Ischaemic manifestations in giant cell arteritis are associated with area level socio-economic deprivation, but not cardiovascular risk factors
Rheumatology, 08/25/2011
Clinical Article
Mackie SL et al. – 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.
Methods- Observational study of rheumatologist/ophthalmologist-diagnosed GCA in 8 UK centres
- 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
- Out of 271 patients, 222 had ischaemic manifestations
- Adjusted ORs for influence of hypertension and atherosclerosis were 1.6 (95% CI 0.8, 3.1) and 1.5 (0.6, 3.5)
- 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 least-deprived quartile
- Similar effect sizes were seen within each recruitment centre. Deprivation was associated with smoking and negatively associated with previous polymyalgia
- Neither of these variables, nor hypertension or atherosclerosis, appeared responsible for mediating 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 most-deprived quartile compared with least-deprived quartile
