1
|
van der Geest KSM, Gheysens O, Gormsen LC, Glaudemans AWJM, Tsoumpas C, Brouwer E, Nienhuis PH, van Praagh GD, Slart RHJA. Advances in PET Imaging of Large Vessel Vasculitis: An Update and Future Trends. Semin Nucl Med 2024; 54:753-760. [PMID: 38538456 DOI: 10.1053/j.semnuclmed.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 08/20/2024]
Abstract
Systemic vasculitides are autoimmune diseases characterized by inflammation of blood vessels. They are categorized based on the size of the preferentially affected blood vessels: large-, medium-, and small-vessel vasculitides. The main forms of large-vessel vasculitis include giant cell arteritis (GCA) and Takayasu arteritis (TAK). Depending on the location of the affected vessels, various imaging modalities can be employed for diagnosis of large vessel vasculitis: ultrasonography (US), magnetic resonance angiography (MRA), computed tomography angiography (CTA), and [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT). These imaging tools offer complementary information about vascular changes occurring in vasculitis. Recent advances in PET imaging in large vessel vasculitis include the introduction of digital long axial field-of-view PET/CT, dedicated acquisition, quantitative methodologies, and the availability of novel radiopharmaceuticals. This review aims to provide an update on the current status of PET imaging in large vessel vasculitis and to share the latest developments on imaging vasculitides.
Collapse
Affiliation(s)
- Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Lars C Gormsen
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus N, Denmark
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Charalampos Tsoumpas
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter H Nienhuis
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs D van Praagh
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
| |
Collapse
|
2
|
Mestre-Torres J, Sanz-Pérez I. [Doppler ultrasound in giant cell arteritis: More lights than shadows]. Med Clin (Barc) 2024; 163:132-133. [PMID: 38871613 DOI: 10.1016/j.medcli.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Jaume Mestre-Torres
- Servei de Medicina Interna, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - Isidro Sanz-Pérez
- Servei de Medicina Interna, Hospital Universitari Vall d'Hebron, Barcelona, España
| |
Collapse
|
3
|
Juncker AS, Appenzeller S, de Souza JM. Central Nervous System Involvement in Systemic Autoimmune Rheumatic Diseases-Diagnosis and Treatment. Pharmaceuticals (Basel) 2024; 17:1044. [PMID: 39204149 PMCID: PMC11357437 DOI: 10.3390/ph17081044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/19/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
Central nervous system (CNS) involvement in autoimmune rheumatic diseases represents a significant challenge for clinicians across all specialties. While most reviews on the subject focus on neurological manifestations within a specific rheumatic disease, few descriptions shift from neurological clinical syndromes to achieve rheumatological diagnoses. This narrative review aims to synthesize current knowledge on the diagnosis and management of CNS manifestations occurring in the most prevalent rheumatic conditions in adults. We searched the MEDLINE database using the terms "central nervous system", "rheumatic diseases", "systemic lupus erythematosus", "rheumatoid arthritis", "Sjögren syndrome", and "vasculitis". The search strategy included review articles from 2019 to 2024, published in English, Spanish, or Portuguese. We explored the pathophysiological mechanisms linking autoimmunity to CNS pathology, emphasizing the role of syndromic reasoning, autoantibody profiles, and imaging modalities as tools for diagnosis and determination of inflammatory activity. The review also discusses differential diagnoses through a stepwise approach to neurological syndromes, summarized in diagnostic flowcharts, and presents updated treatment options. Although our approach is primarily semiology-based, the complexity of the subject invites future endeavors involving new technologies, such as functional MRI, MR spectroscopy, and nuclear medicine.
Collapse
Affiliation(s)
- Aline Santana Juncker
- Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-881, Brazil;
- Post-Graduate Program in Medical Sciences, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13000-000, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, Brazil;
| | - Jean Marcos de Souza
- Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-881, Brazil;
| |
Collapse
|
4
|
Kawka L, Chevet B, Arnaud L, Becker G, Carvajal Alegria G, Felten R. The pipeline of immunomodulatory therapies in polymyalgia rheumatica and giant cell arteritis: A systematic review of clinical trials. Autoimmun Rev 2024; 23:103590. [PMID: 39122202 DOI: 10.1016/j.autrev.2024.103590] [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: 05/21/2024] [Revised: 08/01/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for polymyalgia rheumatic (PMR) and giant cell arteritis (GCA), in the coming years. METHODS We conducted a systematic review of 17 national and international clinical trial databases for all disease-modifying anti-rheumatic drugs (DMARDs) for PMR and GCA that are already marketed, in clinical development or withdrawn. The search was performed on January 2024, with the keywords "polymyalgia rheumatica" and "giant cell arteritis". For each molecule, we only considered the study at the most advanced stage of clinical development. RESULTS For PMR, a total of 15 DMARDs were identified: 2 conventional synthetic DMARDs (csDMARDs), 11 biologic DMARDs (bDMARDs) and 2 targeted synthetic DMARDs (tsDMARDs). For GCA, 18 DMARDs were identified: 2 csDMARDs, 14 bDMARDs and 2 tsDMARDs. Currently, there are only 2 approved corticosteroid-sparing therapies in these diseases, which both target the IL-6 signaling pathway, namely tocilizumab in GCA and sarilumab in PMR. Most of the molecules in current development are repurposed from from other conditions and clinical research in PMR/GCA seems to be mostly driven by the potential to repurpose existing treatments rather than by translational research. CONCLUSION This systematic review identified 23 DMARDs evaluated for PMR and GCA: 3 csDMARDs, 17 bDMARDs and 3 tsDMARDs. Several promising treatments are likely to be marketed in the coming years.
