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Harrington R, Al Nokhatha SA, Conway R. Biologic Therapies for Giant Cell Arteritis. Biologics 2021; 15:17-29. [PMID: 33442231 PMCID: PMC7797292 DOI: 10.2147/btt.s229662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/12/2020] [Indexed: 01/31/2023]
Abstract
Glucocorticoids have been the mainstay of treatment in giant cell arteritis (GCA) for the past 70 years. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) have largely failed to show significant clinical efficacy or reduction of the glucocorticoid burden in GCA. Tocilizumab is the first biologic to make a substantial impact in GCA treatment. With the current understanding of GCA pathogenesis implicating multiple cytokines, notably interleukin (IL) 6, IL-12, IL-23, IL-1β, and the role of janus kinases (JAKs) and the signal transducer and activator of transcription (STAT) pathway in these cytokines, many biologics are currently being investigated in GCA. This review article looks at the existing evidence for biologic agents in GCA. In addition to tocilizumab, the potential role of ustekinumab, abatacept, JAK inhibitors and other promising biologics in GCA are discussed in detail. A treatment algorithm based on the best evidence to date is also presented.
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Affiliation(s)
| | | | - Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
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102
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Gribbons KB, Ponte C, Carette S, Craven A, Cuthbertson D, Hoffman GS, Khalidi NA, Koening CL, Langford CA, Maksimowicz-McKinnon K, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Quinn KA, Robson JC, Seo P, Sreih AG, Suppiah R, Warrington KJ, Ytterberg SR, Luqmani R, Watts R, Merkel PA, Grayson PC. Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2020; 72:1615-1624. [PMID: 31444857 DOI: 10.1002/acr.24055] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). METHODS Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort. RESULTS A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage. CONCLUSION Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis.
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Affiliation(s)
- K Bates Gribbons
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
| | | | - Simon Carette
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | - Paul A Monach
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | | | - Christian Pagnoux
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin A Quinn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland, and Georgetown University, Washington, DC
| | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | - Ravi Suppiah
- Auckland District Health Board, Auckland, New Zealand
| | | | | | | | - Richard Watts
- Norwich Medical School, University of East Anglia, Norwich, and University of Oxford, Oxford, UK
| | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases/NIH, Bethesda, Maryland
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103
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Nascimento JDSG, Nascimento KGD, Oliveira JLGD, Alves MG, Silva ARD, Dalri MCB. Clinical simulation for nursing competence development in cardiopulmonary resuscitation: systematic review. Rev Lat Am Enfermagem 2020; 28:e3391. [PMID: 33174995 PMCID: PMC7647418 DOI: 10.1590/1518-8345.4094.3391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify the effectiveness of clinical simulation for competence development regarding cardiopulmonary resuscitation in comparison with different teaching and learning strategies used in the education of nursing students. METHOD systematic review, performed on the databases PubMed®/MEDLINE®, LILACS, Scopus, CINAHL and Web of Science. The Rayyan QCRI application was used to select the studies, in addition to the instruments for assessing the methodological quality of Joanna Briggs Institute and the Medical Education Research Study Quality Instrument. RESULTS a total of 887 studies were identified, and five we included in the final sample. The included studies had good methodological quality by the assessment instruments. All of them had statistically significant results to develop competence through clinical simulation, when compared to other methods. CONCLUSION clinical simulation proved to be effective for the development of clinical competence in cardiopulmonary resuscitation of nursing students.
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Affiliation(s)
- Juliana da Silva Garcia Nascimento
- Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Jordana Luiza Gouvêa de Oliveira
- Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Aline Roberta da Silva
- Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Maria Celia Barcellos Dalri
- Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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104
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Palmowski A, Buttgereit F. Reducing the Toxicity of Long-Term Glucocorticoid Treatment in Large Vessel Vasculitis. Curr Rheumatol Rep 2020; 22:85. [PMID: 33047263 PMCID: PMC7550368 DOI: 10.1007/s11926-020-00961-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/14/2022]
Abstract
Purpose While glucocorticoids (GCs) are effective in large vessel vasculitis (LVV), they may cause serious adverse events (AEs), especially if taken for longer durations and at higher doses. Unfortunately, patients suffering from LVV often need long-term treatment with GCs; therefore, toxicity needs to be expected and countered. Recent Findings GCs remain the mainstay of therapy for both giant cell arteritis and Takayasu arteritis. In order to minimize their toxicity, the following strategies should be considered: GC tapering, administration of conventional synthetic (e.g., methotrexate) or biologic (e.g., tocilizumab) GC-sparing agents, as well as monitoring, prophylaxis, and treatment of GC-related AEs. Several drugs are currently under investigation to expand the armamentarium for the treatment of LVV. Summary GC treatment in LVV is effective but associated with toxicity. Strategies to minimize this toxicity should be applied when treating patients suffering from LVV.
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Affiliation(s)
- Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany.
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105
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Schwartz DM, Burma AM, Kitakule MM, Luo Y, Mehta NN. T Cells in Autoimmunity-Associated Cardiovascular Diseases. Front Immunol 2020; 11:588776. [PMID: 33117403 PMCID: PMC7576936 DOI: 10.3389/fimmu.2020.588776] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
T cells are indisputably critical mediators of atherosclerotic cardiovascular disease (CVD), where they secrete pro-inflammatory cytokines that promote vascular pathology. Equally well-established is the fact that autoimmune diseases, which are mediated by autoreactive T cells, substantially increase the risk of developing CVD. Indeed, as immunomodulatory treatments have become more effective at treating end-organ pathology, CVD has become a leading cause of death in patients with autoimmune diseases. Despite this, investigators have only recently begun to probe the mechanisms by which autoreactive T cells promote CVD in the context of autoimmune diseases. T cells are best-studied in the pathogenesis of systemic vasculitides, where they react to self-antigen in the vessel wall. However, newer studies indicate that T cells also contribute to the increased CVD risk associated with lupus and rheumatoid arthritis. Given the central role of T-cell-derived cytokines in the pathogenesis of psoriasis, the role of these factors in psoriatic CVD is also under investigation. In the future, T cells are likely to represent major targets for the prevention and treatment of CVD in patients with autoimmune diseases.
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Affiliation(s)
- Daniella Muallem Schwartz
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Aarohan M Burma
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Moses M Kitakule
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Yiming Luo
- Rheumatology Fellowship Program, National Institute of Arthritis, Musculoskeletal, and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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106
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Rimland CA, Quinn KA, Rosenblum JS, Schwartz MN, Bates Gribbons K, Novakovich E, Sreih AG, Merkel PA, Ahlman MA, Grayson PC. Outcome Measures in Large Vessel Vasculitis: Relationship Between Patient-, Physician-, Imaging-, and Laboratory-Based Assessments. Arthritis Care Res (Hoboken) 2020; 72:1296-1304. [PMID: 31785185 DOI: 10.1002/acr.24117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/26/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the relationship between measures of disease assessment in patients with large vessel vasculitis. METHODS Patients with giant cell arteritis (GCA) or Takayasu arteritis (TAK) were recruited into a prospective, observational cohort. Assessments within the following outcomes were independently recorded: 1) patient-reported outcomes (Multidimensional Fatigue Inventory, patient global assessment of disease activity [PtGA], Short Form 36 health survey [SF-36], Brief Illness Perception Questionnaire), 2) physician global assessment of disease activity (PhGA), 3) laboratory outcomes (C-reactive protein [CRP] level, erythrocyte sedimentation rate [ESR]), and 4) imaging outcomes (PETVAS, a qualitative score of vascular 18 F-fluorodeoxyglucose-positron emission tomography activity). RESULTS Analyses were performed on 112 patients (GCA = 56, TAK = 56), over 296 visits, with a median follow-up of 6 months. Correlation network analysis revealed assessment measures clustered independently by type of outcome. PhGA was centrally linked to all other outcome types, but correlations were modest (ρ = 0.12-0.32; P < 0.05). PETVAS, CRP level, and PtGA were independently associated with clinically active disease. All 4 patient-reported outcomes strongly correlated with each other (ρ = 0.35-0.60; P < 0.0001). Patient-reported outcomes were not correlated with PETVAS, and only PtGA correlated with CRP level (ρ = 0.16; P < 0.01). Patients whose clinical assessment changed from active disease to remission (n = 29) had a corresponding significant decrease in ESR, CRP level, and PETVAS at the remission visit. Patients whose clinical assessment changed from remission to active disease (n = 11) had a corresponding significant increase in CRP level and PtGA at the active visit. CONCLUSION Measures of disease assessment in large vessel vasculitis consist of independent, yet complementary, outcomes, supporting the need to develop composite outcome measures or a standard set of measures covering multiple types of outcomes.
