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Title: Subclinical giant cell arteritis in new onset polymyalgia rheumatica A systematic review and meta-analysis of individual patient data.
Austin Authors: Hemmig, Andrea K;Gozzoli, Daniele;Werlen, Laura;Ewald, Hannah;Aschwanden, Markus;Blockmans, Daniel;Brouwer, Elisabeth;Buchanan, Russell R C ;Camellino, Dario;Campochiaro, Corrado;Cimmino, Marco A;Corominas, Hector;Gloy, Viktoria;Henckaerts, Liesbet;Kyburz, Diego;Moya-Alvarado, Patricia;Owen, Claire E ;Stegert, Mihaela;Tomelleri, Alessandro;van Sleen, Yannick;Yamashita, Hiroyuki;Imfeld, Stephan;Berger, Christoph T;Hemkens, Lars G;Daikeler, Thomas
Affiliation: Medicine (University of Melbourne)
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
University Medical Library Basel, University of Basel, Basel, Switzerland
Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
Division of Rheumatology, "La Colletta" Hospital, Local Health Trust 3, Arenzano, Italy
Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genova, Italy
Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Leuven, Belgium
Department of Rheumatology, University Hospital Basel, Basel, Switzerland
Department of Biomedicine, University of Basel, Basel, Switzerland
Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
Department of Angiology, University Hospital Basel, Basel, Switzerland
Departments of Dermatology, Rheumatology and Internal Medicine, University Center for Immunology, University Hospital Basel, Basel, Switzerland
Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA; Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
Issue Date: Aug-2022 2022-04-28
Publication information: Seminars in Arthritis and Rheumatism 2022-08; 55: 152017
Abstract: To determine the prevalence and predictors of subclinical giant cell arteritis (GCA) in patients with newly diagnosed polymyalgia rheumatica (PMR). 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). 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%, I2=84%) for any screening method and 29% in the studies using PET/(CT) (95% CI 13%-53%, I2=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). 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.
DOI: 10.1016/j.semarthrit.2022.152017
ORCID: 0000-0002-2694-5411
Journal: Seminars in Arthritis and Rheumatism
PubMed URL: 35537222
PubMed URL:
Type: Journal Article
Subjects: Giant cell arteritis
Polymyalgia rheumatica
Subclinical vasculitis
Systematic review
Appears in Collections:Journal articles

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