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Cox L, Schulz CB, Slaven J, Gounder P, Arunothayaraj S, Alsanjari O, Cockburn J, Wright DA, Oliphant H, Rajak S. Optical frequency domain imaging (OFDI) represents a novel technique for the diagnosis of giant cell arteritis. Eye (Lond) 2024:10.1038/s41433-024-03216-9. [PMID: 39014208 DOI: 10.1038/s41433-024-03216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/04/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND/OBJECTIVES Giant cell arteritis (GCA) is an inflammatory vascular disease in which prompt and accurate diagnosis is critical. The efficacy of temporal artery biopsy (TAB) is limited by 'skip' lesions and a delay in histological analysis. This first-in-man ex-vivo study aims to assess the accuracy of optical frequency domain imaging (OFDI) in diagnosing GCA. SUBJECTS/METHODS 29 TAB samples of patients with suspected GCA were submerged in 0.9% sodium chloride and an OFDI catheter was passed through the lumen to create cross-sectional images prior to histological analysis. The specimens were then preserved in formalin for histological examination. Mean intimal thickness (MIT) on OFDI was measured, and the presence of both multinucleate giant cells (MNGCs) and fragmentation of the internal elastic lamina (FIEL) was assessed and compared with histology, used as the diagnostic gold standard. RESULTS MIT in patients with/without histological evidence of GCA was 0.425 mm (±0.43) and 0.13 mm (±0.06) respectively compared with 0.215 mm (±0.09) and 0.135 mm (±0.07) on OFDI. MIT measured by OFDI was significantly higher in patients with histologically diagnosed arteritis compared to those without (p = 0.0195). For detecting FIEL and MNGCs, OFDI had a sensitivity of 75% and 28.6% and a specificity of 100% and 77.3% respectively. Applying diagnostic criteria of MIT > 0.20 mm, or the presence of MNGCs or FIEL, the sensitivity of detecting histological arteritis using OFDI was 91.4% and the specificity 94.1%. CONCLUSIONS OFDI provided rapid imaging of TAB specimens achieving a diagnostic accuracy comparable to histological examination. In-vivo imaging may allow imaging of a longer arterial section.
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Affiliation(s)
- Laurence Cox
- King's College Hospital NHS Foundation Trust, Queen Mary's Hospital, Frognal Avenue, DA14 6LT, London, UK
| | - Christopher B Schulz
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK
| | - James Slaven
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK
- Brighton and Sussex Medical School, University of Sussex, BN1 9PX, Brighton, UK
| | - Pav Gounder
- Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, WA, 6009, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, WA, Australia
| | - Sandeep Arunothayaraj
- Department of Cardiology, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK
| | - Osama Alsanjari
- Department of Cardiology, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK
| | - James Cockburn
- Department of Cardiology, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK
| | - David A Wright
- Department of Histopathology, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK
| | - Huw Oliphant
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK
- Brighton and Sussex Medical School, University of Sussex, BN1 9PX, Brighton, UK
| | - Saul Rajak
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, BN2 5BF, Brighton, UK.
- Brighton and Sussex Medical School, University of Sussex, BN1 9PX, Brighton, UK.
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Kwok L, Wu E, Sheth SJ, Campbell TG, Chakrabarti R. Predictive Factors for Biopsy-Negative Giant Cell Arteritis and Alternative Diagnoses in a Neuro-Ophthalmology Context. Neuroophthalmology 2024; 48:267-271. [PMID: 38933754 PMCID: PMC11197916 DOI: 10.1080/01658107.2024.2311131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/22/2024] [Indexed: 06/28/2024] Open
Abstract
Giant cell arteritis is a challenging diagnosis for patients given the high prevalence of negative temporal artery biopsies (TAB). Despite the lack of histopathological evidence of giant cell arteritis in the TAB, patients can still have TAB-negative giant cell arteritis. The purpose of this paper is to analyse the predictors for TAB-negative giant cell arteritis and the alternative diagnosis of biopsy-negative patients without a giant cell arteritis diagnosis. A retrospective electronic database review of all TABs performed at the Royal Victorian Eye and Ear Hospital from February 2015 to May 2020. Logistic regression analysis was performed to determine predictive factors for a diagnosis of TAB-negative giant cell arteritis. In all cases, a clinical diagnosis of TAB-negative giant cell arteritis was determined by a neuro-ophthalmologist. Alternative diagnoses for negative TABs were identified and explored. A total of 368 TABs were analysed with 287 (78%) negative for histopathological evidence of GCA. Twenty-seven (9.4%) patients were diagnosed and treated as TAB-negative giant cell arteritis. The clinical predictors of a TAB-negative giant cell arteritis diagnosis were the presence of jaw claudication (OR 2.77, 95% CI 1.10-6.98) and CRP (OR 1.02, 95% CI 1.00-1.03). Alternative diagnoses included non-specific headache, non-arteritic anterior ischaemic optic neuropathy, retinal vessel occlusions, and ocular nerve palsies. Predictive factors for a diagnosis of TAB-negative giant cell arteritis were jaw claudication and an elevated CRP. Several alternative diagnoses can be considered for patients with a negative TAB in a neuro-ophthalmology context.
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Affiliation(s)
- Lawrence Kwok
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Emma Wu
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Shivanand J. Sheth
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Thomas G. Campbell
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - Rahul Chakrabarti
- Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Alfred Hospital, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
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3
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Nair V, Fishbein GA, Padera R, Seidman MA, Castonguay M, Leduc C, Tan CD, Rodriguez ER, Maleszewski JJ, Miller D, Romero M, Lomasney J, d'Amati G, De Gaspari M, Rizzo S, Angelini A, Basso C, Litovsky S, Buja LM, Stone JR, Veinot JP. Consensus statement on the processing, interpretation and reporting of temporal artery biopsy for arteritis. Cardiovasc Pathol 2023; 67:107574. [PMID: 37683739 DOI: 10.1016/j.carpath.2023.107574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Giant cell arteritis (GCA) is the most common systemic vasculitis in adults in Europe and North America, typically involving the extra-cranial branches of the carotid arteries and the thoracic aorta. Despite advances in noninvasive imaging, temporal artery biopsy (TAB) remains the gold standard for establishing a GCA diagnosis. The processing of TAB depends largely on individual institutional protocol, and the interpretation and reporting practices vary among pathologists. To address this lack of uniformity, the Society for Cardiovascular Pathology formed a committee tasked with establishing consensus guidelines for the processing, interpretation, and reporting of TAB specimens, based on the existing literature. This consensus statement includes a discussion of the differential diagnoses including other forms of arteritis and noninflammatory changes of the temporal artery.
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Affiliation(s)
- Vidhya Nair
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael A Seidman
- Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mathieu Castonguay
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Charles Leduc
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Carmela D Tan
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Dylan Miller
- Intermountain Central Laboratory, Salt Lake City, UT, USA
| | - Maria Romero
- Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jon Lomasney
- Department of Pathology, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Silvio Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - John P Veinot
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Al-Nejar M, Wustenberghs K, Thomas B, Schoonjans C, Deleersnijder R. Occipital artery biopsy: Surgical technique. J Vasc Surg Cases Innov Tech 2023; 9:101286. [PMID: 37662567 PMCID: PMC10474598 DOI: 10.1016/j.jvscit.2023.101286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Giant cell arteritis is a systemic inflammatory disorder that primarily affects medium- and large-size arteries. Usually, the temporal artery is involved. In rare cases, the patient experiences symptoms elsewhere, such as in the occipital region. In such cases, biopsy of the occipital artery can be considered. Few studies are available on how to perform such a biopsy. In this case report, we describe the procedure in detail, with a focus on the important anatomic structures. We wish to offer other surgeons a quick reference in the case of a request for a biopsy of the occipital artery.
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Affiliation(s)
- Mohammed Al-Nejar
- Department of Thoracic and Vascular Surgery, GZA Sint Augustinus, Wilrijk, Belgium
| | - Karen Wustenberghs
- Department of Thoracic and Vascular Surgery, GZA Sint Augustinus, Wilrijk, Belgium
| | - Benoit Thomas
- Department of Thoracic and Vascular Surgery, GZA Sint Augustinus, Wilrijk, Belgium
| | - Carmen Schoonjans
- Department of Thoracic and Vascular Surgery, GZA Sint Augustinus, Wilrijk, Belgium
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5
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Farina N, Tomelleri A, Campochiaro C, Dagna L. Giant cell arteritis: Update on clinical manifestations, diagnosis, and management. Eur J Intern Med 2023; 107:17-26. [PMID: 36344353 DOI: 10.1016/j.ejim.2022.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Giant cell arteritis (GCA) is the most common vasculitis affecting people older than 50 years. The last decades have shed new light on the clinical paradigm of this condition, expanding its spectrum beyond cranial vessel inflammation. GCA can be now considered a multifaceted vasculitic syndrome encompassing inflammation of cranial and extra-cranial arteries and girdles, isolated or combined. Such heterogeneity often leads to diagnostic delays and increases the likelihood of acute and chronic GCA-related damage. On the other hand, the approach to suspected GCA patients has been revolutionized by the introduction of vascular ultrasound which allows a rapid, cost-effective, and non-invasive GCA diagnosis. Likewise, the use of tocilizumab is now part of the therapeutic algorithm of GCA and ensures a satisfactory disease control even in steroid-refractory patients. Nonetheless, some aspects of GCA still need to be clarified, including the clinical correlation of different histological patterns, and the prevention of long-term vascular complications. This narrative review depicts the diagnostic and therapeutic aspects of GCA most relevant in clinical practice, with a focus on clinical updates and novelties introduced over the last decade.
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Affiliation(s)
- Nicola Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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6
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Vaiopoulos A, Kanakis M, Vaiopoulos G, Samanidis G, Kaklamanis P. Giant Cell Arteritis: Focusing on Current Aspects From the Clinic to Diagnosis and Treatment. Angiology 2022:33197221130564. [PMID: 36164723 DOI: 10.1177/00033197221130564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Giant cell arteritis (GCA) is a granulomatous arteritis involving large arteries, particularly the aorta and its major proximal branches, including the carotid and temporal arteries. GCA involves individuals over 50 years old. The etiopathogenesis of GCA may involve a genetic background triggered by unknown environmental factors (eg infections), the activation of dendritic cells as well as inflammatory and vascular remodeling. However, its pathogenetic mechanism still remains unclear, although progress has been made in recent years. In the past, inflammatory markers and arterial biopsy were considered as gold standard for the diagnosis of GCA. However, emerging imaging methods have been made more sensitive and specific for the diagnosis of GCA. Treatment includes biological and other modalities including interleukin-6 (IL-6) inhibitors.
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Affiliation(s)
- Aristeidis Vaiopoulos
- 2nd Department of Dermatology and Venereology, 69038Attikon University General Hospital, Athens, Greece
| | - Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Surgery Center, Athens, Greece
| | - George Vaiopoulos
- Department of Physiology, Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece
| | - George Samanidis
- First Department of Adult Cardiac Surgery, 69106Onassis Cardiac Surgery Center, Athens, Greece
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7
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Diagnosis of Giant Cell Arteritis using Clinical, Laboratory, and Histopathological Findings in Patients Undergoing Temporal Artery Biopsy. Clin Neurol Neurosurg 2022; 221:107377. [DOI: 10.1016/j.clineuro.2022.107377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
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8
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Evangelatos G, Grivas A, Pappa M, Kouna K, Iliopoulos A, Fragoulis GE. Cranial giant cell arteritis mimickers: A masquerade to unveil. Autoimmun Rev 2022; 21:103083. [PMID: 35341973 DOI: 10.1016/j.autrev.2022.103083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis that affects cranial and extra-cranial arteries. Extra-cranial GCA presents mainly with non-specific symptoms and the differential diagnosis is very broad, while the cranial form has more typical clinical picture and physicians have a lower threshold for diagnosis and treatment. Although temporal artery biopsy (TAB) has an established role, ultrasound (US) is being increasingly used as the first-line imaging modality in suspected GCA. Vasculitides (especially ANCA-associated), hematological disorders (mainly amyloidosis), neoplasms, infections, atherosclerosis and local disorders can affect the temporal arteries or might mimic the symptoms of cranial GCA and produce US and TAB findings that resemble those of temporal vasculitis. Given that prompt diagnosis is essential and proper treatment varies significantly among these diseases, in this review we aimed to collectively present disorders that can masquerade cranial GCA.
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Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexandros Grivas
- Clinical Immunology-Rheumatology Unit, Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kouna
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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9
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Garvey TD, Koster MJ, Warrington KJ. My Treatment Approach to Giant Cell Arteritis. Mayo Clin Proc 2021; 96:1530-1545. [PMID: 34088416 DOI: 10.1016/j.mayocp.2021.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults 50 years or older. Expanded use of advanced arterial imaging has assisted both in the diagnosis of GCA and recognition of disease subsets. Although glucocorticoids have been the mainstay of treatment for almost 7 decades, new therapeutic options have emerged. This review aims to provide the clinician with a pragmatic approach to evaluating and managing patients with GCA while also addressing recent diagnostic and therapeutic developments.
