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Fang C, Du L, Gao S, Chen Y, Chen Z, Wu Z, Li L, Li J, Zeng X, Li M, Li Y, Tian X. Association between premature vascular smooth muscle cells senescence and vascular inflammation in Takayasu's arteritis. Ann Rheum Dis 2024:ard-2024-225630. [PMID: 38816066 DOI: 10.1136/ard-2024-225630] [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: 02/06/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Arterial wall inflammation and remodelling are the characteristic features of Takayasu's arteritis (TAK). It has been proposed that vascular smooth muscle cells (VSMCs) are the main targeted cells of inflammatory damage and participate in arterial remodelling in TAK. Whether VSMCs are actively involved in arterial wall inflammation has not been elucidated. Studies have shown that cellular senescence in tissue is closely related to local inflammation persistence. We aimed to investigate whether VSMCs senescence contributes to vascular inflammation and the prosenescent factors in TAK. METHODS VSMCs senescence and senescence-associated secretory phenotype were detected by histological examination, bulk RNA-Seq and single-cell RNA-seq conducted on vascular surgery samples of TAK patients. The key prosenescent factors and the downstream signalling pathway were investigated in a series of in vitro and ex vivo experiments. RESULTS Histological findings, primary cell culture and transcriptomic analyses demonstrated that VSMCs of TAK patients had the features of premature senescence and contributed substantially to vascular inflammation by upregulating the expression of senescence-associated inflammatory cytokines. IL-6 was found to be the critical cytokine that drove VSMCs senescence and senescence-associated mitochondrial dysfunction in TAK. Mechanistically, IL-6-induced non-canonical mitochondrial localisation of phosphorylated STAT3 (Tyr705) prevented mitofusin 2 (MFN2) from proteasomal degradation, and subsequently promoted senescence-associated mitochondrial dysfunction and VSMCs senescence. Mitochondrial STAT3 or MFN2 inhibition ameliorated VSMCs senescence in ex vivo cultured arteries of TAK patients. CONCLUSIONS VSMCs present features of cellular senescence and are actively involved in vascular inflammation in TAK. Vascular IL-6-mitochondrial STAT3-MFN2 signalling is an important driver of VSMCs senescence.
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Affiliation(s)
- Chenglong Fang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Lihong Du
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shang Gao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zuoguan Chen
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Li
- The State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yongjun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Bonnan M, Debeugny S. Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy? Front Neurol 2023; 14:1305093. [PMID: 38130834 PMCID: PMC10733536 DOI: 10.3389/fneur.2023.1305093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Stroke is a rare and severe complication of giant cell arteritis (GCA). Although early diagnosis and treatment initiation are essential, the mechanism of stroke is often related to vasculitis complicated by arterial stenosis and occlusion. Its recurrence is often attributed to early steroid resistance or late GCA relapse, so immunosuppressive treatment is often reinforced. However, many questions concerning the mechanisms of stroke remain elusive, and no review to date has examined the whole data set concerning GCA-related stroke. We therefore undertook this scoping review. GCA-related stroke does not necessarily display general signs and inflammatory parameters are sometimes normal, so clinicians should observe caution. Ischemic lesions often show patterns predating watershed areas and are associated with stenosis or thrombosis of the respective arteries, which are often bilateral. Lesions predominate in the siphon in the internal carotid arteries, whereas all the vertebral arteries may be involved with a predominance in the V3-V4 segments. Ultrasonography of the cervical arteries may reveal edema of the intima (halo sign), which is highly sensitive and specific of GCA, and precedes stenosis. The brain arteries are spared although very proximal arteritis may rarely occur, if the patient has microstructural anatomical variants. Temporal artery biopsy reveals the combination of mechanisms leading to slit-like stenosis, which involves granulomatous inflammation and intimal hyperplasia. The lumen is sometimes occluded by thrombi (<15%), suggesting that embolic lesions may also occur, although imaging studies have not provided strong evidence for this. Moreover, persistence of intimal hyperplasia might explain persisting arterial stenosis, which may account for delayed stroke occurring in watershed areas. Other possible mechanisms of stroke are also discussed. Overall, GCA-related stroke mainly involves hemodynamic mechanisms. Besides early diagnosis and treatment initiation, future studies could seek to establish specific preventive or curative treatments using angioplasty or targeting intimal proliferation.
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Affiliation(s)
- Mickael Bonnan
- Service de Neurologie, Hôpital Delafontaine, Saint-Denis, France
| | - Stephane Debeugny
- Département d'Information Médicale, Centre Hospitalier de Pau, Pau, France
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Elfishawi M, Rakholiya J, Gunderson TM, Achenbach SJ, Crowson CS, Matteson EL, Turesson C, Wadström K, Weyand C, Koster MJ, Warrington KJ. Lower Frequency of Comorbidities Prior to Onset of Giant Cell Arteritis: A Population-Based Study. J Rheumatol 2023; 50:526-531. [PMID: 36521923 PMCID: PMC10066824 DOI: 10.3899/jrheum.220610] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the frequency of comorbidities and metabolic risk factors at and prior to giant cell arteritis (GCA) diagnosis. METHODS This is a retrospective case control study of patients with incident GCA between January 1, 2000, and December 31, 2019, in Olmsted County, Minnesota. Two age- and sex-matched controls were identified, and each assigned an index date corresponding to an incidence date of GCA. Medical records were manually abstracted for comorbidities and laboratory data at incidence date, 5 years, and 10 years prior to incidence date. Twenty-five chronic conditions using International Classification of Diseases, 9th revision, diagnosis codes were also studied at incidence date and 5 years prior to incidence date. RESULTS One hundred and twenty-nine patients with GCA (74% female) and 253 controls were identified. At incidence date, the prevalence of diabetes mellitus (DM) was lower among patients with GCA (5% vs 17%; P = 0.001). At 5 years prior to incidence date, patients were less likely to have DM (2% vs 13%; P < 0.001) and hypertension (27% vs 45%; P = 0.002) and had a lower mean number (SD) of comorbidities (0.7 [1.0] vs 1.3 [1.4]; P < 0.001) compared to controls. Moreover, patients had significantly lower median fasting blood glucose (FBG; 96 mg/dL vs 104 mg/dL; P < 0.001) and BMI (25.8 vs 27.7; P = 0.02) compared to controls. Multivariable logistic regression analysis revealed negative associations for FBG with GCA at 5 and 10 years prior to diagnosis/index date. CONCLUSION DM prevalence and median FBG and BMI were lower in patients with GCA up to 5 years prior to diagnosis, suggesting that metabolic factors influence the risk of GCA.