Collapse
Affiliation(s)
- Lou Kawka
- Service de Rhumatologie, Centre National de Référence des Maladies Auto-immunes et Systémiques Rares (RESO), Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Baptiste Chevet
- UMR 1227 Lymphocytes B et auto-immunité, université de Brest, Inserm, CHU de Brest, Brest, France; Service de Rhumatologie, Hôpital de la Cavale Blanche, CHU de Brest, Bd Tanguy-Prigent, 29200 Brest, France
| | - Laurent Arnaud
- Service de Rhumatologie, Centre National de Référence des Maladies Auto-immunes et Systémiques Rares (RESO), Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Guillaume Becker
- Pôle Pharmacie-Pharmacologie, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France; Département Universitaire de Pharmacologie, Addictologie, Toxicologie et Thérapeutique (DUPATT), Université de Strasbourg, Strasbourg, France
| | | | - Renaud Felten
- Service de Rhumatologie, Centre National de Référence des Maladies Auto-immunes et Systémiques Rares (RESO), Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France; Département Universitaire de Pharmacologie, Addictologie, Toxicologie et Thérapeutique (DUPATT), Université de Strasbourg, Strasbourg, France; Center for Clinical Investigation, INSERM U1434, Strasbourg, France.
| |
Collapse
|
5
|
Milchert M, Wójcik K, Musiał J, Masiak A, Majdan M, Jeleniewicz R, Tłustochowicz W, Kur-Zalewska J, Wisłowska M, Lewandowska-Polak A, Makowska J, Brzosko M. Increased interest with the introduction of fast-track diagnostic pathway is associated with the regionally increased frequency of giant cell arteritis in Poland: a study based on POLVAS registry data. Front Med (Lausanne) 2024; 11:1440725. [PMID: 39170043 PMCID: PMC11336242 DOI: 10.3389/fmed.2024.1440725] [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: 05/29/2024] [Accepted: 07/22/2024] [Indexed: 08/23/2024] Open
Abstract
Slavic populations, such as those in Poland, are considered to have a low prevalence of giant cell arteritis (GCA), although epidemiological data are sparse. The study aimed to compare the reported frequency of GCA in various regions of Poland and analyze the differences between them. We conducted a multicenter, retrospective study of all GCA patients included in the POLVAS registry-the first large multicenter database of patients with vasculitis in Poland. The data from the POLVAS registry were compared with the reported prevalence provided by national insurers from the corresponding regions. A 10-fold increase in the diagnostic rates of GCA was observed in Poland between 2008 and 2019, reaching 8.38 per 100,000 population > 50 years old. It may be attributed to increased interest accompanied by improved diagnostic modalities with the introduction of ultrasound-based, fast-track diagnostic pathways in some centers. However, regional inequities are present, resulting in 10-fold differences (from 2.57 to 24.92) in reported prevalence between different regions. Corticosteroid (CS) monotherapy was the main stem of treatment. Further cooperation and education are needed to minimize regional inequities. This observational study suggests some potential for further increase of the recognizability of GCA and wider use of other than CS monotherapy treatment regimens. We hope that the Polish experience might be interesting and serve as some guidance for the populations where GCA is underdiagnosed.
Collapse
Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Diseases, Diabetology, Geriatrics and Clinical Immunology with Gastroenterology Department, Pomeranian Medical University, Szczecin, Poland
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Musiał
- 2nd Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland
| | - Radoslaw Jeleniewicz
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland
| | | | - Joanna Kur-Zalewska
- Clinical Trials Support Center, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Małgorzata Wisłowska
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases, Diabetology, Geriatrics and Clinical Immunology with Gastroenterology Department, Pomeranian Medical University, Szczecin, Poland
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
6
|
Baig A, Gafoor-Haseeb S, Goldsher J, Siddique F. Updates in the Management of Giant Cell Arteritis. Curr Neurol Neurosci Rep 2024; 24:285-291. [PMID: 38913278 DOI: 10.1007/s11910-024-01348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF THE REVIEW To briefly review the latest updates in management in giant cell arteritis, an autoimmune vasculitis affecting the medium to large vessels. RECENT FINDINGS Here, we review the known and newer trends in management of giant cell arteritis. While high dose glucocorticoids remain the mainstay of therapy, immunosuppressive medications are increasingly utilized to reduce the burden and risk of long-term glucocorticoid use. Published guidelines by the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) suggest early use of steroid-sparing immunosuppressive medications in patients with recently diagnosed or relapsing giant cell arteritis. Immunosuppressive medications include oral small molecules such as methotrexate and leflunomide and biologics, including the recently Federal Drug Administration (FDA) approved tocilizumab. Glucocorticoids remain the cornerstone of management for newly diagnosed disease but with the increasing use of medications such as IL-6 inhibitors, patients are decreasing steroid use within weeks, thereby limiting risks associated with long-term steroid use.
