LARGE VESSEL- GIANT CELL ARTERITIS: A DIAGNOSTIC CHALLENGE
- Francesca Regola (Italy)
Abstract
Background and Aims
Giant Cell Arteritis (GCA) is a systemic vasculitis of medium and large arteries. Inflammation of carotid artery branches gives rise to the classic GCA symptoms. However, GCA can involve the aorta and its major branches, leading to a different atypical clinical picture, challenging to diagnose. This study aims to analyze the clinical presentation of large-vessel GCA compared to classical cranial disease.
Methods
100 consecutive GCA-patients were enrolled in this retrospective study. Based on vascular involvement, patients were classified in only cranial arteritis (C-GCA), only extracranial large-vessel vasculitis (LV-GCA) or both cranial and large-vessel vasculitis (LV-C-GCA).
Results
61 patients had C-GCA, 16 LV-GCA and 23 LV-C-GCA. Compared to C-GCA, patients with large vessel involvement (LV-GCA and LV-C-GCA) were younger and more frequently women, with a further significant difference in patients with isolated LV-GCA. Patients with isolated LV-GCA had also the longer duration of symptoms at GCA diagnosis. Systemic symptoms, as fever and fatigue, were associated with large-vessel involvement. Polymyalgia rheumatica was equally reported in all three groups and no significant differences were found in inflammatory markers levels. In patients with large-vessels vasculitis, thoracic aorta and subclavian arteries were the most frequently involved arteries.
Conclusions
the different clinical manifestations of large-vessel GCA lead to a longer time to diagnosis. Female gender, younger age and systemic symptoms are associated with large-vessel vasculitis, regardless the presence or absence of cranial symptoms. In patients with these characteristics, a large-vessel involvement should be considered in order to reduce the time to diagnosis.
