Giant cell arteritis is the most frequently diagnose vasculitis among patients older than 50 years. Classification is done by Hunder criteria (1990). Headache is the most frequent symptom. Vascular involvement has been extensively studied by imaging techniques, including temporal artery biopsy, suggesting the existence of two different clinical subsets of the disease. Evidence suggests that a high proportion of patients present with aortitis and that this situation is associated to a higher corticosteroid dose requirement and a higher risk of developing aortic aneurisms. Moreover, ocular involvement is the most feared complication nowadays as it is usually irreversible. The objective of this study was to identify different patterns of vascular involvement on PET/CT at GCA diagnosis according to the presence or absence of ischaemic manifestations at disease onset, including ocular involvement. Furthermore, we sought to describe clinical and histological patterns on TAB according to the presence or absence of aortitis in PET/CT. In the first study, performed with a cohort that comprised 30 patients with a newly diagnosed GCA, patients with ischaemic symptoms showed a higher proportion of vertebral involvement when compared to those patients without these symptoms (OR 5.0, CI 95%: 0.99 – 24.86, p=0.051). Patients with ischaemic manifestations showed a lower proportion of large vessel vasculitis, being aortitis a protector factor against ischaemic manifestations (OR 19.0, CI 95%: 2.79 – 127.97, p=0.001) and against permanent visual loss (OR 10.67, CI 95%: 1.12 – 101.34, p=0.04). In this cohort, the presence or absence of ischaemic symptoms was associated to different vascular patterns of PET/TC (p=0.001). In the second study we showed that patients with aortitis were younger (69.9 years vs. 83.7 years, p=0.04) and had less frequently ischaemic manifestations, including ocular involvement (25.0% of patients with aortitis vs. 84.2% of patients without aortitis, p=0.006). The presence of giant multinucleated cells on TAB was an independent risk factor for the presence of aortitis on PET/CT (OR 12.23, p=0.046). The halo sign was absent in patients with aortitis. We can conclude that PET/CT is a useful technique at GCA diagnosis that allows identifying two patterns of vascular involvement according to the presence or absence of ischaemic symptoms. When we compared PET/CT and TAB findings, we identified that aortitis was related to the presence of giant multinucleated cells.
Factors pronòstics en la pèrdua visual en larteritis de cèl·lules gegants.
Mestre Torres, J. (Author). 25 Oct 2019
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis