of bacterial carriage in the upper respiratory tract: a cross sectional study

BMJ Open ◽

10.1136/bmjopen-2014-005341 ◽

2014 ◽

Vol 4 (10) ◽

pp. e005341 ◽

Cited By ~ 13

Author(s):

A L Coughtrie ◽

R N Whittaker ◽

N Begum ◽

R Anderson ◽

A Tuck ◽

...

Keyword(s):

Respiratory Tract ◽

Large Population ◽

Population Based ◽

Cross Sectional Study ◽

Research Network ◽

Upper Respiratory Tract ◽

Sectional Study ◽

Baseline Measure ◽

Cross Sectional ◽

Upper Respiratory

ObjectivesBacterial carriage in the upper respiratory tract is usually asymptomatic but can lead to respiratory tract infection (RTI), meningitis and septicaemia. We aimed to provide a baseline measure of Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae and Neisseria meningitidis carriage within the community. Self-swabbing and healthcare professional (HCP) swabbing were compared.DesignCross-sectional study.SettingIndividuals registered at 20 general practitioner practices within the Wessex Primary Care Research Network South West, UK.Participants10 448 individuals were invited to participate; 5394 within a self-swabbing group and 5054 within a HCP swabbing group. Self-swabbing invitees included 2405 individuals aged 0–4 years and 3349 individuals aged ≥5 years. HCP swabbing invitees included 1908 individuals aged 0–4 years and 3146 individuals aged ≥5 years.Results1574 (15.1%) individuals participated, 1260 (23.4%, 95% CI 22.3% to 24.5%) undertaking self-swabbing and 314 (6.2%, 95% CI 5.5% to 6.9%) undertaking HCP-led swabbing. Participation was lower in young children and more deprived practice locations. Swab positivity rates were 34.8% (95% CI 32.2% to 37.4%) for self-taken nose swabs (NS), 19% (95% CI 16.8% to 21.2%) for self-taken whole mouth swabs (WMS), 25.2% (95% CI 20.4% to 30%) for nasopharyngeal swabs (NPS) and 33.4% (95% CI 28.2% to 38.6%) for HCP-taken WMS. Carriage rates of S. aureus were highest in NS (21.3%). S. pneumoniae carriage was highest in NS (11%) and NPS (7.4%). M. catarrhalis carriage was highest in HCP-taken WMS (28.8%). H. influenzae and P. aeruginosa carriage were similar between swab types. N. meningitidis was not detected in any swab. Age and recent RTI affected carriage of S. pneumoniae and H. influenzae. Participant costs were lower for self-swabbing (£41.21) versus HCP swabbing (£69.66).ConclusionsHigher participation and lower costs of self-swabbing as well as sensitivity of self-swabbing favour this method for use in large population-based respiratory carriage studies.

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Statin Use in Giant Cell Arteritis: A Retrospective Study

The Journal of Rheumatology ◽

10.3899/jrheum.121150 ◽

2013 ◽

Vol 40 (6) ◽

pp. 910-915 ◽

Cited By ~ 36

Author(s):

Jean Schmidt ◽

Tanaz A. Kermani ◽

Francesco Muratore ◽

Cynthia S. Crowson ◽

Eric L. Matteson ◽

...

Keyword(s):

Retrospective Study ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Clinical Features ◽

Medical Records ◽

Index Date ◽

Clinical Information ◽

Population Based ◽

Acute Phase Reactants ◽

Statin Use

Objective.(1) To examine the association between statin use and giant cell arteritis (GCA); (2) to compare the clinical features and disease course of GCA among statin users and nonusers.Methods.For this retrospective study, we reviewed the medical records of all patients with biopsy-positive GCA diagnosed between 1998 and 2008. Using a case-control design, we compared the frequency of statin use in GCA patients to non-GCA population-based subjects who were randomly selected and individually matched by sex, age, and calendar year to the GCA cases. Statin use at diagnosis or index date and during followup was abstracted. In subjects with GCA, clinical information at diagnosis and followup was collected.Results.We included 594 patients, 297 with GCA (73% female), mean age at diagnosis 75 years. The rate of statin exposure at index date was 18.1% for GCA patients versus 33.3% for controls (p < 0.001). Patients using statins were less likely to develop GCA compared with patients not using statins (OR 0.31, 95% CI 0.15–0.6, p < 0.001), even after adjustment for cardiovascular risk factors. Among patients with GCA, the presenting clinical features and acute-phase reactants were similar in patients receiving statins compared to those not on statin therapy. These 2 groups were also similar with regard to relapse rate, prednisone tapering, and overall survival.Conclusion.Patients using statins may be less likely to develop GCA compared to patients who are not using statins. Statin use does not appear to modify the clinical presentation or the course of the disease.

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