P189 Diabetes may confer protection from giant cell arteritis: results from a large inception cohort. (20th April 2020)

• Record Type: Journal Article
• Authors: Spray, Luke; Reynolds, Gary; Heaney, Jonathon; Houghton, Karolyn; Hargreaves, Ben; Thompson, Ben; Lorenzi, Alice
• Is Part Of: Rheumatology. Volume 59(2020)Supplement 2
• Publication Date: 2020-04-20
• Subjects: Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keaa111.184
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Background: Giant cell arteritis (GCA) is the commonest large-vessel vasculitis. Until recently high dose corticosteroids had been the mainstay of treatment. Significant concern about steroid related co-morbidities have driven interest in developing new treatment strategies, and the potential to reduce costs associated with managing these complications was pivotal in securing funding for tocilizumab. Despite this little is known about the at-risk population, comprising both those diagnosed with GCA and those suspected of GCA, as both groups undergo the same steroid exposure. We therefore sought to determine if patients referred to our GCA fast track pathway (GCA-FTP) were more or less at risk than the general age matched population of developing corticosteroid related side effects. Methods: Data from 356 consecutively referred patients to our GCA-FTP between January 1st 2017 and December 31st 2018 were reviewed. Co-morbidity data is routinely collected as part of our GCA-FTP rolling audit. We determined the frequency of pre-existing co-morbidities most often associated with steroid related side effects and compared these with published background prevalence estimates for a similar age group in the UK. Results: In general rates of co-morbidities were lower than published estimates in over-70s, as we did not actively pursue their identification beyond what was readily available at referral (Table 1). Interestingly, however, whilst the prevalence of diabetes mellitus in our cohort (n = 356) was comparable to that in the general population (23.6%), it was significantly lower in those diagnosed with GCA (n = 83) at 11% (p = 0.0017). Despite this difference, background rates of cardiovascular and peripheral vascular disease were similar in each group. Conclusion: In our cohort, diabetes mellitus seems to be a protective factor against the development of GCA. Similar results were reported in 2015 from a meta-analysis of inception cohorts involving 903 patients with GCA and 1064 controls. The interaction between diabetes and the onset of GCA merits further investigation. Disclosures: L. Spray None. G. Reynolds None. J. Heaney None. K. Houghton None. B. Hargreaves None. B. Thompson None. A. Lorenzi None.