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Affiliation(s)
- Casey A Rimland
- NIH, Bethesda, Maryland, and University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Kaitlin A Quinn
- NIH, Bethesda, Maryland, and MedStar Georgetown University Hospital, Washington, District of Columbia
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Matza MA, Fernandes AD, Stone JH, Unizony SH. Reply. Arthritis Care Res (Hoboken) 2020; 73:1057-1058. [PMID: 32961035 DOI: 10.1002/acr.24454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Mark A Matza
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ana D Fernandes
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John H Stone
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sebastian H Unizony
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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108
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Schäfer VS, Jin L, Schmidt WA. Imaging for Diagnosis, Monitoring, and Outcome Prediction of Large Vessel Vasculitides. Curr Rheumatol Rep 2020; 22:76. [PMID: 32959107 PMCID: PMC7505874 DOI: 10.1007/s11926-020-00955-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose of Review To discuss and summarize the latest evidence on imaging techniques in giant cell arteritis (GCA) and Takayasu arteritis (TAK). This is a report on the performance of ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18-FDG-PET), and other emerging imaging techniques in diagnosis, outcome prediction, and monitoring of disease activity. Recent Findings Imaging techniques have gained an important role for diagnosis of large vessel vasculitides (LVV). As signs of vasculitis, US, MRI, and CT show a homogeneous arterial wall thickening, which is mostly concentric. PET displays increased FDG uptake in inflamed artery walls. US is recommended as the initial imaging modality in GCA. MRI and PET/CT may also detect vasculitis of temporal arteries. For TAK, MRI is recommended as the first imaging modality as it provides a good overview without radiation. Extracranial LVV can be confirmed by all four modalities. In addition, MRI and PET/CT provide consistent examination of the aorta and its branches. New techniques such as contrast-enhanced ultrasound, PET/MRI, and auxiliary methods such as “computer-assisted quantitative analysis” have emerged and need to be further validated. Summary Imaging has partly replaced histology for confirming LVV. Provided experience and adequate training, US, MRI, CT, or PET provide excellent diagnostic accuracy. Imaging results need to complement history and clinical examination. Ongoing studies are evaluating the role of imaging for monitoring and outcome measurement.
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Affiliation(s)
- Valentin Sebastian Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany.
| | - Lei Jin
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Germany
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109
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Oftedal BE, Wolff ASB. New era of therapy for endocrine autoimmune disorders. Scand J Immunol 2020; 92:e12961. [PMID: 32853446 DOI: 10.1111/sji.12961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
The new era of immune and reconstitution therapy of autoimmune disorders is ongoing. However, endocrine autoimmune diseases comprise a group of elaborating pathologies where the development of new treatment strategies remains slow. Substitution of the missing hormones is still standard practice, taking care of the devastating symptoms but not the cause of disease. As our knowledge of the genetic contribution to the aetiology of endocrine disorders increases and early diagnostic tools are available, it is now possible to identify persons at risk before they acquire full-blown disease. This review summarizes current knowledge and treatment of endocrine autoimmune disorders, focusing on type 1 diabetes, Addison's disease, autoimmune thyroid diseases and primary ovarian insufficiency. We explore which new therapies might be used in the different stages of the disease, focus on legalized therapy and elaborate on the ongoing clinical studies for these diseases and the research front, before hypothesizing on the way ahead.
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Affiliation(s)
- Bergithe E Oftedal
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Anette S B Wolff
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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110
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Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica. Nat Rev Rheumatol 2020; 16:481-495. [DOI: 10.1038/s41584-020-0458-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
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111
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Mears KA, Feinsilber D. High-Sensitivity C-Reactive Protein and Magnetic Resonance Imaging in Occult Giant Cell Arteritis. Cureus 2020; 12:e9530. [PMID: 32775116 PMCID: PMC7402541 DOI: 10.7759/cureus.9530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Giant cell arteritis (GCA) can be an elusive diagnosis and is particularly challenging to monitor during the course of treatment when traditional acute phase reactants are all normal, leaving no empirical means of monitoring. Our study aims to explore the use of more sensitive acute phase reactants and imaging in the initial evaluation and monitoring of GCA. We report the case of an 84-year-old in whom the traditional acute phase reactants were normal but who had perineuritis on imaging and whose high-sensitivity C-reactive protein (CRP) levels were elevated. In cases where the traditional measure of inflammatory activity is normal, it may be necessary to consider additional markers.
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Affiliation(s)
- Katrina A Mears
- Ophthalmology, Retina Consultants of Southwest Florida/National Ophthalmic Research Institute, Fort Myers, USA
| | - Doron Feinsilber
- Hematology/Oncology, Medical College of Wisconsin/Froedtert Cancer Center, Milwaukee, USA
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112
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Mackie SL, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-Chiappe S, Mahr A, Mukhtyar C, Reynolds G, de Souza AWS, Brouwer E, Bukhari M, Buttgereit F, Byrne D, Cid MC, Cimmino M, Direskeneli H, Gilbert K, Kermani TA, Khan A, Lanyon P, Luqmani R, Mallen C, Mason JC, Matteson EL, Merkel PA, Mollan S, Neill L, Sullivan EO, Sandovici M, Schmidt WA, Watts R, Whitlock M, Yacyshyn E, Ytterberg S, Dasgupta B. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis: executive summary. Rheumatology (Oxford) 2020; 59:487-494. [PMID: 31970410 DOI: 10.1093/rheumatology/kez664] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria.,South Tyrol Health Trust, Department of Rheumtaology, Hospital of Bruneck, Bruneck, Italy
| | - Simone Appenzeller
- Rheumatology Unit, Department of Medicine, University of Campinas, São Paulo, Brazil
| | - Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Local Health Trust 3 Genoa.,Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Alfred Mahr
- Internal Medicine, Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | | | - Alexandre Wagner S de Souza
- Rheumatology Division, Universidade Federal de Sao Paulo Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marwan Bukhari
- Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, Cumbria, UK
| | - Frank Buttgereit
- Department of Medicine (Rheumatology and Clinical Immunology), Charité University Medicine, Berlin, Germany
| | | | - Maria C Cid
- Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigacions, Biomèdiques, August Pi I, Sunyer (IDIBAPS), Catalunya, Barcelona, Spain
| | - Marco Cimmino
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy
| | - Haner Direskeneli
- Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | - Asad Khan
- Rheumatology, Solihull Hospital, University Hospitals Birmingham, Birmingham
| | - Peter Lanyon
- Academic Rheumatology, Nottingham University Hospitals, Nottingham
| | - Raashid Luqmani
- Nuffield Orthopaedic Centre - Rheumatology, University of Oxford, Oxford
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Staffordshire
| | | | - Eric L Matteson
- Division of Rheumatology and Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Peter A Merkel
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Eoin O' Sullivan
- Department of Ophthalmology, King's College Hospital, London, UK
| | - Maria Sandovici
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Hospital Berlin, Berlin, Germany
| | - Richard Watts
- Rheumatology, Ipswich Hospital, Ipswich, UK.,University of East Anglia, Ipswich
| | - Madeline Whitlock
- Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Ytterberg
- Department of Rheumatology, Mayo Clinic of Medicine and Science, Rochester, MN, USA
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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113
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Abstract
PURPOSE OF THE REVIEW Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatologic condition occurring in older adults. It is characterized by proximal pain and stiffness in the shoulders, neck, and/or pelvic girdle in individuals over 50 years of age along with evidence of an intense systemic inflammatory response. Although the above clinical symptoms are very characteristic for the condition, it can be mimicked by other autoimmune, infectious, malignant, and endocrine disorders chief among which are giant cell arteritis (GCA) and elderly-onset rheumatoid arthritis (EORA). Recently, PMR was reported in relation to treatment with immune checkpoint inhibitors. Current treatment of PMR consists of low-to-medium doses of glucocorticosteroids (GC) with variable response rates and disease recurrence estimated to occur in 50% of patients while tapering down GC doses. In addition, GC-based regimens cause much of the morbidity associated with PMR in older adults, requiring close monitoring for GC-induced toxicity during therapy and highlighting the need for novel therapeutic strategies. Here, we review the latest findings in the field regarding specific etiologic factors, genetic associations, diagnostic methods, and advancements in treatment strategies and disease monitoring indices. RECENT FINDINGS Recent discoveries involving novel therapeutic targets in GCA have accelerated the study of PMR pathophysiology and have advanced treatment strategies in PMR management leading to current trials in IL-6 blocking agents. PMR remains an enigmatic inflammatory condition affecting older adults, with current treatment approach causing much morbidity in this patient population. Advancements in our understanding of novel immunopathologic targets can serve as a solid foundation for future treatment strategies in the field.