Collapse
Affiliation(s)
- Aqil Baig
- St James School of Medicine, A-1, Albert Lake Dr, The Quarter, 2640, Anguilla
| | - Sana Gafoor-Haseeb
- Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA
| | - Jay Goldsher
- Internal Medicine Resident, Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA
| | - Faizah Siddique
- Loyola University Medical Center, 2160 S First Ave, Maywood, IL, 60153, USA.
| |
Collapse
|
7
|
González-García A, Fabregate M, Serralta G, de Miguel Campo B, Noblejas-Mozo A, Robles-Marhuenda Á. The utility of 18F-FDG-PET/CT in detecting extracranial large vessel vasculitis in rheumatic polymyalgia or giant cell arteritis. A systematic review and meta-analysis. Rev Clin Esp 2024; 224:445-456. [PMID: 38852739 DOI: 10.1016/j.rceng.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/25/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Systematic review of current evidence to analyze the prevalence of extracranial large vessel vasculitis (LVV) using 18F-FDG PET/CT in patients with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA). MATERIALS AND METHODS PubMed and EMBASE were searched and the results were screened by two reviewers. Study quality was assessed using a modified version of the Newcastle-Ottawa scale. Heterogeneity between studies was assessed using the I2 statistic and the Q test. Further subgroup analyses were performed by disease type, study quality, and 18F-FDG PET/CT uptake criteria. Publication bias was assessed by funnel plot and Egger's test. RESULTS 268 publications were identified, of which 17 met the selection criteria and were included in the meta-analysis. The overall pooled prevalence of extracranial LVV by 18F-FDG PET/CT was 54.5% [95% CI: 42.6%-66.1%]. In patients with GCA the prevalence was significantly higher than in patients with PMR (60.1% vs. 41.8%, P = 0.006). Likewise, studies with a lower risk of bias reported a higher prevalence of extracranial LVV (61.1% vs. 46.9%; P = 0.010). No publication bias was observed. CONCLUSIONS The 18F-FDG PET/CT test may be useful in the detection of extracranial LVV, both in patients with PMR or GCA. Such involvement is more frequent in patients with GCA, and may vary depending on the quality of the studies.
Collapse
Affiliation(s)
- Andrés González-García
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - Martín Fabregate
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Gonzalo Serralta
- Servicio de Medicina Interna, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Borja de Miguel Campo
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital 12 de Octubre, Madrid, Spain
| | - Ana Noblejas-Mozo
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital La Paz, Madrid, Spain
| | - Ángel Robles-Marhuenda
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital La Paz, Madrid, Spain
| |
Collapse
|
8
|
Fedorinova EE, Bulanov NM, Meshkov AD, Borodin OO, Smitienko IO, Chachilo EV, Nartov AA, Filatova AL, Naumov AV, Novikov PI, Moiseev SV. Clinical Manifestations and Prognosis of Giant Cell Arteritis: A Retrospective Cohort Study. DOKL BIOCHEM BIOPHYS 2024; 517:250-258. [PMID: 39002010 DOI: 10.1134/s1607672924700984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 07/15/2024]
Abstract
The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA). MATERIALS AND METHODS . A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan-Meier method. RESULTS . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0-54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. CONCLUSIONS : Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.
Collapse
Affiliation(s)
- E E Fedorinova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia.
| | - N M Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A D Meshkov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - O O Borodin
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - I O Smitienko
- International Institute of Postgraduate Medical Education, Moscow, Russia
| | - E V Chachilo
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A A Nartov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A L Filatova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
| | - A V Naumov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - P I Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - S V Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
| |
Collapse
|
9
|
Billet AC, Thibault T, Liozon É, De Boysson H, Perard L, Espitia O, Daumas A, De Pinho QG, Durel CA, Hot A, Bienvenu B, Humbert S, Bachmeyer C, Mainbourg S, Sené T, Devilliers H, Bailloud BD, Greigert H, Cochet A, Bonnotte B, Alberini JL, Samson M. Prognostic value of 18 FDG-PET at diagnosis and follow-up in giant cell arteritis: An observational restrospective study. Eur J Intern Med 2024; 126:69-76. [PMID: 38627183 DOI: 10.1016/j.ejim.2024.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES To evaluate the ability of 18FDG PET/CT, at diagnosis of giant cell arteritis (GCA) and during follow-up, to predict occurrence of relapse in large-vessel GCA (LV-GCA). METHODS We conducted a retrospective study using the French Study Group for Large-Vessel Vasculitis (GEFA) network. Data from patients with LV-GCA diagnosed by PET/CT and who had PET/CT in the following year were collected. For each PET/CT, PET vascular activity score (PETVAS) and total vascular score (TVS) were assessed, and their ability to predict the occurrence of subsequent relapse was assessed. RESULTS A total of 65 LV-GCA patients were included, of whom 55 had undergone a follow-up PET/CT 3 to 12 months after the diagnosis of GCA. Patients for whom the second PET/CT (PET2) was performed during active GCA were excluded. PETVAS and TVS decreased between PET1 and PET2 in all patients (p < 0.001). There was no correlation between vascular activity scores in PET2 and time to prednisone taper. For relapse prediction, at PET1, the AUC of the TVS and PETVAS were respectively 51.9 and 41.9 at 6 months, 55.3 and 49.7 at 1 year, 55 and 55.7 at 2 years. For PET2, the AUC were respectively 46.1 and 46.7 at 6 months, 52.1 and 48.9 at 1 year, 58.4 and 52.3 at 2 years. CONCLUSION PET vascular activity scores at diagnosis and at follow-up PET/CT performed outside a period of GCA activity do not display high performance to predict the occurrence of subsequent relapse in LV-GCA patients.
