Giant cell arteritis-related stroke in a large inception cohort: A comparative study

Simon Parreau; Stéphanie Dumonteil; Francisco Macian Montoro; Guillaume Gondran; Holy Bezanahary; Sylvain Palat; Kim-Heang Ly; Anne-Laure Fauchais; Eric Liozon

doi:10.1016/j.semarthrit.2022.152020

Giant cell arteritis-related stroke in a large inception cohort: A comparative study

Semin Arthritis Rheum. 2022 Aug:55:152020. doi: 10.1016/j.semarthrit.2022.152020. Epub 2022 Apr 28.

Authors

Simon Parreau¹, Stéphanie Dumonteil¹, Francisco Macian Montoro², Guillaume Gondran¹, Holy Bezanahary¹, Sylvain Palat¹, Kim-Heang Ly¹, Anne-Laure Fauchais¹, Eric Liozon³

Affiliations

¹ Internal Medicine Department, University Hospital of Limoges, France.
² Neurology Department, University Hospital of Limoges, France.
³ Internal Medicine Department, University Hospital of Limoges, France. Electronic address: eric.liozon@chu-limoges.fr.

PMID: 35512621
DOI: 10.1016/j.semarthrit.2022.152020

Abstract

Objective: Stroke caused by giant cell arteritis (GCA) is a rare but devastating condition and early recognition is of critical importance. The features of GCA-related stroke were compared with those of GCA without stroke and atherosclerosis-related or embolic stroke with the aim of more readily diagnosing GCA.

Methods: The study group consisted of 19 patients who experienced GCA-related strokes within an inception cohort (1982-2021) of GCA from the internal medicine department, and the control groups each consisted of 541 GCA patients without a stroke and 40 consecutive patients > 50 years of age with usual first ever stroke from the neurology department of a French university hospital. Clinical, laboratory, and imaging findings associated with GCA related-stroke were determined using logistic regression analyses. Early survival curves were estimated using the Kaplan-Meier method and compared using the log rank test.

Results: Amongst 560 patients included in the inception cohort, 19 (3.4%) developed GCA-related stroke. GCA-related stroke patients had more comorbid conditions (p = 0.03) and aortitis on imaging (p = 0.02), but less headache (p < 0.01) and scalp tenderness (p = 0.01). Multivariate logistic regression analysis showed that absence of involvement of the anterior circulation (OR = 0.1 - CI: 0.01-0.5), external carotid ultrasound (ECU) abnormalities (OR = 8.1 - CI: 1.3-73.9), and C-reactive protein (CRP) levels > 3 mg/dL (OR = 15.4 - CI: 1.9-197.1) were independently associated with GCA-related stroke. Early survival of GCA-related stroke patients was significantly decreased compared with control stroke patients (p = 0.02) and GCA patients without stroke (p < 0.001).

Conclusions: The location of stroke and assessment of ECU results and CRP level could help improve the prognosis of GCA-related stroke by bringing this condition to the clinician's attention more quickly, thus shortening diagnostic delay.

Keywords: Giant cell arteritis; Predictive factors; Stroke; Survival.

MeSH terms

Aortitis* / complications
Delayed Diagnosis
Giant Cell Arteritis* / complications
Giant Cell Arteritis* / diagnostic imaging
Humans
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / etiology