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115
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Frentsch M, Japp AS, Dingeldey M, Matzmohr N, Thiel A, Scheiflinger F, Reipert BM, de la Rosa M. Blockade of the costimulatory CD28-B7 family signal axis enables repeated application of AAV8 gene vectors. J Thromb Haemost 2020; 18:1075-1080. [PMID: 32011092 PMCID: PMC7318590 DOI: 10.1111/jth.14757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/31/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
Abstract
Adeno-associated virus serotype 8 (AAV8) gene therapy has shown efficacy in several clinical trials and is considered a highly promising technology to treat monogenic diseases such as hemophilia A and B. However, a major drawback of AAV8 gene therapy is that it can be applied only once because anti-AAV8 immunity develops after the first treatment. Readministration may be required in patients who are expected to need redosing, eg, due to organ growth, or to boost suboptimal expression levels, but no redosing protocol has been established. We have developed a preventive immune-suppressive protocol for a human factor IX (FIX) vector with an intended dose of ~5 × 1011 vg/kg that inhibits the development of anti-AAV8 neutralizing-antibody (NAb) responses and anti-AAV8 T-cell responses using CTLA4-IgG (abatacept). In a preclinical model, transient treatment with abatacept during initial human FIX gene therapy efficiently inhibited the generation of AAV8-specific cellular and humoral responses, and thus permitted redosing of FIX. Furthermore, our data suggest that by suppression of anti-AAV8 NAb responses after the second higher dose (4 × 1012 vg/kg) this protocol can be used to enable redosing up to such high doses. An additional advantage of CTLA4-IgG blocking CD28-mediated signals is its potential suppression of AAV8-specific cytotoxic CD8 T-cell responses, which are believed to kill transduced hepatocytes and might interfere with a successful readministration. Redosing protocols using approved drugs would be beneficial for patients because they could effortlessly be applied in clinical trials and enable safe and efficient treatment options for patients undergoing AAV8 gene therapy.
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Affiliation(s)
- Marco Frentsch
- Berlin‐Brandenburg Center for Regenerative TherapiesCharité‐UniversitätsmedizinBerlinGermany
| | - Alberto Sada Japp
- Berlin‐Brandenburg Center for Regenerative TherapiesCharité‐UniversitätsmedizinBerlinGermany
| | - Manuela Dingeldey
- Berlin‐Brandenburg Center for Regenerative TherapiesCharité‐UniversitätsmedizinBerlinGermany
| | - Nadine Matzmohr
- Berlin‐Brandenburg Center for Regenerative TherapiesCharité‐UniversitätsmedizinBerlinGermany
| | - Andreas Thiel
- Berlin‐Brandenburg Center for Regenerative TherapiesCharité‐UniversitätsmedizinBerlinGermany
| | | | - Birgit M. Reipert
- Baxalta Innovations GmbHA Member of the Takeda Group of CompaniesViennaAustria
| | - Maurus de la Rosa
- Baxalta Innovations GmbHA Member of the Takeda Group of CompaniesViennaAustria
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Cid MC, Ríos-Garcés R, Terrades-García N, Espígol-Frigolé G. Treatment of giant-cell arteritis: from broad spectrum immunosuppressive agents to targeted therapies. Rheumatology (Oxford) 2020; 59:iii17-iii27. [DOI: 10.1093/rheumatology/kez645] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
For decades, the treatment of GCA has relied on glucocorticoids. Work over the past two decades has supported a modest efficacy of MTX but no clear benefit from anti-TNF-based therapies. More recently, the therapeutic armamentarium for GCA has expanded. The availability of agents targeting specific cytokines, cytokine receptors or signalling pathways, along with a better, although still limited, understanding of the immunopathology of GCA, are opening further therapeutic possibilities. Blocking IL-6 receptor with tocilizumab has been effective in maintaining remission and reducing glucocorticoid exposure and tocilizumab has been approved for the treatment of GCA. However, nearly half of the patients do not benefit from tocilizumab and additional options need to be investigated. This review focuses on standard therapeutic approaches and on targeted therapies that have been or are currently under investigation.
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Affiliation(s)
- Maria C Cid
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Roberto Ríos-Garcés
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Nekane Terrades-García
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona. Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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118
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Abstract
Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a small to medium vessel vasculitis associated with excess morbidity and mortality. This review explores how management of AAV has evolved over the past two decades with pivotal randomized controlled trials shaping the management of induction and maintenance of remission. Contemporary AAV care is characterized by approaches that minimize the cumulative exposure to cyclophosphamide and glucocorticoids, increasingly use rituximab for remission induction and maintenance, and consider therapies with less toxicity (for example, methotrexate, mycophenolate mofetil) for manifestations of AAV that do not threaten organ function or survival. Simultaneously, improvements in outcomes, such as renal and overall survival, have been observed. Additional trials and observational studies evaluating the comparative effectiveness of agents for AAV in various patient subgroups are needed. Prospective studies are necessary to assess the effect of psychosocial interventions on patient reported outcomes in AAV. Despite the expanding array of treatments for AAV, little guidance on how to personalize AAV care is available to physicians.
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Affiliation(s)
- Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eli M Miloslavsky
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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119
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Nielsen BD, Gormsen LC. 18F-Fluorodeoxyglucose PET/Computed Tomography in the Diagnosis and Monitoring of Giant Cell Arteritis. PET Clin 2020; 15:135-145. [PMID: 32145884 DOI: 10.1016/j.cpet.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
18F-Fluorodeoxyglucose (FDG) PET/computed tomography (CT) is a highly accurate diagnostic tool for large vessel vasculitis (LVV) and is one of the recommended imaging modalities for confirmation of the diagnosis. This article focuses on the role of FDG-PET/CT in LVV diagnosis and disease monitoring, mainly focusing on giant cell arteritis; in particular, the diagnostic accuracy, diagnostic criteria, the potential pitfalls in the interpretation of large vessel FDG uptake, and the clinical indication compared with other imaging modalities are discussed.
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Affiliation(s)
- Berit Dalsgaard Nielsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 59, Entrance E, Aarhus, Aarhus N 8200, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Entrance J, Aarhus 8200, Denmark; Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1A, 8600 Silkeborg, Denmark.
| | - Lars Christian Gormsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Entrance J, Aarhus 8200, Denmark
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Abstract
Patients with untreated active giant cell arteritis (GCA) are at high risk of permanent vision loss. Therefore, treatment with glucocorticoids should be immediately initiated at an initial dose of 40-60 mg prednisolone equivalent dose per day. Once remission is achieved, the prednisolone dose should be reduced to 15-20 mg within 2-3 months and then to ≤5 mg per day within 1 year. Glucocorticoid-sparing treatment with tocilizumab or alternatively methotrexate should be initiated in patients with an increased risk or pre-existing complications of glucocorticoid treatment and patients with relapse. In polymyalgia rheumatica, prednisolone dosages of 15-25 mg/day are sufficient. After achieving remission, the dose should then be reduced to 10 mg within 4-8 weeks and then to 1 mg per month thereafter. Glucocorticoid-sparing treatment with methotrexate should be initiated in patients with an increased risk or existing complications of glucocorticoid treatment, relapse or increased glucocorticoid requirements.
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121
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Aeschlimann FA, Twilt M, Yeung RSM. Childhood-onset Takayasu Arteritis. Eur J Rheumatol 2020; 7:S58-S66. [PMID: 35929861 PMCID: PMC7004266 DOI: 10.5152/eurjrheum.2019.19195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/04/2019] [Indexed: 09/02/2023] Open
Abstract
Childhood-onset Takayasu Arteritis (cTAK) is a rare, large-vessel type of vasculitis seen in children, mainly affecting the aorta and its major branches. Clinical manifestations are often severe and arise as a result of systemic and local inflammation, along with end-organ ischemia. Disease flares are common and the disease burden is high, with a significant rate of morbidity and mortality. Recent advances in understanding the underlying disease pathobiology resulted in the use of pathway-targeting agents, such as TNF- or IL-6 inhibitors with improved disease control. Nonetheless, the prognosis often remains guarded and the accrued damage is significant. This review aims at summarizing the recent evidence and observations regarding this condition, with a focus on pediatric publications.
