Overall and cause-specific mortality in giant cell arteritis: A meta-analysis

Objective: This study aimed to assess the all-cause and cause-specific standardized mortality ratios (SMRs) in patients with giant cell arteritis (GCA). Methods: We surveyed studies examining all-cause and/or cause-specific SMRs in patients with GCA compared to the general population, using MEDLINE, EMBASE, Cochrane databases, and manual searches. We then performed a meta-analysis of all-cause, sex-specific, region-specific, and cause-specific SMRs in patients with GCA. Results: In total, 8 reports including 1972 patients with GCA (including 877 patients who died) met the inclusion criteria. Compared with the general population, all-cause SMR was not increased in patients with GCA (SMR 1.081, 95% confidence interval [CI] 0.963–1.214, p = 0.184). Stratification by region showed no significant increase in all-cause SMR in Europe and USA. Sex-specific meta-analysis revealed that the pooled SMR was 1.046 (95%CI 0.834–1.314, p = 0.696) for women and 1.051 (95%CI 0.974–1.133, p = 0.204) for men. There were no sex-specific significant differences in SMR. The risk of mortality due to cardiovascular disease (CVD) was significantly increased (SMR 1.312, 95%CI 1.136–1.516, p < 0.001). However, there was no significant increase in the SMR for mortality due to cancer (SMR 0.833, 95%CI 0.613–1.132, p = 0.243). Conclusions: Patients with GCA do not show increased rates of death from all causes, regardless of sex, region, or malignancy. However, these patients are at an increased risk of death due to CVD.