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Affiliation(s)
- Mohanad Elfishawi
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA;
| | - Jigisha Rakholiya
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina M Gunderson
- T.M. Gunderson, MS, S.J. Achenbach, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara J Achenbach
- T.M. Gunderson, MS, S.J. Achenbach, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- C.S Crowson, PhD, E.L. Matteson, MD, MPH, Division of Rheumatology, Department of Internal Medicine, and Department of Quantitative Health Sciences. Mayo Clinic, Rochester, Minnesota, USA
| | - Eric L Matteson
- C.S Crowson, PhD, E.L. Matteson, MD, MPH, Division of Rheumatology, Department of Internal Medicine, and Department of Quantitative Health Sciences. Mayo Clinic, Rochester, Minnesota, USA
| | - Carl Turesson
- C. Turesson, MD, PhD, Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Karin Wadström
- K. Wadström, MD, PhD, Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, and Center for Rheumatology, Academic Specialist Center, Region Stockholm, Stockholm, Sweden
| | - Cornelia Weyand
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J Koster
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth J Warrington
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Cardiovascular Disease in Large Vessel Vasculitis: Risks, Controversies, and Management Strategies. Rheum Dis Clin North Am 2023; 49:81-96. [PMID: 36424028 DOI: 10.1016/j.rdc.2022.08.004] [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: 11/22/2022]
Abstract
Takayasu's arteritis (TAK) and giant cell arteritis (GCA) are the 2 most common primary large vessel vasculitides (LVV). They share common vascular targets, clinical presentations, and histopathology, but target a strikingly different patient demographic. While GCA predominantly affects elderly people of northern European ancestry, TAK preferentially targets young women of Asian heritage. Cardiovascular diseases (CVD), including ischemic heart disease, cerebrovascular disease, aortic disease, and thromboses, are significantly increased in LVV. In this review, we will compare and contrast the issue of CVD in patients with TAK and GCA, with respect to prevalence, risk factors, and mechanisms of events to gain an understanding of the relative contributions of active vasculitis, vascular damage, and accelerated atherosclerosis. Controversies and possible mitigation strategies will be discussed.
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de Boysson H, Aouba A. An Updated Review of Cardiovascular Events in Giant Cell Arteritis. J Clin Med 2022; 11:1005. [PMID: 35207277 PMCID: PMC8878095 DOI: 10.3390/jcm11041005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis with a direct and indirect increased risk of acute and chronic vascular events, affecting large and medium vessels, and responsible for most of the morbidity and mortality of this disease. We aimed in this review to provide an updated synthesis of knowledge regarding cardiovascular events observed in GCA. By definition, GCA patients are over 50 and often over 70 years old, and subsequently also present age-related cardiovascular risk factors. In addition, the systemic and vascular inflammation as well as glucocorticoids (GC) probably contribute to an accelerated atherosclerosis and to vascular changes leading to arterial stenoses and aortic dilations and/or dissections. GCA-related ischemic complications, especially ophthalmologic events, stroke or myocardial infarcts are mostly observed within the first months after the diagnosis, being mainly linked to the vasculitic process. Conversely, aortic complications, including dilations or dissections, generally occur several months or years after the diagnosis, mainly in patients with large-vessel vasculitis. In these patients, other factors such as atherosclerosis, GC-related endothelial damage and vascular wall remodeling/healing probably contribute to the vascular events. GCA management includes the detection and treatment of these previous and newly induced cardiovascular risk factors. Hence, the use of cardiovascular treatments (e.g., aspirin, anticoagulation, statins, anti-hypertensive treatments) should be evaluated individually. Aortic structural changes require regular morphologic evaluations, especially in patients with previous aortitis. The initial or secondary addition of immunosuppressants, especially tocilizumab, an anti-IL-6 receptor antibody, is discussed in patients with GCA-related cardiovascular complications and, more consensually, to limit GC-mediated comorbidities.
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Affiliation(s)
- Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France;
- Caen University-Normandie, 14000 Caen, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, 14000 Caen, France;
- Caen University-Normandie, 14000 Caen, France
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Clifford AH, Cohen Tervaert JW. Cardiovascular events and the role of accelerated atherosclerosis in systemic vasculitis. Atherosclerosis 2021; 325:8-15. [PMID: 33873090 DOI: 10.1016/j.atherosclerosis.2021.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The spectrum of inflammatory blood vessel diseases includes both atherosclerosis and the primary systemic vasculitides. Although the inciting triggers differ, significant overlap exists in the mechanisms that contribute to sustained inflammation and vascular damage in both entities. With improvement in therapeutics to control acute vasculitis leading to longer survival, cardiovascular morbidity and mortality has emerged as the leading cause of death for vasculitis patients. Cardiovascular events likely occur as a consequence of vasculitis, vascular damage from prior inflammation causing a sustained procoagulant state, and accelerated atherosclerosis. In this review, we discuss the latest evidence regarding risk of cardiovascular events in patients with major forms of primary systemic vasculitis, and review the mechanisms by which accelerated atherosclerosis may occur.
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Affiliation(s)
- Alison H Clifford
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada.
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Elhfnawy AM, Elsalamawy D, Abdelraouf M, Schliesser M, Volkmann J, Fluri F. Red flags for a concomitant giant cell arteritis in patients with vertebrobasilar stroke: a cross-sectional study and systematic review. Acta Neurol Belg 2020; 120:1389-1398. [PMID: 32323167 PMCID: PMC8423705 DOI: 10.1007/s13760-020-01344-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/20/2020] [Indexed: 01/30/2023]
Abstract
Giant cell arteritis (GCA) may affect the brain-supplying arteries, resulting in ischemic stroke, whereby the vertebrobasilar territory is most often involved. Since etiology is unknown in 25% of stroke patients and GCA is hardly considered as a cause, we examined in a pilot study, whether screening for GCA after vertebrobasilar stroke might unmask an otherwise missed disease. Consecutive patients with vertebrobasilar stroke were prospectively screened for GCA using erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, and halo sign of the temporal and vertebral artery on ultrasound. Furthermore, we conducted a systematic literature review for relevant studies. Sixty-five patients were included, and two patients (3.1%) were diagnosed with GCA. Patients with GCA were older in age (median 85 versus 69 years, p = 0.02). ESR and CRP were significantly increased and hemoglobin was significantly lower in GCA patients compared to non-GCA patients (median, 75 versus 11 mm in 1 h, p = 0.001; 3.84 versus 0.25 mg/dl, p = 0.01, 10.4 versus 14.6 mg/dl, p = 0.003, respectively). Multiple stenoses/occlusions in the vertebrobasilar territory affected our two GCA patients (100%), but only five (7.9%) non-GCA patients (p = 0.01). Our literature review identified 13 articles with 136 stroke patients with concomitant GCA. Those were old in age. Headache, increased inflammatory markers, and anemia were frequently reported. Multiple stenoses/occlusions in the vertebrobasilar territory affected around 70% of stroke patients with GCA. Increased inflammatory markers, older age, anemia, and multiple stenoses/occlusions in the vertebrobasilar territory may be regarded as red flags for GCA among patients with vertebrobasilar stroke.
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Affiliation(s)
- Ahmed Mohamed Elhfnawy
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Street 11, 97080 Würzburg, Germany
- Department of Neurology, University Hospital of Alexandria, Alexandria, Egypt
- Department of Neurology, University Hospital of Essen, Essen, Germany
| | - Doaa Elsalamawy
- Department of Neurology, University Hospital of Alexandria, Alexandria, Egypt
| | - Mervat Abdelraouf
- Department of Neurology, University Hospital of Alexandria, Alexandria, Egypt
| | - Mira Schliesser
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Street 11, 97080 Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Street 11, 97080 Würzburg, Germany
| | - Felix Fluri
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Street 11, 97080 Würzburg, Germany
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Dumont A, Parienti JJ, Delmas C, Boutemy J, Maigné G, Martin Silva N, Sultan A, Planchard G, Aouba A, de Boysson H. Factors Associated with Relapse and Dependence on Glucocorticoids in Giant Cell Arteritis. J Rheumatol 2019; 47:108-116. [PMID: 30877210 DOI: 10.3899/jrheum.181127] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant cell arteritis (GCA). METHODS We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses. RESULTS The 326 patients (73% women) were followed up for 62 (12-262) months. During followup, 171 (52%) patients relapsed, including 113 (35%) who developed GC dependence. Relapsing patients had less history of stroke (p = 0.01) and presented large-vessel vasculitis (LVV) more frequently on imaging (p = 0.01) than patients without relapse. During the first months, therapeutic strategy did not differ among relapsing and nonrelapsing patients. GC-dependent patients were less likely to have a history of stroke (p = 0.004) and presented LVV on imaging more frequently (p = 0.005) than patients without GC-dependent disease. In multivariable analyses, LVV was an independent predictive factor of relapse (HR 1.49, 95% CI 1.002-2.12; p = 0.04) and GC dependence (OR 2.19, 95% CI 1.19-4.05; p = 0.01). Conversely, stroke was a protective factor against relapse (HR 0.21, 95% CI 0.03-0.68; p = 0.005) and GC-dependent disease (OR 0.10, 95% CI 0.001-0.31; p = 0.0005). Patients with a GC-dependent disease who received a GC-sparing agent had a shorter GC treatment duration than those without (p = 0.008). CONCLUSION In this study, LVV was an independent predictor of relapse and GC dependence. Further prospective studies are needed to confirm these findings and to determine whether patients with LVV require a different treatment approach.
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Affiliation(s)
- Anael Dumont
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Jean-Jacques Parienti
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Claire Delmas
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Jonathan Boutemy
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Gwénola Maigné
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Nicolas Martin Silva
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Audrey Sultan
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Gaétane Planchard
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Achille Aouba
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France.,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital
| | - Hubert de Boysson
- From the Department of Internal Medicine, Department of Pathology, and Department of Biostatistics, Caen University Hospital, Caen, France. .,A. Dumont, MD, Department of Internal Medicine, Caen University Hospital; J.J. Parienti, PhD, Department of Biostatistics, Caen University Hospital; C. Delmas, MD, Department of Internal Medicine, Caen University Hospital; J. Boutemy, MD, Department of Internal Medicine, Caen University Hospital; G. Maigné, MD, Department of Internal Medicine, Caen University Hospital; N. Martin Silva, MD, Department of Internal Medicine, Caen University Hospital; A. Sultan, PhD, Department of Internal Medicine, Caen University Hospital; G. Planchard, MD, Department of Pathology, Caen University Hospital; A. Aouba, MD, PhD, Department of Internal Medicine, Caen University Hospital; H. de Boysson, MD, MSc, Department of Internal Medicine, Caen University Hospital.
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Banz Y, Stone JH. Why do temporal arteries go wrong? Principles and pearls from a clinician and a pathologist. Rheumatology (Oxford) 2018; 57:ii3-ii10. [PMID: 29982782 DOI: 10.1093/rheumatology/kex524] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
Early diagnosis and treatment of GCA is essential to prevent complications of the disease, including permanent vision loss. Temporal artery biopsy has been intrinsically linked with the diagnosis of GCA for several decades. A negative predictive value of > 90% has been reported for temporal artery biopsy; however, a negative result does not reliably indicate the absence of GCA because inflammation of the temporal artery is not always evident because of segmental involvement or other reasons. This is demonstrated by a case study of a patient hospitalized following acute vision loss to the right eye whose glucocorticoid treatment was suspended after temporal artery biopsy revealed no evidence of GCA. The patient subsequently lost sight in the left eye 6 weeks after stopping glucocorticoid therapy. The specificity of temporal artery biopsy for the diagnosis of GCA is variable and influenced by many factors, including length of biopsy specimens, vasculitis in vessels other than the temporal artery (ophthalmic, retinal and posterior ciliary vessels), unilateral versus bilateral biopsy, expertise of the surgeon, interpretation of histology, effects of treatment and confounding factors such as atherosclerosis or other non-GCA diseases that can affect the temporal artery. Considering the limitations of temporal artery biopsy, collaboration and education between the clinician, the pathologist and the patient, taking into account a thorough examination of patient history, recognizing signs and symptoms, and potentially involving newer imaging studies with trained technicians and physicians, are essential in confirming or eliminating diagnosis of GCA.
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Affiliation(s)
- Yara Banz
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - John H Stone
- Massachusetts General Hospital Rheumatology Unit, Harvard Medical School, Boston, MA, USA
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Accelerated atheromatosis and arteriosclerosis in primary systemic vasculitides: current evidence and future perspectives. Curr Opin Rheumatol 2018; 30:36-43. [DOI: 10.1097/bor.0000000000000453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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11
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Liozon E. Improving diagnosis and prognosis in giant cell arteritis: Still more issues than answers. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Affiliation(s)
- Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, DY1 2HQ, UK.
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Risk of mortality in patients with giant cell arteritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2017; 46:513-519. [DOI: 10.1016/j.semarthrit.2016.08.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 01/09/2023]
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15
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Approach to giant cell arteritis and recent evidence on its relation with cardiovascular risk. A review. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ungprasert P, Thongprayoon C, Warrington KJ. Lower body mass index is associated with a higher risk of giant cell arteritis: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:232. [PMID: 26539449 DOI: 10.3978/j.issn.2305-5839.2015.09.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To characterize the possible association between body mass index (BMI) and risk of giant cell arteritis (GCA). METHODS We conducted a systematic review of observational studies (case-control or cohort study) that (I) reported BMI of patients with GCA prior to the diagnosis of GCA compared with subjects without GCA and (II) provided relative risk (RR), odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI) from its regression analysis. Meta-analysis of the included studies was then performed to estimate the pooled effect using generic variance method of DerSimonian and Laird. RESULTS Three studies encompassing 141 patients with GCA and 85,736 controls met our eligibility criteria and were included in the data analyses. We demonstrated a statistically significant inverse relationship between BMI and risk of subsequent development of GCA as the risk increased by 8% when BMI was reduced by 1.0 kg/m(2) (pooled OR of 0.92/kg/m(2); 95% CI, 0.88-0.96). CONCLUSIONS Our study demonstrated a statistically significant inverse relationship between BMI and risk of subsequent development GCA. The pathophysiologic link behind this negative correlation is not well-characterized and further investigation is required.
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Affiliation(s)
- Patompong Ungprasert
- 1 Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA ; 2 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ; 3 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Charat Thongprayoon
- 1 Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA ; 2 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ; 3 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Kenneth J Warrington
- 1 Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA ; 2 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ; 3 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Ungprasert P, Upala S, Sanguankeo A, Warrington KJ. Patients with giant cell arteritis have a lower prevalence of diabetes mellitus: A systematic review and meta-analysis. Mod Rheumatol 2015; 26:410-4. [PMID: 26381748 DOI: 10.3109/14397595.2015.1081722] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study is to compare the prevalence of diabetes mellitus (DM) in patients who are recently diagnosed with giant cell arteritis (GCA) with age- and sex-matched controls. METHODS We conducted a systematic review and meta-analysis of observational studies that (1) consisted of GCA cohort and non-GCA cohort that was randomly selected from the same population and (2) provided prevalences of DM at the time of diagnosis for patients with GCA and at the index date for controls. Pooled odds ratios and 95% confidence intervals (CIs) were calculated using a random-effect, Mantel-Haenszel analysis. RESULTS Five studies with 903 patients with GCA and 1064 controls were identified and included in our data analysis. We demonstrated a statistically significant lower prevalence of DM among patients with GCA with the pooled OR of 0.74 (95% CI, 0.57-0.97). CONCLUSION At diagnosis, patients with GCA had a lower prevalence of DM. Whether DM could be a protective factor against the development of GCA needs further investigations.
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Affiliation(s)
- Patompong Ungprasert
- a Department of Internal Medicine , Division of Rheumatology, Mayo Clinic , Rochester , MN , USA .,b Department of Medicine , Faculty of Medicine Siriraj Hospital, Division of Rheumatology , Bangkok , Thailand , and
| | - Sikarin Upala
- c Department of Medicine , Bassett Medical Center , New York , NY , USA
| | - Anawin Sanguankeo
- c Department of Medicine , Bassett Medical Center , New York , NY , USA
| | - Kenneth J Warrington
- a Department of Internal Medicine , Division of Rheumatology, Mayo Clinic , Rochester , MN , USA
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Ungprasert P, Koster MJ, Warrington KJ. Coronary artery disease in giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2014; 44:586-591. [PMID: 25434528 DOI: 10.1016/j.semarthrit.2014.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the association between giant cell arteritis (GCA) and risk of coronary artery disease (CAD). METHODS We conducted a systematic review and meta-analysis of observational studies that reported relative risks, hazard ratios, or standardized incidence ratios with 95% confidence interval comparing CAD risk in patients with GCA versus non-GCA controls. Pooled risk ratios and 95% confidence intervals were calculated using a random-effect, generic inverse variance of DerSimonian and Laird. RESULT Six studies with 10,868 patients with GCA and 245,323 controls were identified and included in our data analysis. The pooled risk ratio of CAD in patients with GCA was 1.51 and did not achieve statistical significance (95% CI: 0.88-2.61). The statistical heterogeneity was high with an I(2) of 97%. CONCLUSION In contrast to other chronic systemic inflammatory disorders, our meta-analysis did not show any statistically significant increased risk of CAD among patients with GCA.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Matthew J Koster
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Tanaka N, Kusunoki N, Kusunoki Y, Hasunuma T, Kawai S. Resistin is associated with the inflammation process in patients with systemic autoimmune diseases undergoing glucocorticoid therapy: comparison with leptin and adiponectin. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0623-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Nahoko Tanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Natsuko Kusunoki
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshie Kusunoki
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
| | - Tomoko Hasunuma
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
- Research Center for Clinical Pharmacology, Kitasato University,
Tokyo, Japan
| | - Shinichi Kawai
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University,
6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan
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Hafner F, Haas E, Belaj K, Froehlich H, Gary T, Eller P, Brodmann M. Endothelial function and carotid intima-media thickness in giant-cell arteritis. Eur J Clin Invest 2014; 44:249-56. [PMID: 24329018 DOI: 10.1111/eci.12227] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/09/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vascular endothelial dysfunction and intima-media thickness are characteristic aspects of several vasculitides. We investigated retrospectively the impact of steroid treatment on endothelial dysfunction and intima-media thickness in giant-cell arteritis. METHODS Forty-one patients with giant-cell arteritis (28 female and 13 male) underwent flow-mediated dilatation, a marker of endothelial function, and carotid intima-media thickness within 24 h after diagnosis and 6 months thereafter. Both parameters were investigated in 41 patients of an age- and gender-matched control group. RESULTS Brachial flow-mediated dilatation response at baseline was 3.4% (0.2, 8.0) and 1.7% (0.2, 4.8) in giant-cell arteritis patients and control group, respectively. After 6 months treatment, flow-mediated dilatation response was 2.8% (0.4, 4.8) in patients with giant-cell arteritis (P = 0.066) and 1.4% (0.1, 5.5) in the control group (P = 0.741). In contrast, mean carotid intima-media thickness of giant-cell arteritis patients improved significantly between baseline [1.0 mm (0.79, 1.2)] and 6-month follow-up [0.82 mm (0.7, 1.04), P < 0.001]. Subjects with additional symptoms of polymyalgia rheumatica had a notable enlargement of carotid intima-media thickness [1.23 mm (1.14, 2.09)] compared to giant-cell arteritis patients without polymyalgia rheumatica at baseline [0.91 mm (0.76, 1.04), P = 0.001] and 6-month follow-up [1.16 mm (0.80, 1.26) vs. 0.77 mm (0.68, 0.88), P = 0.009]. CONCLUSION Steroid therapy has no influence on endothelial function but does significantly improve carotid intima-media thickness in giant-cell arteritis. This divergence of endothelial function and intima-media thickness reflects the specifity of giant-cell arteritis for cerebrovascular arteries thereby sparing the brachial arteries.
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Affiliation(s)
- Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Cardiovascular disease due to accelerated atherosclerosis in systemic vasculitides. Best Pract Res Clin Rheumatol 2013; 27:33-44. [DOI: 10.1016/j.berh.2012.12.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 12/22/2012] [Accepted: 12/27/2012] [Indexed: 02/08/2023]
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Abstract
BACKGROUND We tested the hypothesis that patients with diabetes mellitus (DM) develop biopsy-positive giant cell arteritis (GCA) significantly less frequently than nondiabetic patients. METHODS We compared the prevalence of DM in patients with positive temporal artery biopsy (TAB) with that in patients with negative TAB via a retrospective study of 215 patients who underwent TAB. Patients were classified as having biopsy-positive GCA if microscopic examination disclosed active or healed arteritis. Patients were classified as having DM if they had a diagnosis of diabetes in their medical history or were taking oral hypoglycemic medications and/or insulin at or before the time of biopsy. In addition, we performed a meta-analysis of 8 previously published articles with a total of 1,401 additional biopsy-proven cases of GCA in patients whose status was recorded as diabetic or nondiabetic. RESULTS Of 44 cases with biopsy-positive GCA in our patient cohort, only 4 (9.1%) were diabetic at or before the time of biopsy. Of 171 patients with negative TAB, 61 (35.7%) had DM (P = 0.0006). The prevalence of DM among recorded cases of biopsy-positive GCA ranged from 0% to 13.8% in the 8 studies included in our meta-analysis, with a combined frequency of 89 diabetic patients in a total of 1,401 cases (6.35%). CONCLUSION The low frequency of a positive TAB in diabetic GCA suspects should be considered when formulating an index of suspicion in the evaluation of patients with possible GCA. More research is needed to delineate the nature of the interaction between DM and GCA.