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Affiliation(s)
- Thomas D Garvey
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Matthew J Koster
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Muratore F, Boiardi L, Cavazza A, Tiengo G, Galli E, Aldigeri R, Pipitone N, Cimino L, Bonacini M, Croci S, Salvarani C. Association Between Specimen Length and Number of Sections and Diagnostic Yield of Temporal Artery Biopsy for Giant Cell Arteritis. Arthritis Care Res (Hoboken) 2021; 73:402-408. [PMID: 32741116 DOI: 10.1002/acr.24393] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the association between specimen length and number of sections evaluated and the diagnostic yield of temporal artery biopsy (TAB) for giant cell arteritis (GCA). METHODS A pathologist reviewed all TABs performed for suspected GCA between January 1991 and December 2012. The blocks of all the inadequate and negative biopsy specimens were recut, and further slides at deeper levels were stained with hematoxylin and eosin in order to avoid missing inflammatory changes. RESULTS In total, findings from 662 TABs were included in the study (71% female; mean age 73.2 years). A total of 427 TAB specimens (65%) were classified as negative, and 235 (35%) were classified as positive for GCA. Compared to those with negative TAB results, patients with positive TAB results were older and more frequently female. There was no difference in postfixation TAB specimen length between TAB specimens negative and positive for GCA (mean 6.5 mm versus 6.9 mm; P = 0.068). Cuts of additional biopsy sections revealed inflammation at deeper levels in 26 of 408 TAB specimens (6.4%) originally reported as uninflamed. The inflamed section was the second in 14 TAB specimens, the third in 9 specimens, and the fourth in 3 specimens. Piecewise logistic regression identified 5 mm as the TAB specimen length change point for diagnostic sensitivity. Compared to a TAB specimen length of <5 mm, the age- and sex-adjusted odds ratio for positive TAB results in samples ≥5 mm long was 1.5 (95% confidence interval 1.0-2.0), P = 0.032. CONCLUSION A postfixation TAB specimen length of at least 5 mm should be sufficient to make a histologic diagnosis of GCA. In order not to miss inflammatory changes, at least 3 further sections at deeper levels should be evaluated in all negative TAB specimens.
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Affiliation(s)
- Francesco Muratore
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Boiardi
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giacomo Tiengo
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Galli
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena and Reggio Emilia, Modena, Italy
| | | | - Nicolò Pipitone
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Martina Bonacini
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Croci
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, and University of Modena and Reggio Emilia, Modena, Italy
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Martire MV, Cipolletta E, Di Matteo A, Di Carlo M, Jesus D, Grassi W, Filippucci E. Is the intima-media thickness of temporal and axillary arteries influenced by cardiovascular risk? Rheumatology (Oxford) 2021; 60:5362-5368. [DOI: 10.1093/rheumatology/keab117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/18/2021] [Indexed: 02/05/2023] Open
Abstract
Abstract
Objectives
To measure with US the intima-media thickness (IMT) of temporal (superficial, parietal and frontal branches) and axillary arteries in subjects without a diagnosis of GCA and/or PMR with different cardiovascular (CV) risk; and to assess the performance of previously proposed cut-off values for normal IMT.
Methods
Subjects ≥ 50 years without a diagnosis of GCA or PMR were included. Bilateral US of the temporal arteries, including the frontal and parietal branches, and axillary arteries was performed by two sonographers using a 10–22 MHz and 6–18 MHz probe. The following previously proposed cut-offs were considered: superficial temporal artery: 0.42 mm; frontal branch: 0.34 mm; parietal branch: 0.29 mm; axillary artery: 1.0 mm.
Results
A total of 808 arteries in 101 subjects were evaluated; of these, 31 (30.7%) were classified as very high CV risk, seven (6.9%) as high, 34 (33.7%) as moderate and 29 (28.7%) as low risk. Subjects with very high or high risk showed higher IMT than those with moderate or low risk in the superficial temporal arteries [0.23 (s.d. 0.07) vs 0.20 (s.d. 0.04), P < 0.01] and in the axillary arteries [0.54 (s.d. 0.17) vs 0.48 (s.d. 0.10), P = 0.002]. The IMT was higher than the reference cut-off in 13/808 (1.6%) arteries, in ≥1 artery in 10/101 subjects (10.1%). Of these 10 subjects, 8 (80%) were classified as having very high or high risk.