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Affiliation(s)
- Florence A Aeschlimann
- Paediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker - Enfants Malades, Paris, France; Division of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Marinka Twilt
- Division of Rheumatology, Department of Paediatric, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Alberta, Canada; Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rae S M Yeung
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Immunology, University of Toronto, Toronto, Ontario, Canada
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122
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Mackie SL, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-Chiappe S, Mahr A, Mukhtyar C, Reynolds G, de Souza AWS, Brouwer E, Bukhari M, Buttgereit F, Byrne D, Cid MC, Cimmino M, Direskeneli H, Gilbert K, Kermani TA, Khan A, Lanyon P, Luqmani R, Mallen C, Mason JC, Matteson EL, Merkel PA, Mollan S, Neill L, Sullivan EO, Sandovici M, Schmidt WA, Watts R, Whitlock M, Yacyshyn E, Ytterberg S, Dasgupta B. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology (Oxford) 2020; 59:e1-e23. [DOI: 10.1093/rheumatology/kez672] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/02/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria
- South Tyrol Health Trust, Department of Rheumtaology, Hospital of Bruneck, Bruneck, Italy
| | - Simone Appenzeller
- Rheumatology Unit, Department of Medicine, University of Campinas, São Paulo, Brazil
| | - Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Local Health Trust 3 Genoa
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Alfred Mahr
- Internal Medicine, Hôpital Saint-Louis, University Paris Diderot, Paris, France
| | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich
| | | | - Alexandre Wagner S de Souza
- Rheumatology Division, Universidade Federal de Sao Paulo Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marwan Bukhari
- Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, Cumbria, UK
| | - Frank Buttgereit
- Department of Medicine (Rheumatology and Clinical Immunology), Charité University Medicine, Berlin, Germany
| | | | - Maria C Cid
- Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigacions, Biomèdiques, August Pi I, Sunyer (IDIBAPS), Catalunya, Barcelona, Spain
| | - Marco Cimmino
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy
| | - Haner Direskeneli
- Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | - Asad Khan
- Rheumatology, Solihull Hospital, University Hospitals Birmingham, Birmingham
| | - Peter Lanyon
- Academic Rheumatology, Nottingham University Hospitals, Nottingham
| | - Raashid Luqmani
- Nuffield Orthopaedic Centre – Rheumatology, University of Oxford, Oxford
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Staffordshire
| | | | - Eric L Matteson
- Division of Rheumatology and Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Peter A Merkel
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | | | - Eoin O’ Sullivan
- Department of Ophthalmology, King’s College Hospital, London, UK
| | - Maria Sandovici
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Hospital Berlin, Berlin, Germany
| | - Richard Watts
- Rheumatology, Ipswich Hospital, Ipswich, UK
- University of East Anglia, Ipswich
| | - Madeline Whitlock
- Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
| | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Ytterberg
- Department of Rheumatology, Mayo Clinic of Medicine and Science, Rochester, MN, USA
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
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123
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Becker M. [Polymyalgia rheumatica and Giant Cell Arteritis - Update on Diagnosis and Therapy]. PRAXIS 2020; 109:347-354. [PMID: 32233763 DOI: 10.1024/1661-8157/a003444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Polymyalgia rheumatica and Giant Cell Arteritis - Update on Diagnosis and Therapy Abstract. Polymyalgia rheumatica (PMR) is an inflammatory syndrome which often co-incides with giant cell arteritis (GCA). Due to unspecific symptoms and a plethora of possible alternative diagnoses, PMR often represents a diagnostic challenge. The use of ultrasound, but also other imaging methods has improved and accelerated the time to diagnosis in PMR and GCA, so that complications such as blindness can be reduced. Glucocorticoids are still the main initial therapy for both diseases. Although further research is needed concerning prevention of and screening for long term complications for GCA, the efficacy of biologicals, namely tocilizumab, has markedly increased therapeutic options for GCA and allows for a reduction of side effects.
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Affiliation(s)
- Mike Becker
- Klinik für Rheumatologie, Universitätsspital Zürich, Zürich
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124
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Matsumoto K, Suzuki K, Yoshimoto K, Seki N, Tsujimoto H, Chiba K, Takeuchi T. Significant association between clinical characteristics and changes in peripheral immuno-phenotype in large vessel vasculitis. Arthritis Res Ther 2019; 21:304. [PMID: 31888748 PMCID: PMC6937853 DOI: 10.1186/s13075-019-2068-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/25/2019] [Indexed: 02/01/2023] Open
Abstract
Background Large vessel vasculitis (LVV) is a type of vasculitis characterized by granulomatous inflammation of medium- and large-sized arteries. Clinical assessment of acute phase reactants has been conventionally used to diagnose and monitor diseases; however, accurate assessment of vascular disease activity status can be difficult. In this study, we investigated comprehensive immuno-phenotyping to explore useful biomarkers associated with clinical characteristics. Methods Consecutive patients with newly diagnosed LVV who visited our institution between May 2016 and May 2019 were enrolled. The number of circulating T cells, B cells, natural killer cells, dendritic cells, monocytes, and granulocytes was examined and chronologically followed. Baseline and time-course changes in immuno-phenotyping associated with disease activity were assessed. Results Comprehensive immuno-phenotyping data from 90 samples from each of 20 patients with LVV were compared with those from healthy controls (HCs). The number of helper T (Th), follicular helper T (Tfh), CD8+ T, CD14++ CD16+ monocytes, and neutrophils were higher in patients with giant cell arteritis (GCA) and/or Takayasu arteritis (TAK) than in HCs. Among them, the number of CD8+ T and CD8+ Tem were higher in patients with TAK than in GCA. Notably, memory CD4+ and CD8+ T cells in patients with TAK remained high even in the remission phase. Further analysis revealed that the number of Th1, Th17, and Tfh cells was associated with disease relapse in GCA and TAK and that the number of CD8+ T cells was associated with relapse in TAK. Th1, Th17, and Tfh cells decreased after treatment with biologic agents, while CD8+ T cells did not. Conclusions Our results from peripheral immuno-phenotyping analysis indicate that the numbers of Th and Tfh cells changed along with the disease condition in both GCA and TAK, while that of CD8+ T cells did not, especially in TAK. Treatment with biologic agents decreased the proportion of Th and Tfh cells, but not CD8+ T cells, in the patients. Chronological immuno-phenotyping data explained the difference in therapeutic response, such as reactivities against biologics, between GCA and TAK.
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Affiliation(s)
- Kotaro Matsumoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Keiko Yoshimoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Noriyasu Seki
- Mitsubishi Tanabe Pharma Corporation, 1000, Kamoshida-cho, Aoba-ku, Yokohama, Kanagawa, Japan
| | - Hideto Tsujimoto
- Mitsubishi Tanabe Pharma Corporation, 1000, Kamoshida-cho, Aoba-ku, Yokohama, Kanagawa, Japan
| | - Kenji Chiba
- Mitsubishi Tanabe Pharma Corporation, 1000, Kamoshida-cho, Aoba-ku, Yokohama, Kanagawa, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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Ciofalo A, Gulotta G, Iannella G, Pasquariello B, Manno A, Angeletti D, Pace A, Greco A, Altissimi G, de Vincentiis M, Magliulo G. Giant Cell Arteritis (GCA): Pathogenesis, Clinical Aspects and Treatment Approaches. Curr Rheumatol Rev 2019; 15:259-268. [DOI: 10.2174/1573397115666190227194014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/30/2019] [Accepted: 02/13/2019] [Indexed: 11/22/2022]
Abstract
:
Giant Cell Arteritis (GCA), or Horton’s Arteritis, is a chronic form of vasculitis of the
large and medium vessels, especially involving the extracranial branches of the carotid arteries, in
particular, the temporal artery, with the involvement of the axillary, femoral and iliac arteries too.
Arterial wall inflammation leads to luminal occlusion and tissue ischemia, which is responsible for
the clinical manifestations of the disease.
:
A substantial number of patients affected by GCA present head and neck symptoms, including ocular,
neurological and otorhinolaryngological manifestations.
:
The aim of this article is to present pathogenesis, clinical aspects and treatment approaches of GCA
manifestations.