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Tanaka N, Kusunoki N, Kusunoki Y, Hasunuma T, Kawai S. Resistin is associated with the inflammation process in patients with systemic autoimmune diseases undergoing glucocorticoid therapy: comparison with leptin and adiponectin. Mod Rheumatol 2012; 23:8-18. [PMID: 22434063 DOI: 10.1007/s10165-012-0623-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 02/14/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the role of adipokines in patients with systemic autoimmune diseases who received glucocorticoid therapy. METHODS Fifty-two patients with systemic autoimmune diseases who had started glucocorticoid therapy were prospectively enrolled. One hundred forty healthy persons were also studied as controls. Serum levels of 3 adipokines [resistin, leptin, and high molecular weight (HMW)-adiponectin] were measured with enzyme-linked immunosorbent assay kits before and at weekly intervals for 4 weeks during glucocorticoid therapy. The effects of lipopolysaccharide and dexamethasone on adipokine expression in human peripheral blood mononuclear cells (PBMCs) were also examined. RESULTS The serum resistin level was significantly higher in patients than in controls before glucocorticoid therapy, and it decreased after glucocorticoid therapy. Consistent with these results, dexamethasone inhibited lipopolysaccharide-induced upregulation of resistin expression in PBMCs in vitro. Serum leptin and HMW-adiponectin levels were lower in the patients than in the controls at baseline, and both adipokine levels were increased after glucocorticoid therapy. There was a significant correlation between serum resistin and high-sensitivity C-reactive protein. However, there was no association between serum adipokines and intima-media thickness. CONCLUSION Resistin may be associated with the inflammatory process but not atherosclerosis in patients with systemic autoimmune diseases.
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Affiliation(s)
- Nahoko Tanaka
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Faculty of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Czihal M, Tatò F, Rademacher A, Kuhlencordt P, Schulze-Koops H, Hoffmann U. Involvement of the femoropopliteal arteries in giant cell arteritis: clinical and color duplex sonography. J Rheumatol 2012; 39:314-21. [PMID: 22247342 DOI: 10.3899/jrheum.110566] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the extent and clinical significance of giant cell arteritis (GCA) of the femoropopliteal arteries. METHODS This was a retrospective clinical color duplex sonography (CDS) study; 60 of 112 consecutive patients with the diagnosis of GCA underwent complete clinical examination of the lower extremities including the vasculature, systolic ankle pressure measurement, and CDS scans of the femoropopliteal arteries within 1 year after diagnosis of GCA. Circumferential, hypoechogenic, homogenous wall thickening was regarded as a hallmark of femoropopliteal GCA. RESULTS GCA of femoropopliteal arteries was present in 32 (53.3%) of 60 patients. In general, femoropopliteal GCA developed bilaterally (100%) and 14 patients (23.3%) had significant lower extremity artery obstructions secondary to vasculitis, all leading to symptomatic lower extremity ischemia, with development of critical leg ischemia in 4 patients. Compared with subjects without lower extremity vasculitis, patients with femoropopliteal involvement had a significant time delay until diagnosis (mean 23.9 vs 11.1 weeks; p = 0.03) and a higher frequency of concomitant vasculitis of the arm arteries (74.2% vs 42.9%; p = 0.02). CONCLUSION Femoropopliteal artery involvement appears to be a clinically relevant manifestation of GCA, frequently leading to symptomatic lower extremity ischemia. CDS of the femoropopliteal arteries is a noninvasive diagnostic tool for detection of lower extremity vasculitis in GCA.
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Affiliation(s)
- Michael Czihal
- Division of Vascular Medicine, Medical Policlinic, University Hospital, Campus City Center, Munich, Germany.
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García-Martínez A, Hernández-Rodríguez J, Espígol-Frigolé G, Prieto-González S, Butjosa M, Segarra M, Lozano E, Cid MC. Clinical relevance of persistently elevated circulating cytokines (tumor necrosis factor alpha and interleukin-6) in the long-term followup of patients with giant cell arteritis. Arthritis Care Res (Hoboken) 2010; 62:835-41. [PMID: 20535794 DOI: 10.1002/acr.20043] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the clinical relevance of increased circulating cytokines in patients with giant cell arteritis (GCA) after long-term followup. METHODS We performed a cross-sectional evaluation of 54 patients with biopsy-proven GCA prospectively followed for a median of 5.4 years (range 4-10.5 years). GCA-related complications, vascular events, relapses, current prednisone dose, time required to achieve a maintenance prednisone dosage <10 mg/day, cumulated prednisone at that point, and adverse effects during followup were recorded. Serum interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFalpha) were determined by immunoassay. RESULTS All patients were in clinical remission. Both cytokines were significantly higher in patients than in controls (mean +/- SD 21 +/- 35 versus 5 +/- 11 pg/ml; P < 0.001 for IL-6 and mean +/- SD 32 +/- 14 versus 16 +/- 9 pg/ml; P < 0.001 for TNFalpha). No differences were found in patients with or without GCA-related complications or vascular events during followup. Circulating cytokines were significantly higher in patients who had experienced relapses (mean +/- SD 25 +/- 39 versus 10 +/- 11 pg/ml; P = 0.04 for IL-6 and mean +/- SD 34 +/- 15 versus 25 +/- 11 pg/ml; P = 0.042 for TNFalpha). IL-6 was significantly higher in patients still requiring prednisone (mean +/- SD 29 +/- 45 versus 13 +/- 17 pg/ml; P = 0.008), and TNFalpha correlated with cumulated prednisone dose (r = 0.292, P = 0.04). No significant relationship was found between elevated cytokines and prednisone adverse effects or patients' quality of life. CONCLUSION Circulating TNFalpha and IL-6 may persist elevated in GCA patients after long-term followup and remain higher in patients who have experienced more relapsing disease. However, in this patient cohort, elevated circulating cytokines were not associated with increased frequency of GCA complications, vascular events, or treatment-related side effects.
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Affiliation(s)
- Ana García-Martínez
- Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Abstract
Objective—
To perform a systematic review and meta-analysis to examine whether rheumatic disease is associated with an increased carotid intima-media thickness (CIMT; increasingly used as a surrogate marker for atherosclerosis) when compared with healthy control subjects.