Conclusion
Our results suggest that CV risk might influence the US-determined IMT of the temporal and axillary arteries in subjects without GCA. Therefore, in patients with suspected GCA, particular attention should be paid when measuring the IMT in those patients with very high/high CV risk.
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Affiliation(s)
| | | | - Andrea Di Matteo
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Italy
| | - Marco Di Carlo
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Italy
| | - Diogo Jesus
- Rheumatology Department, Centro Hospitalar de Leiria, Leiria
- Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Walter Grassi
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Italy
| | - Emilio Filippucci
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Italy
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13
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Bolha L, Pižem J, Frank-Bertoncelj M, Hočevar A, Tomšič M, Jurčić V. Identification of microRNAs and their target gene networks implicated in arterial wall remodelling in giant cell arteritis. Rheumatology (Oxford) 2021; 59:3540-3552. [PMID: 32594153 DOI: 10.1093/rheumatology/keaa204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/31/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To identify dysregulated microRNAs (miRNAs) and their gene targets in temporal arteries from GCA patients, and determine their association with GCA pathogenesis and related arterial wall remodelling. METHODS We included 93 formalin-fixed, paraffin-embedded temporal artery biopsies (TABs) from treatment-naïve patients: 54 positive and 17 negative TABs from clinically proven GCA patients, and 22 negative TABs from non-GCA patients. miRNA expression analysis was performed with miRCURY LNA miRNome Human PCR Panels and quantitative real-time PCR. miRNA target gene prediction and pathway enrichment analysis was performed using the miRDB and Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) databases, respectively. RESULTS Dysregulation of 356 miRNAs was determined in TAB-positive GCA arteries, among which 78 were significantly under-expressed and 22 significantly overexpressed above 2-fold, when compared with non-GCA controls. Specifically, TAB-positive GCA arteries were characterized by a significant overexpression of 'pro-synthetic' (miR-21-3p/-21-5p/-146a-5p/-146b-5p/-424-5p) and under-expression of 'pro-contractile' (miR-23b-3p/-125a-5p/-143-3p/-143-5p/-145-3p/-145-5p/-195-5p/-365a-3p) vascular smooth muscle cell phenotype-associated regulatory miRNAs. These miRNAs targeted gene pathways involved in the arterial remodelling and regulation of the immune system, and their expression correlated with the extent of intimal hyperplasia in TABs from GCA patients. Notably, the expression of miR-21-3p/-21-5p/-146a-5p/-146b-5p/-365a-3p differentiated between TAB-negative GCA arteries and non-GCA temporal arteries, revealing these miRNAs as potential biomarkers of GCA. CONCLUSION Identification of dysregulated miRNAs involved in the regulation of the vascular smooth muscle cell phenotype and intimal hyperplasia in GCA arterial lesions, and detection of their expression profiles, enables a novel insight into the complexity of GCA pathogenesis and implies their potential utilization as diagnostic and prognostic biomarkers of GCA.
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Affiliation(s)
- Luka Bolha
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jože Pižem
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Frank-Bertoncelj
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Schlieren, Switzerland
| | - Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vesna Jurčić
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Galli E, Muratore F, Boiardi L, Cavazza A, Salvarani C. Response to 'The Relevance of Restricted Inflammation in a TAB' by Griffin KJ et al. Semin Arthritis Rheum 2021; 51:e8-e9. [PMID: 33451760 DOI: 10.1016/j.semarthrit.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Elena Galli
- University of Modena and Reggio Emilia, Modena
| | - Francesco Muratore
- Rheumatology Unit, Department of Specialistic Medicine, Azienda USL -IRCCS di Reggio Emilia
| | - Luigi Boiardi
- Rheumatology Unit, Department of Specialistic Medicine, Azienda USL -IRCCS di Reggio Emilia
| | - Alberto Cavazza
- Operative Unit of Pathologic Anatomy, Azienda USL -IRCCS di Reggio Emilia, Italy
| | - Carlo Salvarani
- University of Modena and Reggio Emilia, Modena; Rheumatology Unit, Department of Specialistic Medicine, Azienda USL -IRCCS di Reggio Emilia.
