Inaugural Forum- GCA-related Stroke
Wed, 03/01/2017 - 11:01
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Inaugural Forum- GCA-related Stroke
Welcome to the inaugural edition of #chatJRheum
When a patient presents with a new diagnosis of giant cell arteritis (GCA), we instantly think about vision loss as a potential complication. In this month’s inaugural community forum, we will highlight and discuss an interesting study on stroke in GCA. It calls our attention to this complication with a high burden of morbidity and mortality.
In this French multicenter cohort study, de Boysson et al. compare 40 patients with GCA and stroke with 200 control GCA patients without stroke. It raises several interesting clinical questions:
- While the incidence of stroke is rare (~4-7% in patients with CGA), the recorded mortality rate is high (28%). For such a significant comorbidity, how can we better predict who might be at higher risk of stroke? The study revealed that features associated with increased risk of stroke are not necessarily those one might predict.
- The study did not find an association with cardiovascular (CV) risk factors and stroke in GCA, nor were antiplatelet agents or anticoagulation treatment protective against stroke. If that is the case, is there still a role for Aspirin after diagnosis?
- Interestingly, the posterior vertibrobasilar territory was most commonly involved, occurring in almost three quarters of stroke patients. This got me wondering, does this association go the other way around? Should we be considering GCA in stroke patients when the posterior territory is involved?
The forum is open to you as an informal and open-minded place to post your comments, pose questions or share ideas. Let’s chat!
- Dr. Sarah Troster, Forum Editor
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Dear Sarah - thanks for posting and providing another way to share ideas and learning. In response to your question, with the small numbers in the study it would seem hypothesis generating at this point and not sure could generalize. Look forward to hearing from everyone else!