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Objectives To compare limited with a more extended ultrasound examination (anteromedial ultrasound, A2-ultrasound) to detect large vessel (LV) involvement in patients with newly diagnosed GCA. Methods Patients with new-onset GCA were included at the time of diagnosis. All patients were examined using limited ultrasound (ultrasound of the axillary artery as visualized in the axilla) and an extended A2-ultrasound method (which also includes the carotid, vertebral, subclavian and proximal axillary arteries), in addition to temporal artery ultrasound. Results One hundred and thirty-three patients were included in the study. All patients fulfilled the criteria according to a proposed extension of the 1990 ACR classification criteria for GCA and had a positive ultrasound examination at diagnosis. Ninety-three of the 133 GCA patients (69.9%) had LV involvement when examined by extended A2-ultrasound, compared with only 56 patients (42.1%) by limited ultrasound (P Conclusion Extended A2-ultrasound examination identified more patients with LV involvement than the limited ultrasound method. However, extended A2-ultrasound requires high expertise and high-end equipment and should be performed by ultrasonographers with adequate training.

Background In Norway, an annual tender system for the prescription of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has been used since 2007. This study aimed to explore annual b/tsDMARDs costs and disease outcomes in Norwegian rheumatoid arthritis (RA) patients between 2010 and 2019 under the influence of the tender system. Methods RA patients monitored in ordinary clinical practice were recruited from 10 Norwegian centers. Data files from each center for each year were collected to explore demographics, disease outcomes, and the prescribed treatment. The cost of b/tsDMARDs was calculated based on the drug price given in the annual tender process. Results The number of registered RA patients increased from 4909 in 2010 to 9335 in 2019. The percentage of patients receiving a b/tsDMARD was 39% in 2010 and 45% in 2019. The proportion of b/tsDMARDs treated patients achieving DAS28 remission increased from 42 to 67%. The estimated mean annual cost to treat a patient on b/tsDMARDs fell by 47%, from 13.1 thousand euros (EUR) in 2010 to 6.9 thousand EUR in 2019. The mean annual cost to treat b/tsDMARDs naïve patients was reduced by 75% (13.0 thousand EUR in 2010 and 3.2 thousand EUR in 2019). Conclusions In the period 2010–2019, b/tsDMARD treatment costs for Norwegian RA patients were significantly reduced, whereas DAS28 remission rates increased. Our data may indicate that the health authorities’ intention to reduce treatment costs by implementing a tender system has been successful.

Background: Our objective was to determine the survival and causes of death in a large and well-characterized cohort of patients with giant cell arteritis (GCA). Methods: This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in Western Norway during 1972–2012. Patients were identified through computerized hospital records using the International Classification of Diseases (ICD)-coding system. Medical records were reviewed. Patients were randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway (CPRN). Date and cause of death were obtained from the Norwegian Cause of Death Registry (NCoDR). The survival was analyzed using Kaplan-Meier methods with the Gehan-Breslow test and the causes of death using cumulative incidence and Cox models for competing risks. Results: We identified 881 cases with a clinical diagnosis of GCA of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria. Among those fulfilling the ACR criteria, 528 were also biopsy-verified. Cases were matched with 2577 population controls. A total of 490 (56%) GCA patients and 1517 (59%) controls died during the study period. We found no difference in the overall survival of GCA patients compared to controls, p = 0.413. The most frequent underlying causes of death in both groups were diseases of the circulatory system followed by cancer. GCA patients had increased risk of dying of circulatory disease (HR 1.31, 95% CI 1.13–1.51, p

Objective.To determine the risk of cancer in a large Norwegian cohort of patients with giant cell arteritis (GCA).Methods.This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in the Bergen Health Area during 1972–2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding system. Medical records were reviewed. Each patient was randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway. Data on the occurrence of cancer were obtained from the Cancer Registry of Norway. The cumulative risk of malignancy was estimated using Kaplan-Meier methods and potential differences were analyzed using the Gehan-Breslow and log-rank tests.Results.We identified 881 cases with a clinical diagnosis of GCA, of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria and 528 were biopsy-verified. Cases with no registered cancer prior to GCA diagnosis were included in a time-to-event analysis, with first cancer as the event (n = 767 with clinical GCA diagnosis, 686 fulfilling ACR criteria for GCA, 463 biopsy-verified). These cases were matched with previously cancer-free population controls (n = 1437, 1284, 895, respectively). We found no significant difference in the risk of malignancy after time of diagnosis/matching for GCA patients compared to population controls (p > 0.05).Conclusion.In this study of a large and well-characterized cohort of patients with GCA, there was no difference in the risk of malignancy in patients with GCA compared to matched population controls.