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15
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Giant cell aortitis masquerading as intramural hematoma. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:694-697. [PMID: 33294756 PMCID: PMC7691541 DOI: 10.1016/j.jvscit.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022]
Abstract
Giant cell aortitis is a rare cause of acute aortic syndrome. We describe the cases of two patients who had presented with chest pain, hypertension, and computed tomography angiographic evidence of mural thickening typical of thoracic aortic intramural hematoma. Although the patients' symptoms improved with hypertension control, elevated inflammatory markers and persistent fever to 103°F raised concern for an inflammatory etiology. Empiric steroids were administered, resulting in prompt cessation of fever and decreasing inflammatory markers. The findings from temporal artery biopsies were positive in both patients. Follow-up axial imaging after 2 weeks of steroid therapy revealed improvement in aortitis with decreased wall thickening. Giant cell aortitis should be considered in patients presenting with acute aortic syndrome in the setting of elevated inflammatory markers and noninfectious fever.
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16
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Giant cell arteritis and its mimics: A comparison of three patient cohorts. Semin Arthritis Rheum 2020; 50:923-929. [DOI: 10.1016/j.semarthrit.2020.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 01/27/2023]
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17
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Isobe M, Amano K, Arimura Y, Ishizu A, Ito S, Kaname S, Kobayashi S, Komagata Y, Komuro I, Komori K, Takahashi K, Tanemoto K, Hasegawa H, Harigai M, Fujimoto S, Miyazaki T, Miyata T, Yamada H, Yoshida A, Wada T, Inoue Y, Uchida HA, Ota H, Okazaki T, Onimaru M, Kawakami T, Kinouchi R, Kurata A, Kosuge H, Sada KE, Shigematsu K, Suematsu E, Sueyoshi E, Sugihara T, Sugiyama H, Takeno M, Tamura N, Tsutsumino M, Dobashi H, Nakaoka Y, Nagasaka K, Maejima Y, Yoshifuji H, Watanabe Y, Ozaki S, Kimura T, Shigematsu H, Yamauchi-Takihara K, Murohara T, Momomura SI. JCS 2017 Guideline on Management of Vasculitis Syndrome - Digest Version. Circ J 2020; 84:299-359. [PMID: 31956163 DOI: 10.1253/circj.cj-19-0773] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine.,Internal Medicine, Kichijoji Asahi Hospital
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University
| | - Shinya Kaname
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | | | - Yoshinori Komagata
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki
| | | | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
| | - Hidehiro Yamada
- Medical Center for Rheumatic Diseases, Seirei Yokohama Hospital
| | | | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hideki Ota
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine
| | - Takahiro Okazaki
- Vice-Director, Shizuoka Medical Center, National Hospital Organization
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University
| | - Reiko Kinouchi
- Medicine and Engineering Combined Research Institute, Asahikawa Medical University.,Department of Ophthalmology, Asahikawa Medical University
| | - Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University
| | | | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Eiichi Suematsu
- Division of Internal Medicine and Rheumatology, National Hospital Organization, Kyushu Medical Center
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine
| | - Naoto Tamura
- Department of Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine
| | | | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine Department of Internal Medicine, Faculty of Medicine, Kagawa University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Shoichi Ozaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroshi Shigematsu
- Clinical Research Center for Medicine, International University of Health and Welfare
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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18
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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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19
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Martin de Frémont G, Gimenez de Mestral S, Jubault V, Chauchard M, Mekinian A, Fain O. [Polyarteritis nodosa, an alternative diagnosis of giant cell arteritis in cases of temporal arteritis]. Rev Med Interne 2019; 40:533-535. [PMID: 31201015 DOI: 10.1016/j.revmed.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/11/2019] [Accepted: 05/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Weight loss, myalgias, neurologic manifestations and arterial hypertension are common features of polyarteritis nodosa (PAN) at diagnosis. Temporal arteritis is a rarer manifestation of PAN, more suggestive of giant cell arteritis (GCA). CASE We report the case of a 77-year-old woman who presented with fatigue, weight loss, fever, neck pain, jaw claudication and cough, diagnosed with giant cell arteritis. Diagnosis was reconsidered in favour of a medium and small-sized vessels necrotizing vasculitis corresponding to PAN because of steroid dependence, mononeuritis and suggestive histological features. CONCLUSION Although temporal arteritis is suggestive of GCA, other causes of temporal arteritis can be identified with temporal artery biopsy.
