Cough as a clinical manifestation of giant cell arteritis

OBJECTIVES: Cough is an underrecognized and atypical manifestation of giant cell arteritis (GCA), which may lead to diagnostic delay. Literature on cough in GCA is limited and lacks comprehensive data on clinical relevance. The aim of this study was to assess the frequency of cough at diagnosis in GCA patients and to compare clinical characteristics between those with and without cough. METHOD: Consecutive patients diagnosed with GCA between 2000 and 2020 and followed for ≥ 12 months at the University Hospitals Leuven (Belgium) were included retrospectively. RESULTS: We included 398 GCA patients, of whom 72 (18%) reported cough. Patients with cough were slightly younger (69.8 vs 72.3 years, p = 0.019), more frequently had constitutional symptoms (94% vs 73%, p < 0.001), and less often had polymyalgia rheumatica (26% vs 50%, p < 0.001) or permanent visual loss (3% vs 19%, p < 0.001). They had higher C-reactive protein (86 vs 68 mg/L, p = 0.003) and erythrocyte sedimentation rate (80 vs 67 mm/h, p = 0.036), and lower haemoglobin (11.3 vs 11.8 g/dL, p = 0.008) and albumin (36.7 vs 38.4 g/L, p = 0.013). Positron emission tomography total vascular score (10 vs 5, p = 0.009) was higher in GCA patients with cough. Although time to first relapse was shorter (10 vs 13 months, p = 0.018), relapse probability [hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.82-1.61, p = 0.420] and the probability of discontinuing glucocorticoids were similar (HR 1.10, 95% CI 0.80-1.50, p = 0.563). CONCLUSION: GCA patients with cough may represent a distinct phenotype associated with systemic inflammation and large-vessel involvement. Further prospective studies with standardized cough assessment are needed to clarify the role of cough in GCA.