Endothelial function and carotid intima-media thickness in giant-cell arteritis.

BackgroundVascular endothelial dysfunction and intima-media thickness are characteristic aspects of several vasculitides. We investigated retrospectively the impact of steroid treatment on endothelial dysfunction and intima-media thickness in giant-cell arteritis. MethodsForty-one patients with giant-cell arteritis (28 female and 13 male) underwent flow-mediated dilatation, a marker of endothelial function, and carotid intima-media thickness within 24h after diagnosis and 6months thereafter. Both parameters were investigated in 41 patients of an age- and gender-matched control group. ResultsBrachial flow-mediated dilatation response at baseline was 34% (02, 80) and 17% (02, 48) in giant-cell arteritis patients and control group, respectively. After 6months treatment, flow-mediated dilatation response was 28% (04, 48) in patients with giant-cell arteritis (P=0066) and 14% (01, 55) in the control group (P=0741). In contrast, mean carotid intima-media thickness of giant-cell arteritis patients improved significantly between baseline [10mm (079, 12)] and 6-month follow-up [082mm (07, 104), P<0001]. Subjects with additional symptoms of polymyalgia rheumatica had a notable enlargement of carotid intima-media thickness [123mm (114, 209)] compared to giant-cell arteritis patients without polymyalgia rheumatica at baseline [091mm (076, 104), P=0001] and 6-month follow-up [116mm (080, 126) vs. 077mm (068, 088), P=0009]. ConclusionSteroid therapy has no influence on endothelial function but does significantly improve carotid intima-media thickness in giant-cell arteritis. This divergence of endothelial function and intima-media thickness reflects the specifity of giant-cell arteritis for cerebrovascular arteries thereby sparing the brachial arteries.