Collapse
Affiliation(s)
- Anne-Claire Billet
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Systemic Autoimmune and Autoinflammatory Diseases (MAIS), Dijon Bourgogne University Hospital, Dijon, France
| | - Thomas Thibault
- Department of internal medicine and systemic diseases, Dijon Bourgogne University Hospital, Dijon, France
| | - Éric Liozon
- Department of Internal Medicine, University Hospital, Limoges, France
| | | | - Laurent Perard
- Department of Internal Medicine, Saint Joseph Saint Luc Hospital, Lyon, France
| | - Olivier Espitia
- Nantes University, CHU Nantes, Department of Internal and Vascular Medicine, l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, F-44000 Nantes, France
| | - Aurélie Daumas
- Department of Internal Medicine, Geriatric and Therapeutic, La Timone, APHM, C2VN, Aix-Marseille University, France
| | | | - Cécile-Audrey Durel
- Department of Internal Medicine, Saint Joseph Saint Luc Hospital, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | - Boris Bienvenu
- Department of Internal Medicine, Saint Joseph Hospital, Marseille, France
| | - Sébastien Humbert
- Department of Internal Medicine, University Hospital, Besancon, France
| | - Claude Bachmeyer
- Department of Internal Medicine, Tenon, Paris University Hospital, France
| | - Sabine Mainbourg
- Department of Internal and Vascular Medicine, South University Hospital, Hospices Civils de Lyon, France
| | - Thomas Sené
- Department of Internal Medicine, Rothschild Hospital Foundation, Paris, France
| | - Hervé Devilliers
- Department of internal medicine and systemic diseases, Dijon Bourgogne University Hospital, Dijon, France
| | | | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Systemic Autoimmune and Autoinflammatory Diseases (MAIS), Dijon Bourgogne University Hospital, Dijon, France; INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, Dijon, France
| | - Alexandre Cochet
- Laboratoire ICMUB, CNRS UMR 6302, Université de Bourgogne, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Systemic Autoimmune and Autoinflammatory Diseases (MAIS), Dijon Bourgogne University Hospital, Dijon, France; INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, Dijon, France
| | | | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Referral Center for Rare Systemic Autoimmune and Autoinflammatory Diseases (MAIS), Dijon Bourgogne University Hospital, Dijon, France; INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, Dijon, France.
| |
Collapse
|
10
|
El Haddad J, Charbonneau F, Guillaume J, Clavel G, Chazal T, Poillon G, Tran A, Niro A, Sore R, Litman-Roventa L, Mahe K, Chhour S, Savatovsky J, Lecler A. Reproducibility and accuracy of vessel wall MRI in diagnosing giant cell arteritis: a study with readers of varying expertise. Eur Radiol 2024; 34:5360-5369. [PMID: 38206404 DOI: 10.1007/s00330-023-10567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/16/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate the reproducibility of vessel wall magnetic resonance imaging (VW-MRI) in diagnosing giant cell arteritis (GCA) among groups of radiologists with varying levels of expertise. METHODS This institutional review board-approved retrospective single-center study recruited patients with suspected GCA between December 2014 and September 2021. Patients underwent 3 -T VW-MRI before temporal artery biopsy. Ten radiologists with varying levels of expertise, blinded to all data, evaluated several intracranial and extracranial arteries to assess GCA diagnosis. Interobserver reproducibility and diagnostic performance were evaluated. RESULTS Fifty patients (27 women and 23 men) with a mean age of 75.9 ± 9 years were included. Thirty-one of 50 (62%) had a final diagnosis of GCA.VW-MRI had an almost perfect reproducibility among expert readers (kappa = 0.93; 95% CI 0.77-1) and substantial reproducibility among all readers, junior and non-expert senior readers (kappa = 0.7; 95% CI 0.66-0.73; kappa = 0.67 95% CI 0.59-0.74; kappa = 0.65; 95% CI 0.43-0.88 respectively) when diagnosing GCA. Substantial interobserver agreement was observed for the frontal branch of superficial temporal artery. Moderate interobserver agreement was observed for the superficial temporal artery and its parietal branch, as well as ophthalmic arteries in all groups of readers. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy varied depending on the group of readers. CONCLUSION VW-MRI is a reproducible and accurate imaging modality for detecting GCA, even among less-experienced readers. This study advocates for the use of VW-MRI when diagnosing GCA even in less-experienced centers. CLINICAL RELEVANCE STATEMENT VW-MRI is a reproducible and accurate imaging modality for detecting GCA, even among less-experienced readers, and it could be used as a first-line diagnostic tool for GCA in centers with limited expertise in GCA diagnosis. KEY POINTS • Vessel wall magnetic resonance imaging (VW-MRI) is a reproducible and accurate imaging modality for detecting giant cell arteritis (GCA) in both extracranial and intracranial arteries. • The reproducibility of vessel wall magnetic resonance imaging for giant cell arteritis diagnosis was high among expert readers and moderate among less-experienced readers. • The use of vessel wall magnetic resonance imaging for giant cell arteritis diagnosis can be recommended even in centers with less-experienced readers.
Collapse
Affiliation(s)
- Jérôme El Haddad
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France.
| | | | - Jessica Guillaume
- Department of Clinical Research, A. Rothschild Foundation Hospital, Paris, France
| | - Gaëlle Clavel
- Department of Internal Medicine, A. Rothschild Foundation Hospital, Paris, France
| | - Thibaud Chazal
- Department of Internal Medicine, A. Rothschild Foundation Hospital, Paris, France
| | - Guillaume Poillon
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Alexia Tran
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Alexandre Niro
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Rémi Sore
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Luca Litman-Roventa
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Kévin Mahe
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Samantha Chhour
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Julien Savatovsky
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France
| | - Augustin Lecler
- Department of Neuroradiology, A. Rothschild Foundation Hospital, Paris, France.
