Outcome of giant cell arteritis of the arm arteries managed with medical treatment alone: cross-sectional follow-up study

Objective. To assess the long-term outcome of GCA of the arm arteries under medical treatment alone. Methods. Retrospective cross-sectional study of 34 patients with a diagnosis of GCA involving the arm arteries (i.e. subclavian, axillary and/or brachial arteries). All patients were managed with immunosuppressive treatment and antiplatelet agents and followed clinically and with colour duplex sonography. Characteristics of patients with and without relief of ischaemic upper extremity symptoms during follow-up were compared using Fisher's exact test and the Mann-Whitney U-test. Results. Sixteen of 34 patients (47.1%) suffered from arm claudication at the time of diagnosis (bilateral symptoms in 8 patients). During a mean follow-up of 21.9 (17.1) months, none of the patients developed new ischaemic symptoms of the upper extremities, and five patients became asymptomatic. Critical limb ischaemia did not occur. Symptom relief was significantly less frequent in patients with symptomatic ischaemia of the right arm vs the left arm and was negatively associated with the presence of anaemia and subclavian artery involvement (all P<0.05). In 32.4% of patients, the vasculitic wall thickening, as depicted by colour duplex sonography, completely disappeared. Conclusion. With medical treatment alone, the prognosis of GCA of the arm arteries is benign. Patients with unilateral left-sided ischaemic symptoms may have a higher probability of complete symptom relief than patients with right-sided or bilateral arm claudication.