Sex differences among patients with giant cell arteritis: insights from the Spanish ARTESER Registry

Abstract

Objective: To evaluate sex-based differences in clinical presentation, vascular phenotype, diagnostic approaches, treatment, adverse events and outcomes among patients with giant cell arteritis (GCA).

Methods: We analysed data from all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 across 26 hospitals in Spain. Eligibility criteria included age ≥50 years and diagnosis confirmed by imaging, the 1990 American College of Rheumatology classification criteria, or expert clinical judgment.

Results: A total of 1675 patients were included. The extracranial phenotype was more prevalent in women (14.8% vs 9.9%; P = 0.039), while the mixed phenotype was more common in men (17.7% vs 11.7%; P = 0.002). Temporal artery ultrasound was more frequently positive in men (73.5% vs 65.1%; P = 0.025). Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) were prescribed more often in women (35.3% vs 28.2%; P = 0.005), while glucocorticoid and tocilizumab use did not differ by sex. Fractures (22.4% vs 10.9%; P = 0.010) and cataracts (6.0% vs 2.8%; P = 0.010) were significantly more frequent in women and men, respectively. Remission rates (23.1% vs 23.8%) and relapse frequencies (19.7% vs 19.3%) were similar between sexes. Mortality was higher in men (13.8% vs 6.6%; P < 0.001).

Conclusions: Women more frequently exhibited the extracranial phenotype, required more csDMARDs, and experienced a higher incidence of fractures. In contrast, men more commonly presented with the mixed phenotype, had more cataracts, and showed a higher mortality rate. These findings highlight the importance of integrating sex as a key biological variable in GCA research and clinical management to support more tailored and effective therapeutic strategies.

Keywords: epidemiology; giant cell arteritis; large vessel vasculitis; sex; temporal arteritis.