Background:Giant cell arteritis (GCA) is the most common systemic vasculitis in adults, and the number of incident cases worldwide is projected to increase [1]. Evidence as to whether or not GCA confers a mortality risk is conflicting, and many studies have been limited by inadequate or lacking adjustment for confounders.Objectives:To investigate possible predictors of death in a large and well characterized Norwegian cohort of GCA-patients.Methods:This is a hospital-based retrospective cohort study including patients diagnosed with GCA during 1972-2012. Patients were identified through computerized hospital records using the International Classification of Diseases coding system. Clinical information was extracted from patients’ medical journals. Further details about the inclusion process have been published previously [2]. Information on time of death was obtained from the Norwegian Cause of Death Registry. We investigated predicting factors using Cox regression. Selected variables were first analyzed in univariate and block regression models (block 1: clinical features including histology, block 2: laboratory and treatment factors, block 3: demographic and traditional risk factors). Variables included in the final multivariate model were selected on the following basis: P-value Results:881 patients were included of which 626 (71.1%) were females. Mean age was 73 years (SD 9). 490 patients (55.6%) died during the study period (1 January 1972 – 31 December 2012). Characteristics and mortality for the GCA-cohort compared to matched controls have been published previously [3]. Within the GCA-cohort we found that presenting with visual disturbance (any) or scalp necrosis was associated with increased risk of death in univariate analysis (Figure 1). However, in multivariate analysis the traditional risk factors (age, smoking, hypertension and previous cardiovascular disease) were more strongly associated with risk of death. Among laboratory parameters only Hemoglobin (Hb) levels were significantly associated with risk of death with increasing Hb-levels indicating decreased risk. Neither temporal artery biopsy result nor initial or maximal (before first tapering) Prednisolone dose were found to be associated with risk of death. Results from univariate and the final multivariate models are presented in Figure 1.Figure 1.Conclusion:In our large cohort of GCA-patients the risk of death was found to be predominantly predicted by age (HR 2.81) and traditional risk factors (smoking (HR 1.61), hypertension (HR 1.48) and previous cardiovascular disease (HR 1.26)). Visual disturbance (HR 1.40), visual loss in particular (HR 2.37), and scalp necrosis (HR 3.42) were found to be the clinical features most associated with risk of death. However, we note that our material lacked information about extra-cranial (large vessel) vasculitis, which may also carry increased risk of death.References:[1]De Smit E, Palmer AJ, Hewitt AW. Projected worldwide disease burden from giant cell arteritis by 2050. J Rheumatol 2015;42:119-25.[2]Brekke LK, Diamantopoulos AP, Fevang BTS, Assmus J, Esperø E, Gjesdal CG. Incidence of giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther. 2017;19(1):278.[3]Brekke LK, Fevang BTS, Diamantopoulos AP, Assmus J, Esperø E, Gjesdal CG. Survival and death causes of patients with giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther. 2019;21(1):154.Disclosure of Interests:Lene Kristin Brekke Grant/research support from: Unrestricted research grant from MSD, Bjørg Tilde Svanes Fevang Consultant of: Been part of advisory board for Lilly, Jörg Assmus: None declared

Following publication of the original article [1], the authors reported an error.

Background Giant cell arteritis (GCA) is the most common vasculitis in adults. The etiology is not fully understood, and environmental factors which may influence the incidence are poorly investigated. Objectives To determine the potential influence of rural or urban residence on the incidence of GCA during a 41 year period. Methods Hospital-based retrospective cohort study including patients diagnosed with GCA in Bergen Health Area during 1972–2012. Patients were identified through computerised hospital records using the International Classification of Diseases (ICD)-coding system. Clinical information was extracted by review of the patients’ medical journals. The patients’ residential address was obtained from the population register in Norway. Municipalities were classified as urban (code 1 and 2) or rural (code 3 thru 6) using the Statistics Norway 2017 classification of centrality. The background population data was obtained from Statistics Norway (www.ssb.no). Wilcoxon signed-rank test was used for statistical comparison. Results The inclusion process have been published previously.1 For the computing of incidence 743 patients were included. Among these there were 536 (72%) females (mean age 73.4 years, SD 8) and 207 (28%) males (mean age 72.6, SD 9). 493 patients (66%) had a positive temporal artery biopsy. 484 patients (65%) had a residential address in a municipality classified as urban and 259 (35%) in a rural municipality. The number of inhabitants (aged ≥50 years) in urban areas (i.e. city of Bergen) was 60 910 in 1972 and 81 972 in 2012. The corresponding number of inhabitants in rural areas was 30 320 and 51 401. The overall annual cumulative incidence of GCA was 16.7 (95% CI 15.5–18.0) per 100 000 persons≥50 years. The mean annual incidence for urban municipalities was 17.1 (95% CI 15.9–18.4) per 100 000≥50 years. The corresponding incidence for rural areas was 16.1 (95% CI 14.9–17.3), p=0.46. With regards to biopsy-proven GCA, the overall annual incidence was 11.2 (95% CI 10.2–12.3). In urban and rural areas, the incidence of biopsy-proven GCA was 11.7 (95% CI 10.6–12.7) and 10.4 (95% CI 9.4–11.4) respectively, p=0.10. There were large fluctuations in annual incidence in both urban and rural areas (figure 1). Conclusions Annual cumulative incidence of GCA was slightly higher in urban than in rural areas in our study, but the difference was not statistically significant. This is in contrast to a previous study, which found GCA more prevalent in urban than in rural populations.2 Further studies are required to determine whether there is a true difference in incidence of GCA in urban versus rural populations, and whether or not exposures to environmental factors may be involved in GCA pathogenesis. References [1] Brekke LK, et al. Incidence of giant cell arteritis in Western Norway 1972–2012: a retrospective cohort study. Arthritis Research & Therapy (2017) 19:278. doi:10.1186/s13075–017–1479–6 [2] Reinhold-Keller E, et al. Giant cell arteritis is more prevalent in urban than in rural populations: results of an epidemiological study of primary systemic vasculitides in Germany. Rheumatology (Oxford)2000;39(12):1396–402. Disclosure of Interest L. Brekke Grant/research support from: MSD, B.-T. Fevang Consultant for: Lilly, Novartis, AbbVie, G. Myklebust: None declared

