Subclinical giant cell arteritis in new onset polymyalgia rheumatica A systematic review and meta-analysis of individual patient data.

Autor: Hemmig AK; Department of Rheumatology, University Hospital Basel, Basel, Switzerland., Gozzoli D; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland., Werlen L; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland., Ewald H; University Medical Library Basel, University of Basel, Basel, Switzerland., Aschwanden M; Department of Angiology, University Hospital Basel, Basel, Switzerland., Blockmans D; Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Leuven, Belgium., Brouwer E; Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Buchanan RRC; Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia., Camellino D; Division of Rheumatology, 'La Colletta' Hospital, Local Health Trust 3, Arenzano, Italy., Campochiaro C; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy., Cimmino MA; Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genova, Italy., Corominas H; Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Gloy V; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland., Henckaerts L; Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Leuven, Belgium., Kyburz D; Department of Rheumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland., Moya-Alvarado P; Department of Rheumatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Owen CE; Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, Austin Health, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia., Stegert M; Department of Rheumatology, University Hospital Basel, Basel, Switzerland., Tomelleri A; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy., van Sleen Y; Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands., Yamashita H; Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan., Imfeld S; Department of Angiology, University Hospital Basel, Basel, Switzerland., Berger CT; Departments of Dermatology, Rheumatology and Internal Medicine, University Center for Immunology, University Hospital Basel, Basel, Switzerland., Hemkens LG; 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., Daikeler T; Department of Rheumatology, University Hospital Basel, Basel, Switzerland. Electronic address: Thomas.Daikeler@usb.ch.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2022 Aug; Vol. 55, pp. 152017. Date of Electronic Publication: 2022 Apr 28.
DOI: 10.1016/j.semarthrit.2022.152017
Abstrakt: 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 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° (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.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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