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Selected Publication:
Mandl, J.
Giant Cell Arteritis (Morbus Horton) – Does this disease influence the survival of patients?
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2014. pp. 62
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- Authors Med Uni Graz:
- Advisor:
- Brodmann Marianne
- Hafner Franz
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- Abstract:
- Introduction: Giant cell arteritis (GCA) is a chronic autoimmune disease of elderly patients affecting the large and medium arteries. GCA is characterized by local inflammation of the artery and systemic inflammatory response. It primarily affects people of European descent, over 50 years of age, peaking in the eightieth decade of life. Current research is not in agreement on whether GCA affects the mortality outcomes for patients, with some studies finding a higher mortality rate and some no change. There is some indication that GCA does increase aortic aneurysm and dissection related mortality. The current study is a retrospective analysis of a cohort of CGA patients, aiming to assess the mortality outcomes for this group and any connection between aortic aneurysms and mortality. Materials & Methods: Records for 177 patients diagnosed with GCA at the division of Angiology at the Medical University of Graz between 1995 and 2012 were collected. The final patient group was 158 after exclusions. Data was collected for diagnostic factors, risk factors, adverse events, adjuvant therapies and survival. Data collection was through analysis of hard copy and electronic patients records. Missing information was followed up through telephone contact with the patients or their GP. Statistical significance was assumed for p-values <0.05. Results: The study population consisted of 112(70.9%) females and 46(29.1%) males. Average age of diagnosis was 71.4 (SD ±9.5) years. 62.7% patients were diagnosed with GCA alone and 37.3% had GCA + PMR. Of the 158 patients, 38 patients died (24.1%). The crude mortality rate in the patient group is 1.41% per year. The mean age at death was 80.53 (SD ±6.7). There was a higher occurrence of death in the patients with GCA versus those with PMR (p=0.046). Patients with an older age at diagnosis appeared to have worse mortality outcomes (p=0.023). Patients who had a history of stroke, those with ocular manifestations and ischaemic opticus neuropathy were associated with mortality (p=0.001, p<0.001, p<0.001). Patients taking statins had better survival than those who were not (p=0.017). Positive biopsy was associated with poorer outcome than anegative one(p=0.001). There were no reported incidences of aortic aneurysm as cause of death. Conclusion: This study revealed several factors to be associated with mortality in GCA patients; older age at diagnosis, GCA only disease type subgroup, presence of ocular manifestations, ischaemic opticus neuropathy, history of stroke, lack of use of statins and a positive biopsy result. These results are comparable to the literature analysed and represent useful information to inform the clinician on particular patient types that need closer medical monitoring and are at higher risk for complications. No conclusions could be made on aneurysms and mortality due to lack of incidence in our study group.