0489: Giant Cell Arteritis Phenotypes and Diagnosis of Aortitis Among 1852 Patients Before and After 2016 Across 10 French Referral Centers

Laurent Sailler¹, Kim Ly², Hubert De Boysson³, Brigitte Granel⁴, Maxima Samson⁵, Christian Agard⁶, Laurence Bouillet⁷, Magnan Julie⁸, Marc Lambert⁹, Arsene Mekinian¹⁰, Lea Tarallo¹, Eric Liozon², Gregory Pugnet¹¹, Jean Luc Davignon¹, Achille Aouba¹², Aurélie Daumas⁴, Quentin Gomes de Pinho⁴, bernard bonnotte¹³, simon parreau², Samuel Deshayes¹² and GEFA Collaborative group¹⁴, ¹CHU Toulouse, Toulouse, France, ²CHU Limoges, Limoges, France, ³Department of Internal Medicine, UR4650 PSIR, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France, ⁴AP-HM, Marseille, France, ⁵Dijon University Hospital, Dijon, France, ⁶Internal medicine, Nantes University Hospital, Nantes, France, ⁷Grenoble University Hospital, Grenoble, France, ⁸CHU Tours, Tours, France, ⁹CHU Lille, Lille, France, ¹⁰AP-HP, Hopital Saint Antoine, Paris, France, ¹¹CHU Toulouse Purpan Service de Medecine Interne, Toulouse, France, ¹²CHU Caen, Caen, France, ¹³Centre Hospitalo-Universitaire de Dijon, Dijon, France, ¹⁴Saint Joseph Hospital, Marseille, France

Background/Purpose: In 2016, French Internal medicine physicians collaborating in the Groupe d'Etude Français de l'Arterite à cellules géantes (GEFA) created a common database to build a large cohort of giant cell arteritis patients. We describe the phenotypes of giant cell arteritis across French referral centers of the GEFA before and after 2016 and predictors of the diagnosis of aortitis.

Methods: Ten French University Hospitals included 1852 patients in the database, 1256 being diagnosed before 1rst January 2016 and 636 after. We compared the main characteristics of patients using the chi2-test, the t-test or ANOVA. Predictors of the diagnosis of aortitis were described by a logistic regression analysis stratified on centers.

Results: Overall, women represented 64.8% of the patients. Mean age was 74.1±8.5 years. Differences before versus after 1rst January 2016 (significant differences are reported in brackets).Manifestations of the disease included: headache 73.9% (78.7 vs 68.2, p=0.0001); vision loss (transient or permanent) 28.9% (no difference); PMR symptoms 34.9% (38.1% vs 30.5%) (p < 0.0001); fever 30.6% (35.1 vs 24.8, p=0.0002), aortitis 20.1% (16.5 vs 28.5%, p< 0.0001); LVV 9.46% (no difference); ESR 79.3 ± 31.9 mm and CRP 97.3 ±77.5 mg/l. CV risk factors were hypertension 47.9%; diabetes 12.4%; (11.7 vs 14.6%; p< 0,001); dyslipidemia (9.3 vs 24.5%; p< 0.0001), smoking 20.8% (17.8 vs 22.9, p=0.1). Mean BMI was 24.9 ±4.59;
TAB was positive in 64% of the patients (no difference). When performed (9.6%), temporal artery duplex ultrasonography showed a halo sign in 42% of the cases (41.1 vs 44.8, p=0.5); Bolus of methylprednisolone were prescribed in 23.6% of the cases (no difference). Mean oral prednisone dose was 0.80 ±0.18 mg/kg (0.80 ±0.18 vs 0.78 ±0.19) (p=0.06).

Differences across centers: significant differences were found for hypertension (36% to 58%; p< 0.0001); diabetes (9 to 14.7%) (p < 0,0001); dyslipidemia (18.6 to 27.4%; p< 0,0001); smoking (past or active) 17.8 to 33.8 (p < 0.0001); fever (20 to 40.4%, p< 0.0001); headache 47.2 vs 81.5 (p=0.0002); aortitis: 10.9 to 36.7% (p < 0.0001); PMR symptoms 24 to 46.2% (p < 0.001); vision loss (transient or permanent) 14.7 to 34.8% (p < 0.0001); CRP 74.8 ±64.9 to 100.7 ±87.8 (p < 0.01); methylprednisolone IV bolus18.9 to 30.6% (p < 0.001). Initial oral prednisone dose was 0.76 ±0.12 to 0.88 ±0.18 (p < 0.0001).

In univariate logitic regression analysis, the diagnosis of aortitis was associated with age OR: 0.91 [0.89-0.94], female gender OR 1.78 [1.26-2.49]; diagnosis after 1rst January 2016 OR:2.73 [1.90-3.92], headache OR 0.45 [0.35-0.59], hypertension OR 0.62 [0.47-0.82], smoking OR 2.09 [1.40-3.11], vision loss (OR: 0.24 [0.15-0.38]). No association was found with presence of fever or PMR.

Conclusion: This large French multicentric study gives new information on 1) many differences across time and centers in the phenotype of the disease, 2) a stable proportion of vision loss across time periods 2) the limited use of temporal arteritis duplex ultrasonography and a weaker than expected sensitivity of the halo sign 3) the potential association of hypertension (paradoxically protective) and smoking with presence of aortitis

Disclosures: L. Sailler, None; K. Ly, None; H. De Boysson, None; B. Granel, None; M. Samson, None; C. Agard, None; L. Bouillet, None; M. Julie, chugai; M. Lambert, None; A. Mekinian, None; L. Tarallo, None; E. Liozon, None; G. Pugnet, None; J. Davignon, None; A. Daumas, None; Q. Gomes de Pinho, None; B. Bonnotte, Roche; S. Parreau, None; S. Deshayes, None; A. Aouba, None; B. Bienvenu, None.