| |
Collapse
|
11
|
Hara M, Mandai S, Mori T, Maejima Y, Uchida S. Takayasu arteritis manifesting as acute kidney injury and congestion due to renal artery stenosis and myocarditis: a case report. Eur Heart J Case Rep 2024; 8:ytae347. [PMID: 39099888 PMCID: PMC11293950 DOI: 10.1093/ehjcr/ytae347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/01/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024]
Abstract
Background Takayasu arteritis is a large-vessel vasculitis that affects the aorta and its primary branches. Myocarditis is a rare life-threatening complication and potential diagnostic pitfall in patients with Takayasu arteritis. Case summary A previously healthy 18-year-old woman presenting with fever, back pain, and dyspnoea was admitted to another hospital for acute hypertension (blood pressure, 230/106 mmHg) and congestive heart failure. Intravenous methylprednisolone pulse with antihypertensive and diuretic medications slightly improved her congestion. However, she developed acute kidney injury and was transferred to our hospital. Transthoracic echocardiography indicated a left ventricular ejection fraction of 45% and diffuse left ventricular hypokinesis. Doppler ultrasound test and magnetic resonance angiography revealed severe bilateral renal artery stenosis. Her diagnosis was Takayasu arteritis, and she received high-dose glucocorticoids. She required temporary haemodialysis, but 2 months after admission, her serum creatinine improved to 1.1 mg/dL without surgical or cardiovascular interventions. Although the pre-discharge test with 1.5 T cardiac magnetic resonance initially failed to diagnose myocarditis, 3 T cardiac magnetic resonance imaging revealed increased native T1 values on T1 mapping (1283-1393 ms), moderate pericardial effusion, and systolic left ventricular wall motion abnormality, indicating active myocarditis. During 6-month subcutaneous tocilizumab treatment (162 mg/week), a left ventricular ejection fraction improved to 55-60% without a relapse. Discussion This case report highlights the benefits of early multimodal imaging tests including cardiac magnetic resonance imaging for myocarditis and renal artery involvement in Takayasu arteritis. Tocilizumab might be an efficient therapeutic option for severe acute manifestations including myocarditis in young women of reproductive age.
Collapse
Affiliation(s)
- Misato Hara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Yasuhiro Maejima
- Department of Cardiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| |
Collapse
|
12
|
Haaversen ACB, Brekke LK, Kermani TA, Molberg Ø, Diamantopoulos AP. Vascular ultrasound as a follow-up tool in patients with giant cell arteritis: a prospective observational cohort study. Front Med (Lausanne) 2024; 11:1436707. [PMID: 39135716 PMCID: PMC11317465 DOI: 10.3389/fmed.2024.1436707] [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: 05/22/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Objectives To evaluate relapses in giant cell arteritis (GCA), investigate the utility of vascular ultrasound to detect relapses, and develop and assess a composite score for GCA disease activity (GCAS) based on clinical symptoms, ultrasound imaging activity, and C-reactive protein (CRP). Methods Patients with GCA were prospectively followed with scheduled visits, including assessment for clinical relapse, protocol ultrasound examination, and CRP. At each visit, patients were defined as having ultrasound remission or relapse. GCAS was calculated at every visit. Results The study included 132 patients, with a median follow-up time of 25 months [interquartile range (IR) 21]. The clinical relapse rate was 60.6%. There were no differences in relapse rates between GCA subtypes (cranial-GCA, large vessel (LV)-GCA, and mixed-GCA) (p = 0.83). Ultrasound yielded a sensitivity of 61.2% and a specificity of 72.3% for diagnosing GCA- relapse in our cohort. In 7.7% of follow-up visits with clinical relapses, neither high CRP nor findings of ultrasound relapse were registered. In comparison, in 10.3% of follow-up visits without symptoms of clinical relapse, there were both a high CRP and findings of ultrasound relapse. Conclusion We found moderate sensitivity and specificity for ultrasound as a monitoring tool for relapse in this prospective cohort of GCA patients. The extent or subtype of vasculitis at the diagnosis did not influence the number of relapses. Based on a combination of clinical symptoms, elevated CRP, and ultrasound findings, a composite score for GCA activity is proposed.
Collapse
Affiliation(s)
- Anne C. B. Haaversen
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene Kristin Brekke
- Department of Rheumatology, Hospital for Rheumatic Diseases, Haugesund, Norway
| | - Tanaz A. Kermani
- Department of Rheumatology, University of California, Los Angeles, CA, United States
| | - Øyvind Molberg
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Rheumatology, Rikshospitalet, Oslo, Norway
| | - Andreas P. Diamantopoulos
- Division of Internal Medicine, Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
13
|
Alba MA, Kermani TA, Unizony S, Murgia G, Prieto-González S, Salvarani C, Matteson EL. Relapses in giant cell arteritis: Updated review for clinical practice. Autoimmun Rev 2024; 23:103580. [PMID: 39048072 DOI: 10.1016/j.autrev.2024.103580] [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: 03/15/2024] [Revised: 07/20/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Abstract
Giant cell arteritis (GCA), the most common primary vasculitis in adults, is a granulomatous systemic vasculitis usually affecting the aorta and its major branches, particularly the carotid and vertebral arteries. Although remission can be achieved in most patients with GCA using high-dose glucocorticoids (GC), relapses are frequent, occurring in >40% of GC-only treated patients, mostly during the first two years after diagnosis. Relapsing courses lead to high GC exposure, increasing the risk of treatment-related adverse effects. Although tocilizumab is an efficacious GC-sparing therapy that allows increased sustained remission and reduced cumulative GC doses, relapses are common after drug discontinuation. This narrative review examines the most relevant features of relapses in GCA, including its definition, classification, frequency, clinical, laboratory, and imaging characteristics, chronology, probable pathophysiology, and predictive factors. In addition, we discuss treatment options for relapsing patients and the effect of relapses on patient outcomes.