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Affiliation(s)
- G Martin de Frémont
- Service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), hôpital Saint Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - S Gimenez de Mestral
- Service d'anatomopathologie, hôpital Saint Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - V Jubault
- Service de médecine interne, clinique Saint Germain, 78100 Saint Germain en Laye, France
| | - M Chauchard
- Service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), hôpital Saint Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - A Mekinian
- Service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), hôpital Saint Antoine, Sorbonne université, AP-HP, 75012 Paris, France.
| | - O Fain
- Service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), hôpital Saint Antoine, Sorbonne université, AP-HP, 75012 Paris, France
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20
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Negative temporal artery biopsy: predictive factors for giant cell arteritis diagnosis and alternate diagnoses of patients without arteritis. Clin Rheumatol 2018; 37:2819-2824. [PMID: 29549493 DOI: 10.1007/s10067-018-4068-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 10/17/2022]
Abstract
To investigate whether among patients with a negative temporal artery biopsy (TAB) there are clinical features that may differentiate between patients with an eventual diagnosis of giant cell arteritis (GCA) and those without arteritis, and to assess the eventual diagnoses of patients without arteritis. Retrospective analysis of patients with a negative TAB performed between 1/1/2000 and 31/12/2015. Information collected included baseline clinical and laboratory data. Patients' final diagnoses were obtained from medical records. Patients eventually diagnosed with GCA were compared with those without arteritis, and predictive features for GCA diagnosis were assessed. A total of 154 patients with a negative TAB were included in the study. Among them, 31 (20%) were eventually diagnosed with GCA. The leading alternative diagnoses of patients without arteritis were self-limited disease (23%), isolated polymyalgia rheumatica (PMR) (18%), and neurological conditions (17%). In the multivariate analysis, predictors for diagnosis of GCA among patients with a negative TAB included PMR (OR = 2.86, 95% CI 1.06-7.69), platelet count (OR = 1.28, 95% CI 1.07-1.53), and ACR score > 2 (OR = 13.4, 95% CI 4.27-42.03). Among patients with a negative TAB, the best predictors for diagnosis of GCA are fulfillment of the ACR criteria, a clinical diagnosis of PMR, and high platelet levels. These features may aid in the diagnostic work-up of patients with a negative TAB.
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21
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Buckingham EM, Foley MA, Grose C, Syed NA, Smith ME, Margolis TP, Thurtell MJ, Kardon R. Identification of Herpes Zoster-Associated Temporal Arteritis Among Cases of Giant Cell Arteritis. Am J Ophthalmol 2018; 187:51-60. [PMID: 29294312 PMCID: PMC5866091 DOI: 10.1016/j.ajo.2017.12.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine whether herpes zoster antigen (also called varicellazoster virus antigen) was detectable in temporal artery biopsies taken from individuals with giant cell arteritis (GCA). DESIGN Retrospective comparative case series. METHODS Sections of formalin-fixed paraffin-embedded temporal arteries were examined first by hematoxylin-eosin (H&E) staining to establish the diagnosis of GCA. Adjacent sections of the same biopsy were then examined by immunohistochemistry, using 2 different monoclonal antibodies against a major antigen of varicella-zoster virus called gE. Pathologic specimens were obtained from patients cared for at the University of Iowa and Washington University in St. Louis ophthalmology clinics. RESULTS The study included biopsies from 25 patients with symptoms of GCA as well as positive H&E pathology and 25 patients with symptoms compatible with GCA but negative H&E pathology. Among the GCA-positive group, 3 patients had positive staining for herpes zoster antigen. Among the GCA-negative group, herpes zoster antigen was not detected in any biopsy. In both groups of patients, false-positive staining for herpes zoster antigen was detected in the presence of calcifications in the arteries. False-positive staining was also detected on some extra-arterial skeletal muscle and erythrocytes. CONCLUSION Herpes zoster antigen was detected in 3 of 25 temporal arteries from patients with biopsy-proven GCA. One of the 3 positive cases was noteworthy because the patient had had herpes zoster ophthalmicus diagnosed 3 weeks before the onset of GCA symptoms. False-positive staining for herpes zoster antigen was detected on several temporal artery biopsies.
