A meta-analysis of the epidemiology of giant cell arteritis across time and space

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Abstract

Introduction

Giant cell arteritis (GCA) is a common large vessel vasculitis in those over age 50 years. This meta-analysis examined the geographical and temporal distribution of the incidence, prevalence, and mortality of GCA.

Methods

A systematic review was conducted using EMBASE, Scopus, and PubMed from their inceptions until 2019. Studies were included if they reported at least 50 or more GCA patients and defined the location and time frame. Articles on mortality were included and standardized mortality ratio (SMR) was extracted where possible. Mean pooled prevalence, incidence, and SMR were calculated using a random effects model. Linear regression was used to explore correlations between latitude and incidence, prevalence, and mortality.

Results

Of the 3569 citations identified, 107 were included. The pooled incidence of GCA was 10.00 [9.22, 10.78] cases per 100,000 people over 50 years old. This incidence was highest in Scandinavia 21.57 [18.90, 24.23], followed by North and South America 10.89 [8.78, 13.00], Europe 7.26 [6.05, 8.47], and Oceania 7.85 [− 1.48, 17.19]. Pooled prevalence was 51.74 [42.04, 61.43] cases per 100,000 people over age 50. Annual mortality was 20.44 [17.84, 23.03] deaths/1000. Mortality generally decreased over the years of publication ( p = 0.0008). Latitude correlated significantly with incidence ( p = 0.0011), but not with prevalence, or mortality.

Conclusions

GCA incidence varies nearly 3-fold between regions and is highest in Scandinavia but not significantly. Mortality may be improving over time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-021-02450-w.

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Most cited references 17

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Temporal trends in the incidence of multiple sclerosis: a systematic review.

A. Alonso, M Hernán (2008)

Multiple sclerosis (MS) has been traditionally considered to be more frequent in women and in regions more distant from the equator. However, recent reports suggest that the latitude gradient could be disappearing and that the female-to-male ratio among patients with MS has increased in the last decades. We have conducted a systematic review of incidence studies of MS to assess the overall incidence of MS and explore possible changes in the latitude gradient and the female-to-male ratio over time. Systematic review of incidence studies of MS published in Medline between 1966 and February 2007. Age- and sex-specific incidence rates were collected from eligible publications. We computed age-adjusted rates using the world population as standard, and assessed differences in rates according to latitude and period of case ascertainment. Additionally, we evaluated the association between period of case ascertainment and the female-to-male ratio. The overall incidence rate of MS was 3.6 cases per 100,000 person-years (95% CI 3.0, 4.2) in women and 2.0 (95% CI 1.5, 2.4) in men. Higher latitude was associated with higher MS incidence, though this latitude gradient was attenuated after 1980, apparently due to increased incidence of MS in lower latitudes. The female-to-male ratio in MS incidence increased over time, from an estimated 1.4 in 1955 to 2.3 in 2000. The latitude gradient present in older incidence studies of multiple sclerosis (MS) is decreasing. The female-to-male MS ratio has increased in the last five decades.

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Immune mechanisms in medium and large-vessel vasculitis.

Cornelia Weyand, J Goronzy (2013)

Vasculitis of the medium and large arteries, most often presenting as giant cell arteritis (GCA), is an infrequent, but potentially fatal, type of immune-mediated vascular disease. The site of the aberrant immune reaction, the mural layers of the artery, is strictly defined by vascular dendritic cells, endothelial cells, vascular smooth muscle cells and fibroblasts, which engage in an interaction with T cells and macrophages to, ultimately, cause luminal stenosis or aneurysmal wall damage of the vessel. A multitude of effector cytokines, all known as critical mediators in host-protective immunity, have been identified in vasculitic lesions. Two dominant cytokine clusters--the IL-6-IL-17 axis and the IL-12-IFN-γ axis--have been linked to disease activity. These two clusters seem to serve different roles in the vasculitic process. The IL-6-IL-17 cluster is highly responsive to standard corticosteroid therapy, whereas the IL-12-IFN-γ cluster is resistant to steroid-mediated immunosuppression. The information exchange between vascular and immune cells and stabilization of the vasculitic process involves members of the Notch receptor and ligand family. Focusing on elements in the tissue context of GCA, instead of broadly suppressing host immunity, might enable a more tailored therapeutic approach that avoids unwanted adverse effects of aggressive immunosuppression.