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Affiliation(s)
- Andrea Ciofalo
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Giampiero Gulotta
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Giannicola Iannella
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Benedetta Pasquariello
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Alessandra Manno
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Diletta Angeletti
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Annalisa Pace
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Antonio Greco
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Giancarlo Altissimi
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Marco de Vincentiis
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
| | - Giuseppe Magliulo
- Otorhinolaryngology Department, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico, 151 - 00161, Rome, Italy
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126
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A new era for giant cell arteritis. Eye (Lond) 2019; 34:1013-1026. [PMID: 31582795 DOI: 10.1038/s41433-019-0608-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022] Open
Abstract
The landscape of the investigation and management of giant cell arteritis (GCA) is advancing. In this review we will outline the recent advances by searching the current English literature for relevant articles using key words of giant cell arteritis, temporal arteritis, Horton's disease, investigation, and treatment. Delay in diagnosis, diagnostic uncertainty and glucocorticoid (GC) morbidity are among the highest concerns of clinicians and patients in this disease area. The positive news is that fast track pathways, imaging techniques and new therapies are emerging for routine management of GCA. Future directions for intervention in the treatment paradigm will be discussed.
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127
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Monti S, Águeda AF, Luqmani RA, Buttgereit F, Cid M, Dejaco C, Mahr A, Ponte C, Salvarani C, Schmidt W, Hellmich B. Systematic literature review informing the 2018 update of the EULAR recommendation for the management of large vessel vasculitis: focus on giant cell arteritis. RMD Open 2019; 5:e001003. [PMID: 31673411 PMCID: PMC6803016 DOI: 10.1136/rmdopen-2019-001003] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/10/2019] [Accepted: 08/17/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives To analyse the current evidence for the management of large vessel vasculitis (LVV) to inform the 2018 update of the EULAR recommendations. Methods Two systematic literature reviews (SLRs) dealing with diagnosis/monitoring and treatment strategies for LVV, respectively, were performed. Medline, Embase and Cochrane databases were searched from inception to 31 December 2017. Evidence on imaging was excluded as recently published in dedicated EULAR recommendations. This paper focuses on the data relevant to giant cell arteritis (GCA). Results We identified 287 eligible articles (122 studies focused on diagnosis/monitoring, 165 on treatment). The implementation of a fast-track approach to diagnosis significantly lowers the risk of permanent visual loss compared with historical cohorts (level of evidence, LoE 2b). Reliable diagnostic or prognostic biomarkers for GCA are still not available (LoE 3b).The SLR confirms the efficacy of prompt initiation of glucocorticoids (GC). There is no high-quality evidence on the most appropriate starting dose, route of administration, tapering and duration of GC (LoE 4). Patients with GCA are at increased risk of dose-dependent GC-related adverse events (LoE 3b). The addition of methotrexate or tocilizumab reduces relapse rates and GC requirements (LoE 1b). There is no consistent evidence that initiating antiplatelet agents at diagnosis would prevent future ischaemic events (LoE 2a). There is little evidence to guide monitoring of patients with GCA. Conclusions Results from two SLRs identified novel evidence on the management of GCA to guide the 2018 update of the EULAR recommendations on the management of LVV.
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Affiliation(s)
- Sara Monti
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Ana F Águeda
- Rheumatology, Baixo Vouga Hospital Centre Agueda Unit, Agueda, Portugal
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Frank Buttgereit
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Maria Cid
- Vasculitis Research Unit, Hospital Clinic; Institute d'Investiacions Biomèdiques August pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Christian Dejaco
- Rheumatology; South Tyrol Health Trust, Gesundheitsbezirk Bruneck, Brunico, Italy.,Rheumatology, University of Graz, Graz, Austria
| | - Alfred Mahr
- Internal Medicine, Université Paris Diderot Institut Saint Louis, Paris, France
| | - Cristina Ponte
- Rheumatology, Hospital de Santa Marta, Lisboa, Portugal.,Rheumatology Research Unit, University of Lisbon Institute of Molecular Medicine, Lisboa, Portugal
| | - Carlo Salvarani
- Rheumatology, Azienda USL-IRCCS di Reggio Emilia, University of Modena and Reggio Emilia, Modena, Italy
| | - Wolfgang Schmidt
- Klinik für Innere Medizin, Rheumatologie und Klinische Immunologie Berlin-Buch, Immanuel Krankenhaus Berlin Standort Berlin-Wannsee, Berlin, Germany
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitis-Zentrum Süd, Medius Kliniken, Universitatsklinikum Tubingen, Tubingen, Germany
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128
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Enfrein A, Espitia O, Bonnard G, Agard C. Aortite de l’artérite à cellules géantes : diagnostic, pronostic et traitement. Presse Med 2019; 48:956-967. [DOI: 10.1016/j.lpm.2019.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/10/2019] [Accepted: 04/15/2019] [Indexed: 01/16/2023] Open
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129
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Different patterns and specific outcomes of large-vessel involvements in giant cell arteritis. J Autoimmun 2019; 103:102283. [DOI: 10.1016/j.jaut.2019.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 02/08/2023]
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130
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Management of difficult polymyalgia rheumatica and giant cell arteritis: Updates for clinical practice. Best Pract Res Clin Rheumatol 2019; 32:803-812. [PMID: 31427056 DOI: 10.1016/j.berh.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) represent a family of systemic inflammatory diseases occurring in adults aged 50 years and above. Clinical presentation of PMR/GCA can be variable, making diagnosis at times challenging. There has been an increased appreciation of the role of various large-vessel imaging modalities to help confirm a diagnosis of GCA. Systemic corticosteroids (CS) remain the mainstay of treatment for both PMR and GCA, yet both relapses and CS-related side effects are common. Recent research has demonstrated efficacy of certain biologic agents in these diseases, with particular emphasis on the role of interleukin-6 (IL-6) blockade in GCA. This chapter discusses the latest updates on the diagnosis and treatment of PMR/GCA, with an emphasis on clinical care.
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Acosta-Herrera M, González-Gay MA, Martín J, Márquez A. Leveraging Genetic Findings for Precision Medicine in Vasculitis. Front Immunol 2019; 10:1796. [PMID: 31428096 PMCID: PMC6687877 DOI: 10.3389/fimmu.2019.01796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
Vasculitides are a heterogeneous group of low frequent disorders, mainly characterized by the inflammation of blood vessels that narrows or occlude the lumen and limits the blood flow, leading eventually to significant tissue and organ damage. These disorders are classified depending on the size of the affected blood vessels in large, medium, and small vessel vasculitis. Currently, it is known that these syndromes show a complex etiology in which both environmental and genetic factors play a major role in their development. So far, these conditions are not curable and the therapeutic approaches are mainly symptomatic. Moreover, a percentage of the patients do not adequately respond to standard treatments. Over the last years, numerous genetic studies have been carried out to identify susceptibility loci and biological pathways involved in vasculitis pathogenesis as well as potential genetic predictors of treatment response. The ultimate goal of these studies is to identify new therapeutic targets and to improve the use of existing drugs to achieve more effective treatments. This review will focus on the main advances made in the field of genetics and pharmacogenetics of vasculitis and their potential application for ameliorating long-term outcomes in patient management and in the development of precision medicine.
