What is certain is that, “in a publicly funded health care system, this is good news.” Dr. Aviña-Zubieta additionally commented: “We need to find out what were the cause-specific outcomes which have improved – for example, cardiovascular disease, infections, or perhaps cancer – and which ones did not, so we can plan how to tackle them.”
Histologic pattern on biopsy linked to survival
Also at the meeting, Dr. Pierluigi Macchioni of Arcispedale S. Maria Nuova – IRCCS in Reggio Emilia, Italy, presented separate data on the survival of patients with GCA over a 26-year period in Italy. He shared the findings of a study that indicated the histologic pattern on temporal artery biopsy (TAB) was correlated with survival.
“In a previous study, we have demonstrated that in GCA the histologic spectrum is broad and the histologic differences appear to have specific clinical correlates,” Dr. Macchioni said. So the aim of the study was to see if these differences might be linked to patient survival.
Dr. Macchioni and associates identified 280 patients with incident TAB-positive GCA diagnosed between 1986 and 2012 who were from an area of Northern Italy and had complete clinical, laboratory, and survival data available. The mean age at disease onset was 74 years.
Patients were divided into groups based on the histologic pattern seen on TAB: the majority had transmural inflammation (TMI), with 8.6% having small-vessel vasculitis, 5% inflammation limited to adventitia (ILA), and 4.6% vasa vasorum vasculitis (VVV).
Over the course of the 26-year follow-up, 159 (56.8%) died, with a median survival time from disease onset of around 8.4 years. Two histologic types were associated with a reduced overall mortality when compared with the most common TMI histologic type: The hazard ratios for death were 0.12 for the VVV and 0.38 for the ILA histologic types.
“The histological spectrum of inflammatory lesions in TAB-positive GCA has a correlation with survival,” Dr. Macchioni said. Furthermore, “the presence of arterial wall calcification at TAB has an impact on the survival of GCA patients.” Indeed, comparing those with those without arterial wall calcification the risk for death was doubled (HR, 2.05).