Subclinical giant cell arteritis in new onset polymyalgia rheumatica A systematic review and meta-analysis of individual patient data
Hemmig, Andrea K. (University Hospital Basel (Basilea, Suïssa))
Gozzoli, Daniele (Department of Internal Medicine. University Hospital Basel)
Werlen, Laura (Department of Clinical Research. University Hospital Basel. University of Basel)
Ewald, Hannah (University Medical Library Basel. University of Basel)
Aschwanden, Markus (Department of Angiology. University Hospital Basel)
Blockmans, Daniel (Department of General Internal Medicine. Department of Microbiology. Immunology and Transplantation. KU Leuven. University Hospitals Leuven)
Brouwer, Elisabeth (Department of Rheumatology and Clinical Immunology. University of Groningen. University Medical Center Groningen)
Buchanan, Russell R.C. (Department of Medicine. Austin Health. Melbourne Medical School. University of Melbourne)
Camellino, Dario (Division of Rheumatology. "La Colletta" Hospital)
Campochiaro, Corrado (Unit of Immunology. Rheumatology. Allergy and Rare Diseases (UnIRAR). San Raffaele Scientific Institute)
Cimmino, Marco Amedeo (University of Genova (Itàlia))
Corominas, Hèctor (Institut d'Investigació Biomèdica Sant Pau)
Gloy, Viktoria (Department of Clinical Research. University Hospital Basel. University of Basel)
Henckaerts, Liesbet (Department of General Internal Medicine. Department of Microbiology. Immunology and Transplantation. KU Leuven. University Hospitals Leuven)
Kyburz, Diego (Department of Biomedicine. University of Basel)
Moya, Patricia (Institut d'Investigació Biomèdica Sant Pau)
Owen, Claire E. (Department of Medicine. Austin Health. Melbourne Medical School. University of Melbourne)
Stegert, Mihaela (University Hospital Basel (Basilea, Suïssa))
Tomelleri, Alessandro (Unit of Immunology. Rheumatology. Allergy and Rare Diseases (UnIRAR). San Raffaele Scientific Institute)
van Sleen, Yannick (Department of Rheumatology and Clinical Immunology. University of Groningen. University Medical Center Groningen)
Yamashita, Hiroyuki (Division of Rheumatic Diseases. National Center for Global Health and Medicine)
Imfeld, Stephan (Department of Angiology. University Hospital Basel)
Berger, Christoph T. (Departments of Dermatology. Rheumatology and Internal Medicine. University Center for Immunology. University Hospital Basel)
Hemkens, Lars G. (Meta-Research Innovation Center Berlin (METRIC-B). Berlin Institute of Health)
Daikeler, Thomas (University Hospital Basel (Basilea, Suïssa))

Data:	2022
Resum:	Objectives: To determine the prevalence and predictors of subclinical giant cell arteritis (GCA) in patients with newly diagnosed polymyalgia rheumatica (PMR). Methods: PubMed, Embase, and Web of Science Core Collection were systematically searched (date of last search July 14, 2021) for any published information on any consecutively recruited cohort reporting the prevalence of GCA in steroid-naïve patients with PMR without cranial or ischemic symptoms. We combined prevalences across populations in a random-effect meta-analysis. Potential predictors of subclinical GCA were identified by mixed-effect logistic regression using individual patient data (IPD) from cohorts screened with PET/(CT). Results: We included 13 cohorts with 566 patients from studies published between 1965 to 2020. Subclinical GCA was diagnosed by temporal artery biopsy in three studies, ultrasound in three studies, and PET/(CT) in seven studies. The pooled prevalence of subclinical GCA across all studies was 23% (95% CI 14%-36%, I=84%) for any screening method and 29% in the studies using PET/(CT) (95% CI 13%-53%, I=85%) (n=266 patients). For seven cohorts we obtained IPD for 243 patients screened with PET/(CT). Inflammatory back pain (OR 2. 73, 1. 32-5. 64), absence of lower limb pain (OR 2. 35, 1. 05-5. 26), female sex (OR 2. 31, 1. 17-4. 58), temperature >37° (OR 1. 83, 0. 90-3. 71), weight loss (OR 1. 83, 0. 96-3. 51), thrombocyte count (OR 1. 51, 1. 05-2. 18), and haemoglobin level (OR 0. 80, 0. 64-1. 00) were most strongly associated with subclinical GCA in the univariable analysis but not C-reactive protein (OR 1. 00, 1. 00-1. 01) or erythrocyte sedimentation rate (OR 1. 01, 1. 00-1. 02). A prediction model calculated from these variables had an area under the curve of 0. 66 (95% CI 0. 55-0. 75). Conclusion: More than a quarter of patients with PMR may have subclinical GCA. The prediction model from the most extensive IPD set has only modest diagnostic accuracy. Hence, a paradigm shift in the assessment of PMR patients in favour of implementing imaging studies should be discussed.
Nota:	Altres ajuts: Swiss Foundation for Research on Muscle Diseases (FSRMM).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Polymyalgia rheumatica ; Giant cell arteritis ; Subclinical vasculitis ; Systematic review ; Meta-analysis
Publicat a:	Seminars in Arthritis and Rheumatism, Vol. 55 (august 2022) , p. 152017, ISSN 1532-866X

DOI: 10.1016/j.semarthrit.2022.152017
PMID: 35537222

8 p, 1.3 MB

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