Subclinical giant cell arteritis in new onset polymyalgia rheumatica A systematic review and meta-analysis of individual patient data
Por:
Hemmig, AK, Gozzoli, D, Werlen, L, Ewald, H, Aschwanden, M, Blockmans, D, Brouwer, E, Buchanan, RRC, Camellino, D, Campochiaro, C, Cimmino, MA, Corominas, H, Gloy, V, Henckaerts, L, Kyburz, D, Moya-Alvarado, P, Owen, CE, Stegert, M, Tomelleri, A, van Sleen, Y, Yamashita, H, Imfeld, S, Berger, CT, Hemkens, LG, Daikeler, T
Publicada:
1 ago 2022
Ahead of Print:
1 may 2022
Resumen:
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-na & iuml;ve 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-2=84%) for any screening method and 29% in the studies using PET/(CT) (95% CI 13%-53%, I-2=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 degrees (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.
Filiaciones:
Hemmig, AK:
Univ Hosp Basel, Dept Rheumatol, Petersgraben 4, CH-4031 Basel, Switzerland
Gozzoli, D:
Univ Hosp Basel, Dept Internal Med, Basel, Switzerland
Werlen, L:
Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland
Ewald, H:
Univ Basel, Univ Med Lib Basel, Basel, Switzerland
Aschwanden, M:
Univ Hosp Basel, Dept Angiol, Basel, Switzerland
Blockmans, D:
Katholieke Univ Leuven, Dept Gen Internal Med, Dept Microbiol Immunol & Transplantat, Univ Hosp Leuven, Leuven, Belgium
Brouwer, E:
Univ Groningen, Univ Med Ctr Groningen, Dept Rheumatol & Clin Immunol, Groningen, Netherlands
Buchanan, RRC:
Univ Melbourne, Melbourne Med Sch, Dept Med, Austin Hlth, Parkville, Vic, Australia
Austin Hlth, Dept Rheumatol, Heidelberg, Vic, Australia
Camellino, D:
La Colletta Hosp, Div Rheumatol, Local Hlth Trust 3, Arenzano, Italy
Campochiaro, C:
Ist Sci San Raffaele, Unit Immunol Rheumtol Allergy & Rare Dis UnIRAR, Milan, Italy
Cimmino, MA:
Univ Genoa, Res Lab & Acad Div Clin Rheumatol, Dept Internal Med, Genoa, Italy
Corominas, H:
Hosp Santa Creu & Sant Pau, Dept Rheumatol, Barcelona, Spain
Gloy, V:
Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland
Henckaerts, L:
Katholieke Univ Leuven, Dept Gen Internal Med, Dept Microbiol Immunol & Transplantat, Univ Hosp Leuven, Leuven, Belgium
Kyburz, D:
Univ Hosp Basel, Dept Rheumatol, Petersgraben 4, CH-4031 Basel, Switzerland
Univ Basel, Dept Biomed, Basel, Switzerland
Moya-Alvarado, P:
Hosp Santa Creu & Sant Pau, Dept Rheumatol, Barcelona, Spain
Owen, CE:
Univ Melbourne, Melbourne Med Sch, Dept Med, Austin Hlth, Parkville, Vic, Australia
Austin Hlth, Dept Rheumatol, Heidelberg, Vic, Australia
Stegert, M:
Univ Hosp Basel, Dept Rheumatol, Petersgraben 4, CH-4031 Basel, Switzerland
Tomelleri, A:
Ist Sci San Raffaele, Unit Immunol Rheumtol Allergy & Rare Dis UnIRAR, Milan, Italy
van Sleen, Y:
Univ Groningen, Univ Med Ctr Groningen, Dept Rheumatol & Clin Immunol, Groningen, Netherlands
Yamashita, H:
Natl Ctr Global Hlth & Med, Div Rheumat Dis, Tokyo, Japan
Imfeld, S:
Univ Hosp Basel, Dept Angiol, Basel, Switzerland
Berger, CT:
Univ Hosp Basel, Univ Ctr Immunol, Dept Dermatol Rheumatol & Internal Med, Basel, Switzerland
Hemkens, LG:
Berlin Inst Hlth, Metares Innovat Ctr Berlin METRIC B, Berlin, Germany
Stanford Univ, Metares Innovat Ctr Stanford METRICS, Palo Alto, CA 94304 USA
Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland
Daikeler, T:
Univ Hosp Basel, Dept Rheumatol, Petersgraben 4, CH-4031 Basel, Switzerland
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