title: Large-vessel giant cell arteritis: a cohort study.
abstract: OBJECTIVE
  The aim of this study was to compare baseline variables, treatment and outcomes in patients with large-vessel GCA (LV-GCA), primarily of the upper extremities, with those with cranial disease (C-GCA).
  
  
  METHODS
  All patients >50 years of age with radiographic evidence of subclavian LV-GCA diagnosed between 1 January 1999 and 31 December 2008 were identified and compared with those with biopsy-positive C-GCA diagnosed in the same period.
  
  
  RESULTS
  The study included 120 LV-GCA patients and 212 C-GCA patients. Compared with C-GCA, patients with LV-GCA were younger [68.2 years (s.d. 7.5) vs 75.7 (7.4), P < 0.001] and had longer duration of symptoms at GCA diagnosis (median 3.5 vs 2.2 months, P < 0.001). A history of PMR was more common in LV-GCA patients (26% vs 15%, P = 0.012), but a smaller proportion had cranial symptoms (41% vs 83%, P < 0.001) and vision loss (4% vs 11%, P = 0.035). ACR classification criteria for GCA were satisfied in 39% of LV-GCA patients and 95% of C-GCA patients (P < 0.001). Compared with C-GCA, patients with LV-GCA had more relapses (4.9 vs 3.0/10 person-years, P < 0.001), higher cumulative corticosteroid (CS) doses at 1 year [11.4 g (s.d. 5.9) vs 9.1 (s.d. 3.7), P < 0.001] and required longer treatment (median 4.5 vs 2.2 years, P < 0.001).
  
  
  CONCLUSIONS
  Although patients with LV-GCA had a lower rate of vision loss, they had a higher relapse rate and greater CS requirements. The ACR criteria for GCA are inadequate for the classification of patients with LV-GCA.
authors.affiliation: Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Muratore
authors.affiliation: Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Tanaz A
authors.initials: TA
authors.lastname: Kermani
authors.affiliation: Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Green
authors.affiliation: Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.affiliation: Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.affiliation: Division of Rheumatology, Department of Medicine, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Division of Rheumatology, Department of Medicine, Division of Biostatistics, Department of Health Sciences Research and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. warrington.kenneth@mayo.edu.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Warrington
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D013700:Giant Cell Arteritis / Q000145:classification* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones
keywords: giant cell arteritis; imaging; large-vessel vasculitis; prognosis; treatment