Background A meta-analysis from 2014 reported a low but statistically significant increased malignancy risk among patients with giant cell arteritis (GCA), but individual epidemiological studies have shown conflicting results.1 Objectives To determine the risk of cancer in GCA patients during a 41 year period. Methods Hospital-based retrospective cohort study including patients diagnosed with GCA in Bergen Health Area during 1972–2012. Patients were identified through computerised hospital records using the International Classification of Diseases (ICD)-coding system. Clinical information was extracted from patients’ medical journals. We excluded patients if data were unavailable, if the reviewing rheumatologist found GCA to be an implausible diagnosis or if the American College of Rheumatology (ACR) 1990 classification criteria for GCA were not fulfilled. Each patient was matched for age, sex, and county of residence to 3 control subjects randomly selected from the Central Population Registry of Norway. Information on the occurrence of cancer was obtained from the Cancer Registry of Norway. The cumulative incidence of malignancy in cases and controls were estimated using Kaplan-Meier plots. Results The patient inclusion process and patient characteristics have been published previously.2 A total of 792 patients were included, 566 (71.5%) women (mean age 73.5 years, SD 8) and 226 (28.5%) men (mean age 72.1, SD 9). There were 2314 matched controls (excluding duplicate controls and control subjects which were also among the cases). The mean duration of follow-up for the GCA-patients was 7.2 years (SD 6.7). The mean duration of follow-up for the controls was 6.6 years (SD 6.1). The relative risk of malignancy during follow-up was higher for controls compared to cases during the majority of the observation period, but the overall difference was not statistically significant (p=0.060, figure 1). However, the subset of 528 patients (66.7%) with a positive temporal artery biopsy (TAB) had a statistically significant lower risk of malignancy compared to their matched controls (p=0.006). Conclusions We did not find a significant difference in the risk of malignancy in the overall GCA cohort compared to their matched controls. However, we found a statistically significant reduced risk of malignancy during follow-up for the subset of GCA-patients with a positive TAB. This is in contrast to the results of a meta-analysis which found an increased risk of malignancy in the subgroup with positive TAB. Further studies are required to determine whether this is a true difference, and what the potential causes may be. References [1] Ungprasert P, Sanguankeo A, Upala S, Knight EL. Risk of malignancy in patients with giant cell arteritis and polymyalgia rheumatica: a systematic review and meta-analysis. Semin Arthritis Rheum2014;44(3):366–70. [2] Brekke LK, Diamantopoulos AP, Fevang B-T, Aβmus J, Espero E, Gjesdal CG. Incidence of giant cell arteritis in Western Norway 1972–2012: a retrospective cohort study. Arthritis Research & Therapy2017;19:278. doi:10.1186/s13075-017-1479-6 Acknowledgements The study has used data from the Cancer Registry of Norway (CRN). The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by CRN is intended nor should be inferred. Disclosure of Interest L. Brekke Grant/research support from: MSD, A. Diamantopoulos: None declared, B.-T. Fevang Consultant for: Lilly, Novartis, AbbVie, J. Assmus: None declared, C. Gjesdal: None declared