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22
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Salvarani C, Soriano A, Muratore F, Shoenfeld Y, Blockmans D. Is PET/CT essential in the diagnosis and follow-up of temporal arteritis? Autoimmun Rev 2017; 16:1125-1130. [DOI: 10.1016/j.autrev.2017.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023]
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Abstract
Giant cell arteritis (GCA) is the most common form of vasculitis in individuals aged 50 years and over. GCA typically affects large and medium-sized arteries, with a predilection for the extracranial branches of the carotid artery. Patients with GCA usually present with symptoms and signs that are directly related to the artery that is affected, with or without constitutional manifestations. The most dreaded complication of GCA is visual loss, which affects about one in six patients and is typically caused by arteritis of the ophthalmic branches of the internal carotid artery. Before the advent of glucocorticoid treatment, the prevalence of visual complications was high. Increasing awareness by physicians of the symptoms of GCA and advances in diagnostic techniques over the past twenty years have also contributed to a substantial decline in the frequency of permanent visual loss. Ischaemic brain lesions are less common than visual lesions, and mostly result from vasculitis of the extradural vertebral or carotid arteries. In the case of both the eye and the brain, ischaemic damage is thought to result from arterial stenosis or occlusion that occurs secondary to the inflammatory process. The inflammatory response at the onset of arteritis, its role as a predictor of complications and the role of traditional cardiovascular risk factors have been extensively investigated in the past decade. In this Review, the epidemiology, risk factors, clinical presentation and current therapeutic approach of GCA-related ischaemic events are discussed, with a particular emphasis on visual loss.
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Muratore F, Pipitone N, Salvarani C. Standard and biological treatment in large vessel vasculitis: guidelines and current approaches. Expert Rev Clin Immunol 2017; 13:345-360. [PMID: 28116918 DOI: 10.1080/1744666x.2017.1285699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Giant cell arteritis and Takayasu arteritis are the two major forms of idiopathic large vessel vasculitis. High doses of glucocorticoids are effective in inducing remission in both conditions, but relapses and recurrences are common, requiring prolonged glucocorticoid treatment with the risk of the related adverse events. Areas covered: In this article, we will review the standard and biological treatment strategies in large vessel vasculitis, and we will focus on the current approaches to these diseases. Expert commentary: The results of treatment trials with conventional immunosuppressive agents such as methotrexate, azathioprine, mycophenolate mofetil, and cyclophosphamide have overall been disappointing. TNF-α blockers are ineffective in giant cell arteritis, while observational evidence and a phase 2 randomized trial support the use of tocilizumab in relapsing giant cell arteritis. Observational evidence strongly supports the use of anti-TNF-α agents and tocilizumab in Takayasu patients with relapsing disease. However biological agents are not curative, and relapses remain common.
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Affiliation(s)
- Francesco Muratore
- a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy
| | - Nicolò Pipitone
- a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy
| | - Carlo Salvarani
- a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy
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25
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Manzo C. Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica. Reumatologia 2016; 54:236-238. [PMID: 27994267 PMCID: PMC5149570 DOI: 10.5114/reum.2016.63663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/29/2016] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION In giant cell arteritis (GCA) headache of new onset due to inflammatory involvement of the temporal artery (TA) represents a diagnostic criterion. A widespread headache (WH) with scalp tenderness due to cranial arteritis can represent another manifestation of GCA. MATERIAL AND METHODS In 225 elderly patients with polymyalgia rheumatica (PMR) followed in our rheumatologic outpatient clinic from 2004 until June 2016, the frequency of WH as the first clinical manifestation of GCA was evaluated. RESULTS Among 26 patients with GCA+PMR (11.6% of total), 5 (23.07%) had WH as first clinical manifestation of GCA without TA. In all these patients TA colour duplex sonography (CDS) and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) with total body contrast-enhanced CT was consistent with the diagnosis of arteritis. TA biopsy was not performed. High doses of prednisone (1 mg/kg/day) led to the immediate and total disappearance of the headache. CONCLUSIONS The widespread headache should be considered as the first symptom GCA and in cases of suspicion of vasculitis patients should have a full diagnostics examination. Colour duplex sonography and FDG-PET with total body contrast-enhanced CT are useful tools for non-invasive diagnosis of GCA.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Department ASL NA 3 sud, Rheumatologic Outpatient Clinic hospital "Mariano Lauro", Sant'Agnello, Italy
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