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Affiliation(s)
| | - Miguel A González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina "López-Neyra," CSIC, Granada, Spain
| | - Ana Márquez
- Instituto de Parasitología y Biomedicina "López-Neyra," CSIC, Granada, Spain.,Systemic Autoimmune Disease Unit, Hospital Clínico San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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132
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Uppal S, Hadi M, Chhaya S. Updates in the Diagnosis and Management of Giant Cell Arteritis. Curr Neurol Neurosci Rep 2019; 19:68. [DOI: 10.1007/s11910-019-0982-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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133
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Shanklin A, Cox A, Ahmed HMA, Lieberman A, Busza A. Clinical Reasoning: A 77-year-old man presenting with episodic expressive aphasia. Neurology 2019; 90:e1822-e1826. [PMID: 29760004 DOI: 10.1212/wnl.0000000000005525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alice Shanklin
- From the University of Rochester School of Medicine and Dentistry (A.S., A.C.); Department of Medicine (H.M.A.A.), Rochester Regional Health; and Department of Medicine, Division of Allergy, Immunology, and Rheumatology (A.L.), and Department of Neurology (A.B.), University of Rochester Medical Center, NY
| | - Andrew Cox
- From the University of Rochester School of Medicine and Dentistry (A.S., A.C.); Department of Medicine (H.M.A.A.), Rochester Regional Health; and Department of Medicine, Division of Allergy, Immunology, and Rheumatology (A.L.), and Department of Neurology (A.B.), University of Rochester Medical Center, NY
| | - Hamdy M A Ahmed
- From the University of Rochester School of Medicine and Dentistry (A.S., A.C.); Department of Medicine (H.M.A.A.), Rochester Regional Health; and Department of Medicine, Division of Allergy, Immunology, and Rheumatology (A.L.), and Department of Neurology (A.B.), University of Rochester Medical Center, NY
| | - Alicia Lieberman
- From the University of Rochester School of Medicine and Dentistry (A.S., A.C.); Department of Medicine (H.M.A.A.), Rochester Regional Health; and Department of Medicine, Division of Allergy, Immunology, and Rheumatology (A.L.), and Department of Neurology (A.B.), University of Rochester Medical Center, NY
| | - Ania Busza
- From the University of Rochester School of Medicine and Dentistry (A.S., A.C.); Department of Medicine (H.M.A.A.), Rochester Regional Health; and Department of Medicine, Division of Allergy, Immunology, and Rheumatology (A.L.), and Department of Neurology (A.B.), University of Rochester Medical Center, NY.
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Sagdeo A, Askari A, Dixey J, Morrissey H, Ball PA. Steroid-Sparing Agents in Giant Cell Arteritis. Open Rheumatol J 2019. [DOI: 10.2174/1874312901913010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Giant cell arteritis is the commonest form of medium-to-large vessel vasculitis, requiring long-term corticosteroid therapy. The short- and long-term side effects of corticosteroids are many, including weight gain, psychological effects, osteoporosis, cardiometabolic complications, and infections.
Materials and Methods:
Various agents used in place of or in combination with corticosteroids to reduce corticosteroid-related side effects were reviewed. However, considerable variation in practice was identified giving unclear guidance. This review included the most recent evidence on methotrexate, mycophenolate mofetil, azathioprine, cyclophosphamide, abatacept, and tocilizumab
Results and Discussion:
Also discussed are encouraging results with tocilizumab in GCA patients. Amongst the agents available for steroid-sparing effects, tocilizumab demonstrated the most robust data and is consequently recommended as the agent of choice for steroid-sparing, for remission induction, remission maintenance, and treating relapsing and refractory cases of GCA.
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136
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Imaging acquisition technique influences interpretation of positron emission tomography vascular activity in large-vessel vasculitis. Semin Arthritis Rheum 2019; 50:71-76. [PMID: 31375256 DOI: 10.1016/j.semarthrit.2019.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the impact of imaging acquisition time on interpretation of disease activity on 18F-fluorodeoxyglucose positron emission tomography (PET) in large-vessel vasculitis (LVV) and assess the relationship between clinical features and image acquisition time. METHODS Patients with giant cell arteritis (GCA) and Takayasu's arteritis (TAK) were recruited into a prospective, observational cohort. After a single injection of FDG, all patients underwent two sequential PET scans at one and two-hour time points. Images were interpreted for active vasculitis by subjective assessment, qualitative assessment, and semi-quantitative assessment. Agreement was assessed by percent agreement, Cohen's kappa, and McNemar's test. Multivariable logistic regression identified associations between PET activity and clinical variables. RESULTS 79 patients (GCA = 44, TAK = 35) contributed 168 paired one and two-hour PET studies. A total of 94 out of 168 scans (56%) were interpreted as active at the one-hour time point, and 129 scans (77%) were interpreted as active at the two-hour time point (p < 0.01). Associations between clinical variables and PET activity categories (dual inactive, delayed active, dual active) were evaluated. Using multivariable nominal regression, clinically active disease was significantly more common in patients in the delayed active group (Odds Ratio 1.94, 95%CI 1.13-3.53; p = 0.02) and the dual active group (Odds Ratio 1.71, 95%CI 1.06-2.93; p = 0.04) compared to the dual inactive group. CONCLUSIONS Imaging protocol significantly influences interpretation of PET activity in LVV. A substantial proportion of patients with LVV have PET activity only detected by delayed imaging. These patients were significantly more likely to have concomitant clinically-determined active disease.
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137
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Abstract
Glucocorticoids (GC) remain the gold standard of the treatment of giant cell arteritis provided objectives of GC-tapering are accurately followed: 15 to 20mg/day at 3 months, 10mg/day at 6 months, 5mg/day at 9-12 months and withdrawal between 12 and 18 months. In case of corticodependance at ≥7.5 mg/day of prednisone or intolerance to GC, a GCsparing therapy has to be introduced, mainly methotrexate or tocilizumab. Individual characteristics of each patient, data about the efficacy of the treatment, its cost and how easy the follow-up under this treatment is are important factors to consider for choosing the right GC-sparing therapy. For all these reasons, except particular situations, we prefer using methotrexate before tocilizumab. Prevention of cardiovascular events is an important aspect of the treatment of GCA. We recommend using aspirin (75-100mg/day) during the first month of treatment or longer in case of occurrence of an ischemic complication. Each patient treated for GCA should receive a prevention of osteoporosis with respect of usual recommendations.
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Hellmich B, Agueda A, Monti S, Buttgereit F, de Boysson H, Brouwer E, Cassie R, Cid MC, Dasgupta B, Dejaco C, Hatemi G, Hollinger N, Mahr A, Mollan SP, Mukhtyar C, Ponte C, Salvarani C, Sivakumar R, Tian X, Tomasson G, Turesson C, Schmidt W, Villiger PM, Watts R, Young C, Luqmani RA. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2019; 79:19-30. [PMID: 31270110 DOI: 10.1136/annrheumdis-2019-215672] [Citation(s) in RCA: 554] [Impact Index Per Article: 110.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Since the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations. METHODS Using EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations. RESULTS Three overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40-60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons. CONCLUSIONS We have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.
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Affiliation(s)
- Bernhard Hellmich
- Department of Internal Medicine, Rheumatology and Immunology, Medius Kliniken, University of Tübingen, Kirchheim-Teck, Germany
| | - Ana Agueda
- Rheumatology Department, Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, Portugal
| | - Sara Monti
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Frank Buttgereit
- Department of Rheumatology and Immunology, University Hospital Charité, Berlin, Germany
| | - Hubert de Boysson
- Internal Medicine, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, UMCG, Groningen, The Netherlands
| | | | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria.,Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Nicole Hollinger
- Department of Internal Medicine, Rheumatology and Immunology, Medus Klinken, Karl-Albrechts-Universität Tübingen, Kirchheim-Teck, Germany
| | - Alfred Mahr
- Hospital Saint-Louis, University Paris Diderot, Paris, France
| | - Susan P Mollan
- Ophthalmology, University Hospitals Birmingham, Birmingham, UK.,Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Chetan Mukhtyar
- Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Cristina Ponte
- Rheumatology, Hospital de Santa Maria - CHLN, Lisbon Academic Medical Centre, Lisbon, Portugal.,Rheumatology Research Unit; Instituto de Medicina Molecular, Instituto de Medicina Molecular, Lisboa, Portugal
| | | | - Rajappa Sivakumar
- Stroke and Neurocritical Care, GLB Hospitals and Acute Stroke Centers, Chennai, India
| | - Xinping Tian
- Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | | | - Carl Turesson
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Wolfgang Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Peter M Villiger
- Rheumatology and Clinical Immunology / Allerg, University Hospital (Inselspital), Bern, Switzerland
| | - Richard Watts
- Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, UK
| | | | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
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139
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Treatment of polymyalgia rheumatica. Biochem Pharmacol 2019; 165:221-229. [DOI: 10.1016/j.bcp.2019.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/18/2019] [Indexed: 12/13/2022]
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140
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González-Gay MÁ, Pina T, Prieto-Peña D, Calderon-Goercke M, Gualillo O, Castañeda S. Treatment of giant cell arteritis. Biochem Pharmacol 2019; 165:230-239. [DOI: 10.1016/j.bcp.2019.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
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141
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Matsumoto K, Kaneko Y, Takeuchi T. Body mass index associates with disease relapse in patients with giant cell arteritis. Int J Rheum Dis 2019; 22:1782-1786. [PMID: 31245915 DOI: 10.1111/1756-185x.13642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify risk factors associated with disease relapse in giant cell arteritis (GCA). METHODS We reviewed data from 30 consecutive, newly diagnosed patients with GCA. The patients were divided according to relapse or non-relapse status, and their baseline characteristics were compared. RESULTS Among the 30 patients, 8 relapsed at a median of 28 weeks from GCA diagnosis. Patients with relapse were male-dominant (male: 88% vs female: 41%, P = 0.02) and showed a higher body mass index (BMI, 23 kg/m2 vs 19 kg/m2 , P < 0.01) than non-relapse patients. Patients with BMI ≥ 21 kg/m2 showed a significantly higher relapse rate than those with BMI < 21 kg/m2 during the 100-week follow-up (46% vs 0%, log-rank test, P < 0.01). CONCLUSION Higher BMI may be associated with relapse in patients with GCA.
