238. EFFICACY OF CONVENTIONAL IMMUNOSUPPRESSANTS IN STEROID-DEPENDENT OR REFRACTORY EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS: STUDY ON A NEW CANADIAN PATIENT COHORT
Rheumatology（2019）SCI 2区
Abstract
determine the utility of chest radiograph (CXR) in identifying ASD in GCA patients at baseline.Methods: We retrospectively reviewed the electronic medical records of patients diagnosed with GCA by rheumatologists between April 2012 and December 2017.For study inclusion, patients must have met ACR 1990 classification criteria for GCA.A standardized form was used to record patient demographics, clinical variables, imaging results and outcomes.Indications for and results of CXR and advanced imaging studies (CT angiogram, MR angiogram, PET/CT) performed at baseline were recorded.Results: Of 133 patients identified on initial search, 52 patients were excluded (38 due to alternative diagnosis, 14 failed to meet ACR classification criteria), leaving 81 patients for study inclusion.Patients were predominantly female (64%), with a mean age of 71 years (þ/-8.4).See Table 1 for patient baseline characteristics.Baseline CXR results were available in 63 (78%) patients.Indications for CXR included ASD screening (12 patients, 19%), presence of symptoms (25 patients, 40%), or other/unknown reasons (26 patients, 41%).Of 63 baseline CXR available, 14 (22%) reported aortic abnormalities, including unfolding/tortuosity of the aorta (8 patients, 13%), widened mediastinum (3 patients, 5%), ectasia (2 patients, 3%), and thoracic aortic aneurysm (1 patient, 1.6%).In the single patient with thoracic aneurysm, urgent CT angiogram revealed type A dissection, and the patient underwent successful surgical repair.Conclusion: Aortic structural disease may already be present at GCA diagnosis.CXR is an easily-accessible, low-cost method that identifies possible aortic changes in 22% of patients at baseline, potentially serving to identify those that need early advanced imaging.Further studies regarding optimal screening protocols, including cost-efficacy assessments, are needed.
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