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Giant cell arteritis in northwestern Spain: a 25-year epidemiologic study.

José Miranda-Filloy, Roberto Pérez-Alvarez, Carlos González-Juanatey … (2007)

To continue our investigation of the epidemiology of giant cell arteritis (GCA) in southern Europe, we assessed the potential presence of trends, peaks, and fluctuations in the incidence of this vasculitis over a 25-year period in the Lugo region of northwestern Spain. We also sought to determine whether changes in the clinical spectrum of the disease existed. From 1981 to 2005, biopsy-proven GCA was diagnosed in 255 Lugo residents. The age- and sex-adjusted annual incidence rate was 10.13 (95% confidence interval [CI], 8.93-11.46) per 100,000 population aged 50 years and older. The mean age +/- SD at the time of diagnosis was 75.0 +/- 6.9 years. The annual incidence rate in women (10.23; 95% CI, 8.60-12.08) was slightly greater than that in men (9.92; 95% CI, 8.19-11.89) (p = 0.15). The annual incidence rate increased with advancing age up to a maximum of 23.16 (95% CI, 19.52-27.28) in the 70-79 year age-group. A progressive increase in the incidence was observed from 1981 through 2000 (p = 0.001). However, the age- and sex-adjusted incidence rate for biopsy-proven GCA in the Lugo region did not show peaks in the annual incidence of GCA. Likewise, we observed no seasonal pattern for the diagnosis of the disease. Visual ischemic manifestations and irreversible visual loss were observed in 57 (22.4%) and 32 (12.5%) of the 255 patients, respectively. A negative trend manifested by a progressive decline in the number of patients with visual ischemic manifestations (p = 0.021) or permanent visual loss (p = 0.018) was found over the 25-year period of study. The decline in the frequency of visual manifestations of GCA could not be attributed to a shorter delay to diagnosis, as no significant differences were observed when the delays to diagnosis in the 5 consecutive 5-year periods were compared. In conclusion, the current study confirms a progressive increase in the incidence of biopsy-proven GCA in northwestern Spain, and suggests that there has been a change in the clinical spectrum of the disease.

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Author and article information

Contributors

Janet Pope:

ORCID: http://orcid.org/0000-0003-1479-5302

janet.pope@sjhc.london.on.ca

Journal

Journal ID (nlm-ta): Arthritis Res Ther

Journal ID (iso-abbrev): Arthritis Res Ther

Title: Arthritis Research & Therapy

Publisher: BioMed Central (London )

ISSN (Print): 1478-6354

ISSN (Electronic): 1478-6362

Publication date (Electronic): 11 March 2021

Publication date PMC-release: 11 March 2021

Publication date (Print): 2021

Volume: 23

Electronic Location Identifier: 82

Affiliations

[1 ]GRID grid.39381.30, ISNI 0000 0004 1936 8884, Schulich School of Medicine, , University of Western Ontario, St. Joseph’s Health Care, ; 268 Grosvenor St, D2 Rheumatology, London, ON N6A 4V2 Canada

[2 ]GRID grid.7886.1, ISNI 0000 0001 0768 2743, University College Dublin, School of Medicine and Medical Sciences, ; Dublin 4, Ireland

Author information

Janet Pope http://orcid.org/0000-0003-1479-5302

Article

Publisher ID: 2450

DOI: 10.1186/s13075-021-02450-w

PMC ID: 7948334

PubMed ID: 33706808

SO-VID: bf383ced-8ca3-45ef-ae56-d142fa192b6b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 6 November 2020

Date accepted : 11 February 2021

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: gca,giant cell arteritis,temporal arteritis,meta-analysis,epidemiology,geographic variation,temporal trend,mortality,prevalence,incidence

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: gca, giant cell arteritis, temporal arteritis, meta-analysis, epidemiology, geographic variation, temporal trend, mortality, prevalence, incidence

A meta-analysis of the epidemiology of giant cell arteritis across time and space

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Abstract

Introduction

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Conclusions

Supplementary Information

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Orthopedics

Most cited references 17

Temporal trends in the incidence of multiple sclerosis: a systematic review.

Immune mechanisms in medium and large-vessel vasculitis.

Giant cell arteritis in northwestern Spain: a 25-year epidemiologic study.

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