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Affiliation(s)
- Kotaro Matsumoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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142
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Mahr A, Belhassen M, Paccalin M, Devauchelle-Pensec V, Nolin M, Gandon S, Idier I, Hachulla E. Characteristics and management of giant cell arteritis in France: a study based on national health insurance claims data. Rheumatology (Oxford) 2019; 59:120-128. [DOI: 10.1093/rheumatology/kez251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objective
Few data are available on the epidemiology and management of GCA in real life. We aimed to address this situation by using health insurance claims data for France.
Methods
This retrospective study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1% representative sample of the French national health insurance system. The EGB contains anonymous data on long-term disease status, hospitalizations and reimbursement claims for 752 717 people. Data were collected between 2007 and 2015. The index date was defined as the date of the first occurrence of a GCA code. Demographics, comorbidities, diagnostic tests and therapies were analysed. Annual incidence rates were calculated, and incident and overall GCA cases were studied.
Results
We identified 241 patients with GCA. The annual incidence was 7–10/100 000 people ⩾50 years old. Among the 117 patients with incident GCA, 74.4% were females, with mean age 77.6 years and mean follow-up 2.2 years. After the index date, 51.3% underwent temporal artery biopsy and 29.1% high-resolution Doppler ultrasonography. Among the whole cohort, 84.3% used only glucocorticoids. The most-prescribed glucocorticoid-sparing agent was methotrexate (12.0%).
Conclusion
The incidence of GCA in France is 7–10/100 000 people ⩾ 50 years old. Adjunct agents, mainly methotrexate, are given to only a few patients. The use of temporal artery biopsy in only half of the patients might reflect a shift toward the use of imaging techniques to diagnose GCA.
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Affiliation(s)
- Alfred Mahr
- Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France
| | | | - Marc Paccalin
- Internal Medicine, University Hospital Poitiers, Poitiers, France
| | | | - Maeva Nolin
- Pelyon EA 7425, University Hospital Lyon, Lyon, France
| | - Sophie Gandon
- Clinical Operations France, Roche S.A.S., Boulogne-Billancourt, France
| | - Isabelle Idier
- Rheumatology Medical, Chugai Pharma France, Paris La Défense, France
| | - Eric Hachulla
- Internal Medicine and Clinical Immunology, CHU Lille, University Lille, LIRIC, INSERM, Lille, France
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143
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Farrah TE, Basu N, Dweck M, Calcagno C, Fayad ZA, Dhaun N. Advances in Therapies and Imaging for Systemic Vasculitis. Arterioscler Thromb Vasc Biol 2019; 39:1520-1541. [PMID: 31189432 DOI: 10.1161/atvbaha.118.310957] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Vasculitis is a systemic disease characterized by immune-mediated injury of blood vessels. Current treatments for vasculitis, such as glucocorticoids and alkylating agents, are associated with significant side effects. Furthermore, the management of both small and large vessel vasculitis is challenging because of a lack of robust markers of disease activity. Recent research has advanced our understanding of the pathogenesis of both small and large vessel vasculitis, and this has led to the development of novel biologic therapies capable of targeting key cytokine and cellular effectors of the inflammatory cascade. In parallel, a diverse range of imaging modalities with the potential to monitor vessel inflammation are emerging. Continued expansion of combined structural and molecular imaging using positron emission tomography with computed tomography or magnetic resonance imaging may soon provide reliable longitudinal tracking of vascular inflammation. In addition, the emergence of radiotracers able to assess macrophage activation and immune checkpoint activity represents an exciting new frontier in imaging vascular inflammation. In the near future, these advances will allow more precise imaging of disease activity enabling clinicians to offer more targeted and individualized patient management.
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Affiliation(s)
- Tariq E Farrah
- From the University/British Heart Foundation Centre of Research Excellence, Centre of Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Scotland (T.E.F., M.D., N.D.)
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Scotland (N.B.)
| | - Marc Dweck
- From the University/British Heart Foundation Centre of Research Excellence, Centre of Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Scotland (T.E.F., M.D., N.D.)
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., Z.A.F.)
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (C.C., Z.A.F.)
| | - Neeraj Dhaun
- From the University/British Heart Foundation Centre of Research Excellence, Centre of Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Scotland (T.E.F., M.D., N.D.)
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Al-Mousawi AZ, Gurney SP, Lorenzi AR, Pohl U, Dayan M, Mollan SP. Reviewing the Pathophysiology Behind the Advances in the Management of Giant Cell Arteritis. Ophthalmol Ther 2019; 8:177-193. [PMID: 30820767 PMCID: PMC6513947 DOI: 10.1007/s40123-019-0171-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
Improving understanding of the underlying pathophysiology of giant cell arteritis (GCA) is transforming clinical management by identifying novel avenues for targeted therapies. One key area of concern for both clinicians and patients with GCA is glucocorticoid (GC) morbidity. The first randomised controlled trials of targeted treatment to reduce cumulative GC use in GCA have been published, with tocilizumab, an interleukin (IL)-6 receptor inhibitor, now the first ever licensed treatment for GCA. Further potential therapies are emerging owing to our enhanced understanding of the pathophysiology of the disease. Other improvements in the care of our patients are rapid access pathways and imaging techniques, such as ultrasound, which are becoming part of modern rheumatology practice in the UK, Europe and beyond. These have been highlighted in the literature to reduce delay in diagnosis and improve long-term outcomes for those investigated for GCA.
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Affiliation(s)
- Alia Z Al-Mousawi
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
| | - Sam P Gurney
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
| | - Alice R Lorenzi
- The Department of Rheumatology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Ute Pohl
- Department of Cellular Pathology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2GW, UK
| | - Margaret Dayan
- Ophthalmology Department, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK.
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145
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Libby P, Lichtman AI. Modulating Adaptive Immunity in Vascular Disease: CD4 to the Fore. J Am Coll Cardiol 2019; 73:1824-1826. [PMID: 30975300 DOI: 10.1016/j.jacc.2019.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Vascular Research Division, Department of Pathology and the Center of Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Andrew I Lichtman
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Vascular Research Division, Department of Pathology and the Center of Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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146
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Zhang H, Watanabe R, Berry GJ, Nadler SG, Goronzy JJ, Weyand CM. CD28 Signaling Controls Metabolic Fitness of Pathogenic T Cells in Medium and Large Vessel Vasculitis. J Am Coll Cardiol 2019; 73:1811-1823. [PMID: 30975299 PMCID: PMC6709860 DOI: 10.1016/j.jacc.2019.01.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/06/2018] [Accepted: 01/07/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In giant cell arteritis, vessel-wall infiltrating CD4 T cells and macrophages form tissue-destructive granulomatous infiltrates, and the artery responds with a maladaptive response to injury, leading to intramural neoangiogenesis, intimal hyperplasia, and luminal occlusion. Lesion-residing T cells receive local signals, which represent potential therapeutic targets. OBJECTIVES The authors examined how CD28 signaling affects vasculitis induction and maintenance, and which pathogenic processes rely on CD28-mediated T-cell activation. METHODS Vasculitis was induced by transferring peripheral blood mononuclear cells from giant cell arteritis patients into immunodeficient NSG mice engrafted with human arteries. Human artery-NSG chimeras were treated with anti-CD28 domain antibody or control antibody. Treatment effects and immunosuppressive mechanisms were examined in vivo and in vitro applying tissue transcriptome analysis, immunohistochemistry, flow cytometry, and immunometabolic analysis. RESULTS Blocking CD28-dependent signaling markedly reduced tissue-infiltrating T cells and effectively suppressed vasculitis. Mechanistic studies implicated CD28 in activating AKT signaling, T-cell proliferation and differentiation of IFN-γ and IL-21-producing effector T cells. Blocking CD28 was immunosuppressive by disrupting T-cell metabolic fitness; specifically, the ability to utilize glucose. Expression of the glucose transporter Glut1 and of glycolytic enzymes as well as mitochondrial oxygen consumption were all highly sensitive to CD28 blockade. Also, induction and maintenance of CD4+CD103+ tissue-resident memory T cells, needed to replenish the vasculitic infiltrates, depended on CD28 signaling. CD28 blockade effectively suppressed vasculitis-associated remodeling of the vessel wall. CONCLUSIONS CD28 stimulation provides a metabolic signal required for pathogenic effector functions in medium and large vessel vasculitis. Disease-associated glycolytic activity in wall-residing T-cell populations can be therapeutically targeted by blocking CD28 signaling.
