Delia Fernández-Lozano1, Marta Domínguez2, Javier Narvaez3, Noemi Garrido-Puñal4, Eugenio De Miguel5, Paula V. Estrada-Alarcón6, Iñigo Hernández-Rodríguez7, Maria. T Silva-Diaz8, Joaquín M. Belzunegui9, Clara Moriano Morales10, Julio Sanchez Martin11, Itziar Calvo-Zorrilla12, Vicente Aldasoro13, lydia Abasolo14, Javier Loricera11, Patricia Moya15, Maria J. García-Villanueva16, Carles Galisteo17, Anne Riveros-Frutos18, Francisco Ortiz-Sanjuán19, Selene Labrada-Arrabal20, Margarida Rocha21, Carlos García-Porrúa22, Maria García-González23, Clara Molina Almela24, María Alcalde25, Antonio Juan Mas26, Fernando Alonso27, Santos Castañeda28, Ricardo Blanco29 and on behalf of the Collaborative Group members30, 1Hospital de Mérida, Merida, Spain, 2Sociedad Española de Reumatología, Madrid, Spain, 3Hospital Universitario de Bellvitge, Barcelona, Spain, 4Hospital Universitario Virgen del Rocío, Sevilla, Spain, 5Hospital Universitario La Paz, Madrid, Spain, 6Hospital de San Juan Despí Moisès Broggi, Barcelona, Spain, 7Hospital do Meixoeiro. Complejo Hospitalario Universitario de Vigo, Vigo, Spain, 8Complexo Hospitalario Universitario A Coruña, A Coruña, Spain, 9Hospital Universitario Donostia, Donostia, Spain, 10Rheumatology, Hospital Universitario de León, León, Spain, 11Hospital Universitario Marqués de Valdecilla, Santander, Spain, 12Basurto University Hospital, Bilbao, Spain, 13Hospital Universitario de Navarra, Pamplona, Spain, 14Hospital Clínico San Carlos, Madrid, Spain, 15Hospital de Santa Creu i Sant Pau, Barcelona, Spain, 16Hospital Ramón y Cajal, Madrid, Spain, 17Hospital Universitario Parc Taulí, Sabadell, Spain, 18Hospital Universitario Germans Trias i Pujol, Barcelona, Spain, 19Hospital Universitario y Politécnico La Fe, Valencia, Spain, 20Hospital del Mar, Barcelona, Spain, 21Osakidetza, Bilbo, Spain, 22Hospital Universitario Lucus Augusti, Lugo, Spain, 23Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, 24Hospital General de Valencia, Valencia, Spain, 25Hospital Severo Ochoa, Madrid, Spain, 26Hospital Universitario Son Llàtzer, Mallorca, Spain, 27Spanish Society of Rheumatology, Madrid, Spain, 28Hospital Universitario de la Princesa, Madrid, Spain, 29Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, 30ARTESER group, Madrid, Spain
Background/Purpose: Giant cell arteritis (GCA) is the most common vasculitis in North America and Western Europe. GCA is more likely to occur in women (1). However, there are scarce data on the epidemiology, clinical presentation, comorbidities, treatment and outcomes between men and women. Our aim was to assess the previous differential features between gender found in ARTESER registry.
Methods: ARTESER is a large Spanish multicenterepidemiological registry of GCA promoted by the Spanish Society of Rheumatology in which 26 national hospitals participated. Patients were included according to whether they met the 1990 ACR criteria, had a positive diagnostic test (biopsy or imaging test) or by the clinical judgement of the investigator. The recruitment period was between 2013 and 2019 and standardized data were included for all patients diagnosed with GCA in these centers. Differences between sexes were compared in a bivariate analysis.
Results: A total of 1675 patients with GCA were included, 1178 women and 497 men. The annual incidence of GCA was higher in the female group (10.07; 95%CI: 8.7-11.5) than in the male group (4.83; 95%CI: 3.8-5.9) with a similar mean age at diagnosis and symptom onset between the two groups of 76.9 and 76.7 years, respectively. Among the comorbidities presented at diagnosis, male had a higher presentation of diabetes mellitus, tobacco use, alcohol consumption, cardiovascular disease and neoplasms than female, in which only osteoporosis was more frequent. The results are shown in table 1. Clinical manifestations were divided into cranial, extracranial and general. Among the cranial manifestations, headache (79.9%), temporal (49.2%) and visual (36.1%) disturbances were the most frequent. Polymyalgia rheumatica was the predominant extracranial manifestation (41.8%) and asthenia the most general symptom reported (52.2%). Main data are shown in table 2. We analyzed the distribution according to sex and observed a higher frequency of headache (p=0.028), polymyalgia rheumatica (p=0.003) and asthenia (p=0.035) in the female group. In contrast, we found a higher frequency of dysphasia in the male group (p=0.013) and visual symptoms, with no statistically significant differences in the latter. In terms of laboratory findings, elevated glomerular sedimentation rate (ESR) (p=0.039) and platelet count (p< 0.001) were higher in female. Treatment and outcome data are shown in table 3. Regarding the use of glucocorticoids and related adverse effects no differences between the two groups were detected. The use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was more frequent in males (p=0.005), but no differences were found regarding tocilizumab administration. There were no differences in the number of relapses or disease remission. However, the proportion of deaths during follow-up was higher in women (13.8% vs. 6.6%, p< 0.001).
Conclusion: GCA was more frequent in females, with more than twice as many cases as males. Some of the classic manifestations, such as headache, polymyalgia rheumatica and asthenia, were more common in women. In addition, women had higher ESR and platelet levels than men. The use of csDMARDs was higher in the male group but mortality was increased in females.
Table 1. Main epidemiologic features and comorbidities at diagnosis.
Table 2. Differences in clinical manifestations and laboratory abnormalities at diagnosis and during follow-up according to sex in ARTESER Registry.
Table 3. Differences in treatment and outcomes during follow-up according to sex in ARTESER Registry.
D. Fernández-Lozano: None; M. Domínguez: None; J. Narvaez: None; N. Garrido-Puñal: None; E. De Miguel: None; P. Estrada-Alarcón: None; I. Hernández-Rodríguez: None; M. Silva-Diaz: None; J. Belzunegui: None; C. Moriano Morales: None; J. Sanchez Martin: None; I. Calvo-Zorrilla: None; V. Aldasoro: None; l. Abasolo: None; J. Loricera: None; P. Moya: None; M. García-Villanueva: AstraZeneca, 6, GSK, 6, Otsuka, 1; C. Galisteo: None; A. Riveros-Frutos: None; F. Ortiz-Sanjuán: Eli Lilly, 6, Grunenthal, 2, GSK, 2; S. Labrada-Arrabal: None; M. Rocha: None; C. García-Porrúa: None; M. García-González: None; C. Molina Almela: None; M. Alcalde: None; A. Mas: None; F. Alonso: None; S. Castañeda: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6; o. Collaborative Group members: None.
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