Cerebrovascular accidents in giant cell arteritis: prevalence and predictive factors from the ARTESER registry

Objective: To determine the prevalence and predictive factors of cerebrovascular accidents (CVA) in GCA. Methods: ARTESER is a large Spanish multicentre registry including patients with GCA from across the entire country diagnosed between June 2013 and March 2019 and sponsored by the Spanish Society of Rheumatology. The variables collected at diagnosis were demographics, clinical manifestations (including the occurrence and location of CVA), laboratory, histology and imaging findings. Patients with and without CVA were compared in a bivariate analysis. Multivariate logistic regression was performed to determine potential predictive factors of CVA. Results: A total of 1540 patients with GCA were included for analysis (mean age 77.1 years, 70% females). CVA occurred in 61 (3.96%), of whom 38 (62.3%) involved the vertebrobasilar territory and 21 (34.4%) the carotid territory. The factors associated with CVA were the occurrence of transient ischaemic attack (TIA) [odds ratio (OR) 8.63; 95% CI 2.877-25.86], large vessel (LV) involvement (OR 2.79; 95% CI 1.421-5.465) and the presence of concomitant visual manifestations (OR 2.73; 95% CI 1.427-5.235). The risk of death during follow-up was significantly higher in patients with CVA (18% vs 8.8%; P = 0.014). Patients with CVA received significantly higher mean prednisone (mg) dose at diagnosis (433.9 vs 216; P < 0.001) and cumulative prednisone dose during follow-up (11 203.9 vs 8,194.1; P < 0.001). Conclusion: The prevalence of CVA in patients with GCA is low, but increases the risk of mortality. The presence of TIA, LV involvement and visual manifestations are factors associated with increased risk of CVA.