Collapse
Affiliation(s)
- Marco A Alba
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
| | - Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sebastian Unizony
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Murgia
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| |
Collapse
|
14
|
Makhzoum JP, Baati Y, Tanase O, Mendel A, Pagnoux C, Ross C. Antiplatelet therapy to prevent ischemic events in giant cell arteritis: protocol for a systematic review and meta-analysis. Syst Rev 2024; 13:173. [PMID: 38978122 PMCID: PMC11229199 DOI: 10.1186/s13643-024-02599-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 06/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Giant cell arteritis (GCA) is the most common systemic vasculitis in adults. Presenting features include new-onset headaches, constitutional symptoms, jaw claudication, polymyalgia rheumatica, and visual symptoms. Arterial inflammation with subsequent stenosis and occlusion may cause tissue ischemia, leading to blindness, strokes, and myocardial infarction. Oral antiplatelet therapy has been hypothesized to reduce GCA-related ischemic events. However, previous studies have demonstrated conflicting results regarding the efficacy of antiplatelet agents in GCA. The objective of this systematic review is to assess the safety and efficacy of antiplatelet therapy for the prevention of these events in adults with giant cell arteritis. METHODS In this systematic review, we will include randomized controlled trials (RTCs), quasi-randomized trials, non-randomized intervention studies, cohort studies, and case-control studies on patients with new-onset or relapsing GCA. The intervention of interest will be pre-existing use or initiation of an oral antiplatelet medication (aspirin, clopidogrel, prasugrel, or ticagrelor) at GCA onset or relapse. The comparator of interest will be the absence of antiplatelet therapy. Endpoints will be evaluated after 6 and 12 months of follow-up. The primary outcome will be GCA-related ischemic events, including permanent blindness, stroke, myocardial infarction, and ischemic event-related deaths. Adverse events such as major bleeding and death caused by a bleeding event will be assessed. DISCUSSION GCA-related ischemic events are catastrophic, sudden, often irreversible, and lead to significant morbidity. Antiplatelet agents are affordable, accessible, and could be effective for the prevention of these events. Nevertheless, the potential benefits of platelet aggregation inhibition must be weighed against their associated risk of bleeding. Assessing the efficacy and safety of antiplatelet therapy in GCA is therefore clinically important. SYSTEMATIC REVIEW REGISTRATION Our systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42023441574.
Collapse
Affiliation(s)
- Jean-Paul Makhzoum
- Vasculitis Clinic, Hopital Sacre-Coeur, University of Montreal, Canadian Vasculitis Research Network, 5400 Bd Gouin O, Montreal, QC, H4J1C5, Canada.
| | - Youssef Baati
- Hopital Sacre-Coeur, University of Montreal, 5400 Bd Gouin O, Montreal, QC, H4J1C5, Canada
| | - Octavian Tanase
- Hopital Sacre-Coeur, University of Montreal, 5400 Bd Gouin O, Montreal, QC, H4J1C5, Canada
| | - Arielle Mendel
- Vasculitis and Lupus Clinic, McGill University Health Center, McGill University, Canadian Vasculitis Research Network, 1001 Bd Decarie, Montréal, QC, H4A 3J1, Canada
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Canadian Vasculitis Research Network, 60 Murray St, Toronto, ON, M5T3L9, Canada
| | - Carolyn Ross
- Vasculitis Clinic, Hopital Sacre-Coeur, University of Montreal, Canadian Vasculitis Research Network, 5400 Bd Gouin O, Montreal, QC, H4J1C5, Canada
| |
Collapse
|
15
|
Harigai M, Miyamae T, Hashimoto H, Umetsu K, Yamashita K, Nakaoka Y. A multicentre, large-scale, observational study of tocilizumab in patients with giant cell arteritis in Japan. Mod Rheumatol 2024; 34:775-783. [PMID: 37522620 DOI: 10.1093/mr/road074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES In clinical trials, tocilizumab (TCZ) is efficacious in patients with giant cell arteritis (GCA). This study evaluated the real-world tolerability and effectiveness of TCZ in Japanese patients with GCA. METHODS In this multicentre, prospective, Phase 4, large-scale, observational study, patients with GCA (with no TCZ treatment 6 months before the study) were recruited from 71 centres across Japan. Patients received subcutaneous TCZ 162 mg weekly (observation period, 52 weeks). RESULTS Of the 117 patients [female, 70.1%; mean age, 74.2 years; mean disease duration, 1.4 years; treated for new-onset GCA, 71.8%; presence of large-vessel lesions (LVLs), 61.5%; previous immunosuppressant use, 28.2%; glucocorticoids at baseline, 95.7% (mean: 22.4 mg/day)], 38.5% reported adverse events. The most common adverse events of special interest were neutropaenia and leukopaenia (7.7%), followed by serious infection (6.0%). The relapse-free proportion was 85.0%; relapse after remission, 6.0%; and no remission, 9.0%. At the last observation, 94.2% of relapse-free patients received a concomitant glucocorticoid dose of <10 mg/day. Fatigue, headache, neck pain, and absence of LVLs were positively associated with the relapse. CONCLUSIONS TCZ was effective and well tolerated in Japanese patients with GCA and may be an effective treatment option combined with glucocorticoids.