Background Giant cell arteritis (GCA) is the most common systemic vasculitis in adults. Objectives To determine the causes of death in GCA patients during a 41 year period. Methods Hospital-based retrospective cohort study including patients diagnosed with GCA in Bergen Health Area during 1972–2012. Patients were identified through computerised hospital records using the International Classification of Diseases (ICD)-coding system. Clinical information was extracted from patients’ medical journals. We excluded patients if data were unavailable, if the reviewing rheumatologist found GCA to be an implausible diagnosis or if the American College of Rheumatology (ACR) 1990 classification criteria for GCA were not fulfilled. Information on cause of death was obtained from the Norwegian Cause of Death Registry (NCoDR). We grouped causes of death according to the European Shortlist for Causes of Death 2012-version (COD-SL-2012). Statistics Norway (www.ssb.no) provided background population data (all deaths during 1972–2012 in the Norwegian population ≥50 years of age). Statistical comparison was performed using mid-p values. Results The patient inclusion process and patient characteristics have been published previously.1 A total of 792 patients were included, 566 (71.5%) females (mean age 73.5 years, SD 8) and 226 (28.5%) males (mean age 72.1, SD 9). 432 patients (54.5%) died during the study period (1 January 1972 – 31 December 2012). NCoDR had data on the cause of death for 431 of these. During the study period (1972–2012) there were 1635979 registered deaths in the general Norwegian population aged ≥50 years. The most frequent underlying causes of death in the overall study population were diseases of the circulatory system (53.4%), cancer (11.6%) and diseases of the respiratory system (10.0%). The most frequent causes of death in the general population were also diseases of the circulatory system (46.0%), cancer (22.8%) and diseases of the respiratory system (10.0%). The distribution of causes of death differed significantly between GCA-patients and the general Norwegian population (mid-p-value Conclusions The most frequent causes of death in our cohort of GCA-patients were diseases of the circulatory system, cancer and diseases of the respiratory system (including influenza and pneumonia). These were also the most frequent causes of death in the general Norwegian population aged ≥50 years, but the distribution of death causes differed significantly between GCA-patients and the general population. However, this might reflect differences in the composition of the populations that we were not able to adjust for. We aim to analyse this further by comparing our GCA-cohort with randomly selected age-, sex- and geographically matched control subjects. Reference [1] Brekke LK, Diamantopoulos AP, Fevang B-T, Assmus J, Espero E, Gjesdal CG. Incidence of giant cell arteritis in Western Norway 1972–2012: a retrospective cohort study. Arthritis Research & Therapy2017;19:278. doi:10.1186/s13075-017-1479-6 Disclosure of Interest L. Brekke Grant/research support from: MSD, A. Diamantopoulos: None declared, B.-T. Fevang Consultant for: Lilly, Novartis, AbbVie, J. Assmus: None declared, C. Gjesdal: None declared

Background Giant cell arteritis (GCA) is the most common systemic vasculitis in persons older than 50 years. The highest incidence rates of the disease have been reported in Scandinavian countries. Our objective was to determine the epidemiology of GCA in an expected high-incidence region during a 41-year period. Methods This is a hospital-based, retrospective, cohort study. Patients diagnosed with GCA in Bergen health area during 1972–2012 were identified through computerized hospital records (n = 1341). Clinical information was extracted from patients’ medical journals, which were reviewed by a standardized method. We excluded patients if data were unavailable (n = 253), if the reviewing rheumatologist found GCA to be an implausible diagnosis (n = 207) or if the American College of Rheumatology (ACR) 1990 classification criteria for GCA were not fulfilled (n = 89). Descriptive methods were used to characterize the sample. Incidence was analyzed by graphical methods and Poisson regression. Results A total of 792 patients were included. The average annual cumulative incidence of GCA was 16.7 (95% CI 15.5-18.0) per 100,000 of the population ≥ 50 years old. The corresponding incidence for biopsy-verified GCA was 11.2 (95% CI 10.2–12.3). The annual cumulative incidence increased with time in the period 1972–1992 (relative risk (RR) 1.1, p

Giant cell arteritis (GCA) is the most common systemic vasculitis in adults. The pathogenesis and the etiology of the disease are not fully understood, and environmental factors, which may influence the incidence and prevalence, are poorly investigated. Only a few small studies have previously addressed the potential influence of rural or urban residence on the occurrence of GCA1,2,3. In 2017 we published the results of a 41-year study of 743 patients with GCA from Bergen Health Area (Norway), in which incidence estimates were stratified by sex, age, biopsy result, and erythrocyte sedimentation rate4. Bergen Health Area is a mixed urban and rural area. In this report we present incidence estimates stratified by centrality, which may clarify the influence of rural versus urban residence on the incidence of GCA. This study was approved by REK sor-ost B regional ethics committee (study reference 2012/643/REK sor-ost B), who granted permission to access records without obtaining consent from patients owing to the long duration of the study and late onset of the disease. We performed a hospital-based … Address correspondence to Dr. L.K. Brekke, HSR AS, PB 2175, 5504 Haugesund, Norway. E-mail: lene.kristin.brekke{at}hsr.as