title: Ischaemic manifestations in giant cell arteritis are associated with area level socio-economic deprivation, but not cardiovascular risk factors.
abstract: OBJECTIVE
  To determine whether ischaemic manifestations of GCA are associated with pre-existing hypertension, atherosclerosis or area-level socio-economic deprivation.
  
  
  METHODS
  We conducted an observational study of rheumatologist/ophthalmologist-diagnosed GCA in eight UK centres. The main outcome measure was ischaemic manifestations observed during active GCA: visual loss/blurring, aura, diplopia, jaw/tongue/limb claudication, cerebral/myocardial ischaemia or scalp necrosis.
  
  
  RESULTS
  Out of 271 patients, 222 had ischaemic manifestations. Adjusted odds ratios (ORs) for the influence of hypertension and atherosclerosis were 1.6 (95% CI 0.8, 3.1) and 1.5 (0.6, 3.5). The most striking finding was an association of ischaemic manifestations with increasing Index of Deprivation 2007 score: OR 4.2 (95% CI 1.3, 13.6) for the most-deprived quartile compared with the least-deprived quartile. Similar effect sizes were seen within each recruitment centre. Deprivation was associated with smoking and negatively associated with previous polymyalgia. However, neither of these variables, nor hypertension or atherosclerosis, appeared responsible for mediating the effect of deprivation on ischaemic complications. Smoking was not associated with ischaemic manifestations. Median symptom duration before treatment was 30 days; after adjusting for symptom duration, the OR for ischaemic complications was 3.2 (95% CI 1.0, 10.8) for the most-deprived quartile compared with the least-deprived quartile.
  
  
  CONCLUSIONS
  In GCA, area-level socio-economic deprivation was associated with ischaemic manifestations: this was not mediated by traditional cardiovascular risk factors. These findings are novel and require replication. Delay between first symptoms and treatment may play a role. Public awareness campaigns about GCA should aim especially to engage individuals living in more deprived areas to encourage early presentation and prompt treatment.
authors.affiliation: NIHR-Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK. s.l.mackie@leeds.ac.uk
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Mackie
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Dasgupta
authors.forename: Lesley
authors.initials: L
authors.lastname: Hordon
authors.forename: Andrew
authors.initials: A
authors.lastname: Gough
authors.forename: Michael
authors.initials: M
authors.lastname: Green
authors.forename: Jane
authors.initials: J
authors.lastname: Hollywood
authors.forename: Shouma
authors.initials: S
authors.lastname: Dutta
authors.forename: Victoria
authors.initials: V
authors.lastname: Bejarano
authors.forename: Stephen
authors.initials: S
authors.lastname: Jarrett
authors.forename: Ann W
authors.initials: AW
authors.lastname: Morgan
authors.forename: Colin T
authors.initials: CT
authors.lastname: Pease
mesh_terms: D050197:Atherosclerosis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D015897:Comorbidity; D013700:Giant Cell Arteritis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D007511:Ischemia / Q000191:economics / Q000453:epidemiology*; D011204:Poverty Areas; D012111:Residence Characteristics; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology