Features and prognosis of giant cell arteritis in patients over 85 years of age: A case-control study

Abstract

BackgroundWe examined the initial features, course, and prognosis of giant cell arteritis (GCA) in patients ≥ 85 years of age (≥85 year) and compared them to those of younger patients. MethodsThe present retrospective study included all patients who were newly diagnosed with GCA in the Internal Departments of two French University Hospitals from 1976 or 1998 to 2017 and who were followed up for at least 6 months. Logistic regression analyses were conducted to identify baseline and prognostic characteristics associated with being ≥85 year. ResultsOf the 865 patients assessed in this study, 87 were ≥85 year. Compared to younger patients, patients ≥ 85 year had more comorbid conditions (odds ratio [OR] = 1.11–1.74, p < 0.01), less often exhibited polymyalgia rheumatica (PMR; OR = 0.33–0.96, p = 0.04), and more often developed permanent visual loss (OR = 1.29–3.81, p < 0.01). The older patients also showed less dependence on glucocorticoid (GC) medications (OR = 0.23–0.94, p = 0.04), had fewer relapses (OR = 0.31–0.87, p = 0.015), less often recovered from GCA (OR = 0.22–0.69, p < 0.01), and more often died during treatment (OR = 1.45–4.65, p = 0.001) compared to younger patients. Being ≥85 year was the only factor associated with an increased 1-year mortality (hazard ratio = 1.77–5.81, p = 0.0001) for the whole cohort. ConclusionsGCA in very elderly patients was characterized by a higher rate of severe ischemic complications and an increased risk for early death compared to younger patients. Thus, there is a need for the early diagnosis of GCA and close clinical monitoring in this unique population.