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Affiliation(s)
- Hui Zhang
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Ryu Watanabe
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | | | - Jörg J Goronzy
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Cornelia M Weyand
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California.
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147
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Ehlers L, Askling J, Bijlsma HW, Cid MC, Cutolo M, Dasgupta B, Dejaco C, Dixon WG, Feltelius N, Finckh A, Gilbert K, Mackie SL, Mahr A, Matteson EL, Neill L, Salvarani C, Schmidt WA, Strangfeld A, van Vollenhoven RF, Buttgereit F. 2018 EULAR recommendations for a core data set to support observational research and clinical care in giant cell arteritis. Ann Rheum Dis 2019; 78:1160-1166. [PMID: 30898837 DOI: 10.1136/annrheumdis-2018-214755] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 11/04/2022]
Abstract
Giant cell arteritis (GCA) represents the most common form of primary systemic vasculitis and is frequently associated with comorbidities related to the disease itself or induced by the treatment. Systematically collected data on disease course, treatment and outcomes of GCA remain scarce. The aim of this EULAR Task Force was to identify a core set of items which can easily be collected by experienced clinicians, in order to facilitate collaborative research into the course and outcomes of GCA. A multidisciplinary EULAR task force group of 20 experts including rheumatologists, internists, epidemiologists and patient representatives was assembled. During a 1-day meeting, breakout groups discussed items from a previously compiled collection of parameters describing GCA status and disease course. Feedback from breakout groups was further discussed. Final consensus was achieved by means of several rounds of email discussions after the meeting. A three-round Delphi survey was conducted to determine a core set of parameters including the level of agreement. 117 parameters were regarded as relevant. Potential items were subdivided into the following categories: General, demographics, GCA-related signs and symptoms, other medical conditions and treatment. Possible instruments and assessment intervals were proposed for documentation of each item. To facilitate implementation of the recommendations in clinical care and clinical research, a minimum core set of 50 parameters was agreed. This proposed core set intends to ensure that relevant items from different GCA registries and databases can be compared for the dual purposes of facilitating clinical research and improving clinical care.
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Affiliation(s)
- Lisa Ehlers
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Johan Askling
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | | | - Maria Cinta Cid
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maurizio Cutolo
- Department Internal Medicine University of Genova, Research Laboratory and Academic Clinical Unit of Rheumatology, Viale Benedetto, Italy
| | | | - Christian Dejaco
- Rheumatology, Medical University Graz, Graz, Austria.,Rheumatology, Hospital Of Bruneck, Bruneck, Italy
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Nils Feltelius
- Medical Products Agency, Uppsala, Sweden.,Cross-Committee Task Force on Registries at the European Medicines Agency, London, UK
| | - Axel Finckh
- Division of Rheumatology, University of Geneva, Geneva, Switzerland
| | | | - Sarah Louise Mackie
- UK and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France
| | - Eric L Matteson
- Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic, Rochester, New York, USA
| | - Lorna Neill
- Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Dundee, UK
| | - Carlo Salvarani
- Division of Rheumatology, Azienda Ospedaliera IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Modena, Italy
| | - Wolfgang A Schmidt
- Rheumatology, Medical Centre for Rheumatology Berlin Buch, Berlin, Germany
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Ronald F van Vollenhoven
- Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, Netherlands
| | - Frank Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
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148
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Banerjee S, Quinn KA, Gribbons KB, Rosenblum JS, Civelek AC, Novakovich E, Merkel PA, Ahlman MA, Grayson PC. Effect of Treatment on Imaging, Clinical, and Serologic Assessments of Disease Activity in Large-vessel Vasculitis. J Rheumatol 2019; 47:99-107. [PMID: 30877209 DOI: 10.3899/jrheum.181222] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Disease activity in large-vessel vasculitis (LVV) is traditionally assessed by clinical and serological variables rather than vascular imaging. This study determined the effect of treatment on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) vascular activity in relation to clinical- and serologic-based assessments. METHODS Patients with giant cell arteritis (GCA) or Takayasu arteritis (TA) were prospectively evaluated at 6-month intervals in an observational cohort. Treatment changes were made at least 3 months before the followup visit and categorized as increased, decreased, or unchanged. Imaging (FDG-PET qualitative analysis), clinical, and serologic (erythrocyte sedimentation rate, C-reactive protein) assessments were determined at each visit and compared over interval visits. RESULTS Serial assessments were performed in 52 patients with LVV (GCA = 31; TA = 21) over 156 visits. Increased, decreased, or unchanged therapy was recorded for 36-, 23-, and 32-visit intervals, respectively. When treatment was increased, there was significant reduction in disease activity by imaging, clinical, and inflammatory markers (p ≤ 0.01 for each). When treatment was unchanged, all 3 assessments of disease activity remained similarly unchanged over 6-month intervals. When treatment was reduced, PET activity significantly worsened (p = 0.02) but clinical and serologic activity did not significantly change. Treatment of GCA with tocilizumab and of TA with tumor necrosis factor inhibitors resulted in significant improvement in imaging and clinical assessments of disease activity, but only rarely did the assessments both become normal. CONCLUSION In addition to clinical and serologic assessments, vascular imaging has potential to monitor disease activity in LVV and should be tested as an outcome measure in randomized clinical trials.
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Affiliation(s)
- Shubhasree Banerjee
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Kaitlin A Quinn
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - K Bates Gribbons
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Joel S Rosenblum
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Ali Cahid Civelek
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Elaine Novakovich
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Peter A Merkel
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Mark A Ahlman
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Peter C Grayson
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. .,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS.
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149
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Turesson C, Börjesson O, Larsson K, Mohammad AJ, Knight A. Swedish Society of Rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis. Scand J Rheumatol 2019; 48:259-265. [DOI: 10.1080/03009742.2019.1571223] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- C Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - O Börjesson
- Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - K Larsson
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - AJ Mohammad
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - A Knight
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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150
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Low C, Conway R. Current advances in the treatment of giant cell arteritis: the role of biologics. Ther Adv Musculoskelet Dis 2019; 11:1759720X19827222. [PMID: 30800174 PMCID: PMC6378487 DOI: 10.1177/1759720x19827222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/19/2018] [Indexed: 12/22/2022] Open
Abstract
Giant cell arteritis (GCA) is the most common form of systemic vasculitis. It is a potentially severe disease with 25% of patients suffering vision loss or stroke. Our treatment paradigm is based on glucocorticoids. Glucocorticoids are required in high doses for prolonged periods and subsequently are associated with a significant amount of treatment-related morbidity. Alternative treatment options are urgently needed to minimize these glucocorticoid adverse events. Many other agents, such as methotrexate and tumour necrosis factor alpha inhibitors have been used in GCA, with limited or no evidence of benefit. Our emerging understanding of the pathogenic processes involved in GCA has led to an increased interest in the use of biologic agents to treat the disease. Two randomized controlled trials have recently reported dramatic effects of the use of the interleukin-6 targeted biologic tocilizumab in GCA, with significant increases in remission rates and decreases in glucocorticoid burden. While encouraging, longer-term and additional outcomes are awaited to clarify the exact positioning of tocilizumab in the treatment approach. Emerging data for other biologic agents, particularly abatacept and ustekinumab, are also encouraging but less well advanced. We are at the dawn of a new era in GCA treatment, but uncertainties and opportunities abound.
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Affiliation(s)
- Candice Low
- Centre for Arthritis and Rheumatic Diseases, St. Vincent’s University Hospital, Dublin Academic Medical Centre, Dublin, Ireland
| | - Richard Conway
- Department of Rheumatology, St. James Hospital, Dublin, Ireland Department of Rheumatology, Suite 2, Blackrock Clinic, Rock Road, Co. Dublin, Ireland
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