Different giant cell arteritis phenotypes may present distinct types of ischaemic complications.

Abstract

Objectives: To determine if the subtype of vascular ultrasound (US) presentation is associated with different types of ischaemic complications (IC) in giant cell arteritis (GCA).

Methods: Retrospective observational analysis of GCA clinically confirmed patients referred to US fast-track clinics at two centres. All patients underwent baseline US of cranial and extracranial arteries (carotid, subclavian and axillary). Two patterns of IC were analysed: the occurrence of acute anterior ischaemic optic neuropathy (AION) or the presence of a non-AION pattern (including stroke, acute coronary syndrome, pulmonary embolism or peripheral artery disease) at diagnosis and in the following 3 months, excluding other potentially implicated causes.

Results: Of 188 clinically confirmed GCA patients, 43 (22.9%) had IC: 24 (12.8%) AION and 19 (10.1%) non-AION. Patients with AION more often exhibited US cranial involvement versus those with non-AION IC and without IC (100%, 63.2%, and 79.3%, respectively; p=0.009). Patients with AION less frequently presented signs of US large vessel (LV)-GCA than those with non-AION IC and without IC (25%, 63.2% and 55.2%, respectively; p=0.014). Patients with previous polymyalgia rheumatica (PMR) (p=0.049) or concomitant PMR symptoms at the time of diagnosis (p=0.014) showed less frequent AION. In contrast, patients with non-AION IC more frequently had positive LV-GCA US findings vs the other two groups (63.2%, 25% and 55.2%, respectively; p=0.014).

Conclusions: The subtype of vascular US presentation influences the IC in GCA. US cranial-GCA patients more frequently present AION, while predominantly US LV-GCA more frequently exhibit non-AION IC.