Collapse
Affiliation(s)
- Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takako Miyamae
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hideyuki Hashimoto
- Risk Communication Department, Drug Safety Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Kosei Umetsu
- Safety Science Department, Drug Safety Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Katsuhisa Yamashita
- Specialty Medical Science Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| |
Collapse
|
16
|
Robinson L, Hamden M, Griggs K, Simon S, Hill C, Limaye V, Proudman S. Tocilizumab use in giant cell arteritis: comparing Pharmaceutical Benefits Scheme eligible and ineligible cases in South Australia. Intern Med J 2024; 54:1228-1232. [PMID: 38953308 DOI: 10.1111/imj.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/07/2024] [Indexed: 07/04/2024]
Abstract
Tocilizumab (TCZ) is increasingly used as a steroid-sparing agent in giant cell arteritis (GCA), but there are strict Pharmaceutical Benefits Scheme (PBS) restrictions for its use in Australia. Patients who do not meet the PBS criteria can obtain TCZ through public hospital individual patient use (IPU) schemes which may not be universally accessible. We compared patients receiving IPU-approved TCZ with patients receiving PBS-subsidised TCZ and found IPU approvals were granted mainly for visual loss, a serious complication of GCA, in patients who otherwise failed to meet PBS criteria. Further studies demonstrating that TCZ is comparatively more effective than prednisolone monotherapy, as well as cost-effective, are needed to substantiate the rationale for expanding PBS approval criteria.
Collapse
Affiliation(s)
- Lucinda Robinson
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maddison Hamden
- Pharmacy Department, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kim Griggs
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Sumu Simon
- Ophthalmology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine Hill
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Vidya Limaye
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
17
|
Moleiro AF, Vilares-Morgado R, Falcão-Reis F, Torres-Costa S. WHEN THE PICTURE MASKS THE DIAGNOSIS - AN ATYPICAL AND SEVERE GIANT CELL ARTERITIS CASE REPORT. Retin Cases Brief Rep 2024; 18:446-450. [PMID: 36989505 PMCID: PMC11302579 DOI: 10.1097/icb.0000000000001409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
PURPOSE The purpose of this study was to describe an atypical and severe case of giant cell arteritis (GCA). METHODS This was a case report description. RESULTS The authors report the case of a 76-year-old man who presented with severe and progressive bilateral visual loss. On presentation at the ophthalmology emergency room, the patient's right eye (OD) displayed aqueous flare, hyphema, rubeosis iridis , and dense posterior capsular opacification. After YAG laser capsulotomy, vitreous densifications, intraretinal hemorrhages, cotton wool spots, retinal ischemia, and vasculitis were observed in the fundoscopy. The patient's left eye (OS) also presented intraretinal hemorrhages and cotton wool spots around the temporal arcades. The diagnostic workup excluded infectious diseases, demyelinating diseases, and ocular ischemic syndrome due to carotid obstruction. Proteinogram revealed a monoclonal gammopathy, suggesting a possible hematologic condition. High-dose corticotherapy was initiated, which improved the vitreous densifications and enabled the visualization of the pale optic disk. The remaining study did not confirm the diagnosis of hematologic disease. During follow-up, bilateral VA deteriorated, with the development of progressive pallor in the OS optic disk. Follow-up fluorescein angiography demonstrated progressive retinal and choroidal ischemia. Finally, owing to high clinical suspicion, temporal artery Doppler ultrasound was performed, confirming the diagnosis of GCA. CONCLUSION GCA may present multiple ocular features. The knowledge of these different presentations, including retinal and choroidal ischemia or uveitis, is critical for timely diagnosis and treatment initiation. Since patients with GCA often present with vision loss, ophthalmologists may be the first medical doctors who contact with these patients, being on the frontline of GCA diagnosis.
Collapse
Affiliation(s)
- Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Sónia Torres-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and
| |
Collapse
|
18
|
Qu W, Chen Y, Zhang Z. Clinical and pathological spectrum of aortitis in a Chinese cohort. Cardiovasc Pathol 2024; 71:107651. [PMID: 38679299 DOI: 10.1016/j.carpath.2024.107651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND This study aimed to explore the clinical and pathological features of aortitis in China, which is a rare disease that is often overlooked preoperatively. METHODS We reviewed the records of 2950 patients who underwent aortic surgery at Wuhan Asia General Hospital from 2016 to 2023. Clinical and pathological data were collected and compared across different groups. RESULTS Out of 2950 patients, 15 had healed aortitis, 2 were healed Takayasu aortitis (TAK), and 13 were not further classified. Forty-two had active aortitis, including clinically isolated aortitis ([CIA], 42.9%), infectious aortitis ([IA], 26.2%), TAK (16.7%), and Behçet's syndrome ([BS], 14.3%), half of these cases were not recognized preoperatively. All patients who developed perivalvular leakage during follow-up had concurrent non-infectious valvulitis with mixed inflammatory pattern at the time of initial surgery. Seventeen out of 18 patients with CIA survived without complications, as did 8 out of 11 patients with IA, 6 out of 7 patients with TAK, and 2 out of 6 patients with BS. CONCLUSIONS Half of the aortitis cases were initially diagnosed by pathologists. Noninfectious valvulitis with mixed inflammatory pattern is a risk factor for perivalvular leakage. BS is associated with a higher rate of complications. Patients with CIA have a good prognosis in China, which is different from the West.
Collapse
Affiliation(s)
- Wei Qu
- Department of Pathology, Wuhan Asia General Hospital, Wuhan 430022, China
| | - Youping Chen
- Department of Pathology, Wuhan Asia General Hospital, Wuhan 430022, China.
