Objectives To evaluate differences in presentation and outcome of GCA patients with and without large vessel vasculitis (LVV) and according to the extent and severity of LVV. Methods Consecutive patients diagnosed with GCA between 2003 and 2020 who have had FDG PET imaging at diagnosis ≤3 days after initiation of glucocorticoids (GC) and followed for ≥12 months at the University Hospitals Leuven (Belgium) were included retrospectively. PET scans were visually scored (0–3) in seven vascular areas and a total vascular score (TVS) was calculated. LVV was defined as FDG uptake ≥2 in any large vessel. Results We included 238 GCA patients, of which 169 (71%) had LVV. LVV patients were younger (69 vs 74 years, P < 0.001) and more frequently female (72% vs 49%, P = 0.001). In patients without PMR symptoms, the presence of LVV was associated with relapse (aOR 3.05 [95% CI 1.32–7.43], P = 0.011) and with a lower probability of stopping GC (aHR 0.59 [95% CI 0.37–0.94], P = 0.025). However, in those with PMR symptoms, there was no difference in relapse risk (aOR 1.20 [95% CI 0.53–2.66], P = 0.657) and in the probability of stopping GC (aHR 1.25 [95% CI 0.75–2.09], P = 0.394) between patients with and without LVV. A higher TVS was associated with an increased risk of relapse (aOR 1.09 [95% CI 1.04–1.15], P = 0.001) in patients without PMR symptoms, but not in those with PMR symptoms (aOR 1.01 [95% CI 0.96–1.07], P = 0.693). Conclusion LVV is a risk factor for relapse in GCA patients without PMR symptoms with a higher relapse risk in those with higher TVS.

中文翻译：

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大血管炎是仅在无风湿性多肌痛的巨细胞动脉炎患者中复发的危险因素


目的 评估 GCA 患者伴和不伴大血管炎 （LVV） 的表现和结局以及 LVV 的范围和严重程度的差异。方法 回顾性纳入 2003 和 2020 年诊断为 GCA 的连续患者，这些患者在诊断时 ≤开始使用糖皮质激素 （GC） 后 3 天进行了 FDG PET 成像，并在鲁汶大学医院 （比利时） 随访了 ≥12 个月。对 7 个血管区域的 PET 扫描进行目视评分 （0-3），并计算总血管评分 （TVS）。LVV 被定义为任何大型血管中的 FDG 摄取 ≥2。结果 我们纳入了 238 例 GCA 患者，其中 169 例 （71%） 患有 LVV。LVV 患者更年轻 （69 岁 vs 74 岁，P < 0.001） 和女性更常见 （72% vs 49%，P = 0.001）。在无 PMR 症状的患者中，LVV 的存在与复发相关 （aOR 3.05 [95% CI 1.32–7.43]，P = 0.011），并且停止 GC 的可能性较低 （aHR 0.59 [95% CI 0.37–0.94]，P = 0.025）。然而，在有 PMR 症状的患者中，有和没有 LVV 的患者复发风险 （aOR 1.20 [95% CI 0.53-2.66]，P = 0.657） 和停止 GC 的概率 （aHR 1.25 [95% CI 0.75-2.09]，P = 0.394） 没有差异。在无 PMR 症状的患者中，较高的 TVS 与复发风险增加相关 （aOR 1.09 [95% CI 1.04-1.15]，P = 0.001），但在有 PMR 症状的患者中则不然 （aOR 1.01 [95% CI 0.96-1.07]，P = 0.693）。结论 LVV 是无 PMR 症状的 GCA 患者复发的危险因素，TVS 较高的患者复发风险较高。