Methods and Results—
A prespecified search strategy was used to identify relevant studies in the MEDLINE and EMBASE databases (January 1, 1986 to December 31, 2008). Methodological quality was assessed using the Newcastle-Ottawa score for observational studies. A total of 68 controlled comparisons from 60 different studies were reviewed: 25 (37%) on rheumatoid arthritis, 24 (35%) on systemic lupus erythematosus, 6 (9%) on systemic sclerosis, and 13 (19%) on other rheumatic diseases. Random-effects meta-regression analysis was performed. The estimated summary effect size between control and study subject CIMT measurement comparisons, with preexisting cardiovascular disease excluded, was 0.64 (95% CI, 0.46 to 0.82). This represented an overall absolute mean difference of 0.06 mm (95% CI, 0.05 to 0.06 mm). Preexisting cardiovascular disease, rheumatic disease type, and disease duration contributed to heterogeneity.
Conclusion—
Accelerated atherosclerosis is a common complication of autoimmune rheumatic diseases, with early changes seen even in pediatric patients. CIMT was significantly increased in rheumatic disease populations. Future studies need to use a standardized protocol to ensure clinically meaningful results when measuring CIMT as a surrogate for premature atherosclerosis.
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Mayadas TN, Tsokos GC, Tsuboi N. Mechanisms of immune complex-mediated neutrophil recruitment and tissue injury. Circulation 2009; 120:2012-24. [PMID: 19917895 DOI: 10.1161/circulationaha.108.771170] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Tanya N Mayadas
- Center for Excellence in Vascular Biology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, Miranda-Filloy JA, Gonzalez-Juanatey C, Martin J, Llorca J. Epidemiology of giant cell arteritis and polymyalgia rheumatica. ACTA ACUST UNITED AC 2009; 61:1454-61. [PMID: 19790127 DOI: 10.1002/art.24459] [Citation(s) in RCA: 363] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gonzalez-Gay MA, Vazquez-Rodriguez TR, Gomez-Acebo I, Pego-Reigosa R, Lopez-Diaz MJ, Vazquez-Triñanes MC, Miranda-Filloy JA, Blanco R, Dierssen T, Gonzalez-Juanatey C, Llorca J. Strokes at time of disease diagnosis in a series of 287 patients with biopsy-proven giant cell arteritis. Medicine (Baltimore) 2009; 88:227-235. [PMID: 19593228 DOI: 10.1097/md.0b013e3181af4518] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with giant cell arteritis (GCA) generally present with cranial ischemic manifestations that are directly related to vascular involvement. They may also experience strokes in the territory of the carotid or the vertebrobasilar artery. We conducted the current study to assess the frequency and predictors of strokes in general, and of vertebrobasilar stroke in particular, at the time of diagnosis in a series of 287 consecutive patients with biopsy-proven GCA diagnosed over a 27-year period at the single hospital for a well-defined population of northwestern Spain.During the study period, 8 (2.8%) patients had strokes (1 in the carotid and 7 in the vertebrobasilar territory) between the onset of symptoms of the disease and 4 weeks after the onset of corticosteroid therapy. Six of the 7 patients with vertebrobasilar stroke were men. In most cases the vertebrobasilar stroke occurred after the onset of corticosteroid therapy. Smoking history was more common among patients with vertebrobasilar stroke (p = 0.01). Patients with vertebrobasilar stroke more commonly had permanent visual loss due to arteritic involvement of ophthalmic branches derived from the internal carotid (3/7; 42.9%) than the rest of GCA patients (33/280; 11.8%) (p = 0.05). Patients with strokes had higher hemoglobin values (13.2 +/- 1.5 g/dL) than patients without (11.7 +/- 1.6 g/dL) (p = 0.009). Moreover, only 1 (14.3%) of the 7 patients with vertebrobasilar stroke had anemia compared to 157 (56.1%) of the remaining 280 patients (p = 0.05). The best predictors of stroke were permanent visual loss (odds ratio [OR], 5.42) and arterial hypertension (OR, 5.06). In contrast, women (OR, 0.10) and patients with anemia at the time of disease diagnosis (OR, 0.11) had a significantly reduced risk of suffering strokes. Smoking history was the best positive predictor of vertebrobasilar stroke (OR, 5.22). In contrast, a reduced risk of suffering vertebrobasilar strokes was found in individuals who had anemia at the time of GCA diagnosis (OR, 0.13).Results of the current study show an increased risk of strokes, in the vertebrobasilar territory in particular, at the time of GCA diagnosis. Patients with biopsy-proven GCA and traditional cardiovascular risk factors or permanent visual loss have an increased risk of suffering strokes. Results also suggest a potential protective role of anemia against the development of these cerebrovascular complications.
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Affiliation(s)
- Miguel A Gonzalez-Gay
- From Divisions of Rheumatology (MAGG, TRVR, JAMF, RB), Neurology (RPR), Medicine (MJLD), and Cardiology (CGJ), Hospital Xeral-Calde, Lugo; Division of Medicine (MCVT), Hospital Xeral, Vigo; Division of Rheumatology (RB), Hospital Universitario Marques de Valdecilla, Santander; and Division of Preventive Medicine and Public Health, Division of Epidemiology and Computational Biology (IGA, TD, JL), School of Medicine, University of Cantabria, Santander; and CIBER Epidemiología y Salud Pública (CIBERESP) (JL), Spain
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Abstract
Patients with polymyalgia rheumatica have been shown to have an increased risk of peripheral arterial disease on longitudinal follow-up. Possible explanations for this include premature atherosclerosis related to chronic inflammation, as with other inflammatory rheumatological conditions. Alternatively, polymyalgia rheumatica can be associated with vasculitis, even in the absence of clinical giant cell arteritis, and peripheral vascular disease may represent subclinical vasculitis. Further work is required to elucidate the reasons for this increased risk. Currently, it would remain reasonable to aggressively control modifiable atherosclerotic risk factors.
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31
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Tervaert JWC. Translational mini-review series on immunology of vascular disease: accelerated atherosclerosis in vasculitis. Clin Exp Immunol 2009; 156:377-85. [PMID: 19309350 DOI: 10.1111/j.1365-2249.2009.03885.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Premature atherosclerosis has been observed during the course of different systemic inflammatory diseases such as rheumatoid arthritis and sytemic lupus erythematosus. Remarkably, relatively few studies have been published on the occurrence of accelerated atherosclerosis in patients with vasculitis. In giant cell arteritis (GCA), mortality because of ischaemic heart disease is not increased. In addition, intima media thickness (IMT) is lower in patients with GCA than in age-matched controls. In contrast, IMT is increased significantly in Takayasu arteritis, another form of large vessel vasculitis occurring in younger patients. In Takayasu arteritis and in Kawasaki disease, a form of medium-sized vessel vasculitis, accelerated atherosclerosis has been well documented. In small vessel vasculitis because of anti-neutrophil cytoplasmic autoantibodies-associated vasculitis, cardiovascular diseases are a major cause of mortality. IMT measurements reveal conflicting results. During active disease these patients experience acceleration of the atherosclerotic process. However, when inflammation is controlled, these patients have atherosclerotic development as in healthy subjects. Several risk factors, such as diabetes and hypertension, are present more often in patients with vasculitis compared with healthy controls. In addition, steroids may be pro-atherogenic. Most importantly, many patients have impaired renal function, persistent proteinuria and increased levels of C-reactive protein, well-known risk factors for acceleration of atherosclerosis. Enhanced oxidation processes, persistently activated T cells and reduced numbers of regulatory T cells are among the many pathophysiological factors that play a role during acceleration of atherogenesis. Finally, autoantibodies that may be relevant for acceleration of atherosclerosis are found frequently in elevated titres in patients with vasculitis. Because patients have an increased risk for cardiovascular events, vasculitis should be treated with as much care as possible. In addition, treatment should be considered with angiotensin-converting-enzyme inhibitors and/or angiotensin receptor-1 blockers, statins and acetylsalicyl acid. Finally, classical risk factors for cardiovascular disease should be monitored and treated as much as possible.
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Affiliation(s)
- J W Cohen Tervaert
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Hadoke PWF, Iqbal J, Walker BR. Therapeutic manipulation of glucocorticoid metabolism in cardiovascular disease. Br J Pharmacol 2009; 156:689-712. [PMID: 19239478 DOI: 10.1111/j.1476-5381.2008.00047.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The therapeutic potential for manipulation of glucocorticoid metabolism in cardiovascular disease was revolutionized by the recognition that access of glucocorticoids to their receptors is regulated in a tissue-specific manner by the isozymes of 11beta-hydroxysteroid dehydrogenase. Selective inhibitors of 11beta-hydroxysteroid dehydrogenase type 1 have been shown recently to ameliorate cardiovascular risk factors and inhibit the development of atherosclerosis. This article addresses the possibility that inhibition of 11beta-hydroxsteroid dehydrogenase type 1 activity in cells of the cardiovascular system contributes to this beneficial action. The link between glucocorticoids and cardiovascular disease is complex as glucocorticoid excess is linked with increased cardiovascular events but glucocorticoid administration can reduce atherogenesis and restenosis in animal models. There is considerable evidence that glucocorticoids can interact directly with cells of the cardiovascular system to alter their function and structure and the inflammatory response to injury. These actions may be regulated by glucocorticoid and/or mineralocorticoid receptors but are also dependent on the 11beta-hydroxysteroid dehydrogenases which may be expressed in cardiac, vascular (endothelial, smooth muscle) and inflammatory (macrophages, neutrophils) cells. The activity of 11beta-hydroxysteroid dehydrogenases in these cells is dependent upon differentiation state, the action of pro-inflammaotory cytokines and the influence of endogenous inhibitors (oxysterols, bile acids). Further investigations are required to clarify the link between glucocorticoid excess and cardiovascular events and to determine the mechanism through which glucocorticoid treatment inhibits atherosclerosis/restenosis. This will provide greater insights into the potential benefit of selective 11beta-hydroxysteroid dehydrogenase inhibitors in treatment of cardiovascular disease.
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Affiliation(s)
- Patrick W F Hadoke
- Centre for Cardiovascular Sciences, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK.
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Abstract
Giant cell arteritis (GCA) is the most common primary vasculitis of adults. The incidence of this disease is practically nil in the population under the age of 50 years, then rises dramatically with each passing decade. The median age of onset of the disease is about 75 years. As the ageing population expands, it is increasingly important for ophthalmologists to be familiar with GCA and its various manifestations, ophthalmic and non-ophthalmic. A heightened awareness of this condition can avoid delays in diagnosis and treatment. It is well known that prompt initiation of steroids remains the most effective means for preventing potentially devastating ischaemic complications. This review summarizes the current concepts regarding the immunopathogenetic pathways that lead to arteritis and the major phenotypic subtypes of GCA with emphasis on large vessel vasculitis, novel modalities for disease detection and investigative trials using alternative, non-steroid therapies.
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Affiliation(s)
- Aki Kawasaki
- Department of Neuro-ophthalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland.
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Gonzalez-Gay MA, Gonzalez-Juanatey C, Vazquez-Rodriguez TR, Martin J, Llorca J. Carotid intima-media thickness and endothelial function: useful surrogate markers for establishing cardiovascular risk in patients with inflammatory rheumatic disease. Arthritis Res Ther 2008; 10:403; author reply 404. [PMID: 18510782 PMCID: PMC2483434 DOI: 10.1186/ar2409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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