| | - Zhenlu Zhang
- Department of Pathology, Wuhan Asia General Hospital, Wuhan 430022, China
| |
Collapse
|
19
|
Wendling D, Al Tabaa O, Chevet B, Fakih O, Ghossan R, Hecquet S, Dernis E, Maheu E, Saraux A, Besson FL, Alegria GC, Cortet B, Fautrel B, Felten R, Morel J, Ottaviani S, Querellou-Lefranc S, Ramon A, Ruyssen-Witrand A, Seror R, Tournadre A, Foulquier N, Verlhac B, Verhoeven F, Devauchelle-Pensec V. Recommendations of the French Society of Rheumatology for the management in current practice of patients with polymyalgia rheumatica. Joint Bone Spine 2024; 91:105730. [PMID: 38583691 DOI: 10.1016/j.jbspin.2024.105730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To develop recommendations for the routine management of patients with polymyalgia rheumatica (PMR). METHODS Following standard procedures, a systematic review of the literature by five supervised junior rheumatologists, based on the questions selected by the steering committee (5 senior rheumatologists), was used as the basis for working meetings, followed by a one-day plenary meeting with the working group (15 members), leading to the development of the wording and determination of the strength of the recommendations and the level of agreement of the experts. RESULTS Five general principles and 19 recommendations were drawn up. Three recommendations relate to diagnosis and the use of imaging, and five to the assessment of the disease, its activity and comorbidities. Non-pharmacological therapies are the subject of one recommendation. Three recommendations concern initial treatment based on general corticosteroid therapy, five concern the reduction of corticosteroid therapy and follow-up, and two concern corticosteroid dependence and steroid-sparing treatments (anti-IL-6). CONCLUSION These recommendations take account of current data on PMR, with the aim of reducing exposure to corticosteroid therapy and its side effects in a fragile population. They are intended to be practical, to help practitioners in the day-to-day management of patients with PMR.
Collapse
Affiliation(s)
- Daniel Wendling
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France.
| | - Omar Al Tabaa
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France; Rhumatologie, Hôpital NOVO, Pontoise, France
| | - Baptiste Chevet
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Olivier Fakih
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Roba Ghossan
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France
| | | | | | - Emmanuel Maheu
- Service de rhumatologie, Hôpital St Antoine, AP-HP, et cabinet médical, Paris, France
| | - Alain Saraux
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Florent L Besson
- Service de médecine nucléaire-imagerie moléculaire, Hôpitaux universitaires Paris-Saclay AP-HP, CHU Bicêtre, DMU SMART IMAGING, Le Kremlin-Bicêtre, France
| | | | - Bernard Cortet
- Service de rhumatologie, CHU de Lille, 59037 Lille, France
| | - Bruno Fautrel
- Service de rhumatologie, GH Pitié Salpêtrière, AP-HP.Sorbonne Université, INSERM UMRS 1136-5, Réseau de recherche clinique CRI-IMIDIATE, 75013 Paris, France
| | - Renaud Felten
- Service de rhumatologie et centre d'investigation clinique 1434, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Jacques Morel
- Service de rhumatologie. CHU et Université de Montpellier, Montpellier, France
| | | | - Solène Querellou-Lefranc
- Nuclear Medicine department, University Hospital, Brest, France, University of Western Brittany (UBO), Brest, France, Inserm, University of Brest, CHRU Brest, UMR 1304, GETBO, Brest cedex, France
| | - André Ramon
- Service de rhumatologie, CHU Dijon Bourgogne, Dijon, France
| | - Adeline Ruyssen-Witrand
- Centre de rhumatologie, CHU de Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Raphaèle Seror
- Service de rhumatologie, CHU Kremlin-Bicetre, AP-HP, Paris, France
| | - Anne Tournadre
- Rhumatologie CHU Clermont-Ferrand, Université Clermont Auvergne INRAe, Clermont-Ferrand, France
| | - Nathan Foulquier
- LBAI, UMR1227, University of Brest, Inserm, CHU de Brest, Brest, France
| | | | - Frank Verhoeven
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France.
| |
Collapse
|
20
|
Jovicic Z, Dragasevic S, Petkovic A, Plesinac S, Sokic Milutinovic A, Stojanovic M. Successful pregnancies in a patient with Takayasu arteritis and antiphospholipid syndrome, maintained on infliximab corticosteroid-free regimen: case-based review. Rheumatol Int 2024; 44:1359-1367. [PMID: 37653060 DOI: 10.1007/s00296-023-05440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
Takayasu arteritis (TA) is a large vessel vasculitis affecting predominantly females below the age of 40. Patients with TA seem to be at increased risk for adverse pregnancy outcomes, resulting in mother or child complications. Although few studies analyzed the presence of antiphospholipid antibodies (APLA) in TA patients, an association between antiphospholipid syndrome (APS) and TA is rarely reported in the literature, mainly in the form of case reports. In fact, very few data regarding pregnancy outcomes in patients with TA and APS are available. An active form of Crohn's disease (CD) might be another risk factor strongly affecting the fertility rate. Here, we would like to present a 33-year-old woman with TA, double-positive APS and Crohn's disease (CD). The report is followed by the literature review of the association of APLA and/or APS with TA, focusing on analyzing the pregnancy outcomes. To our knowledge, this is the first case describing two successful, naturally occurring pregnancies, in a patient suffering from TA, APS and CD, and maintained on infliximab, azathioprine, and a corticosteroid-free regimen.
Collapse
Affiliation(s)
- Zikica Jovicic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Koste Todorovica 2, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Dragasevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Petkovic
- Department of Radiology, Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Snezana Plesinac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandra Sokic Milutinovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Maja Stojanovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Koste Todorovica 2, 11000, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
21
|
Galli E, Muratore F, Warrington KJ. Current management of giant cell arteritis and its complications. Curr Opin Rheumatol 2024:00002281-990000000-00123. [PMID: 38920090 DOI: 10.1097/bor.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
PURPOSE OF THE REVIEW This review provides an update on current management strategies for giant cell arteritis (GCA), emphasizing the need for alternative therapies to reduce disease relapses and mitigate glucocorticoid (GC)-related morbidity. RECENT FINDINGS The standard of care for GCA has traditionally involved prolonged use of GC, and recent studies are exploring faster GC tapering regimens in an effort to reduce adverse effects while maintaining disease control. Randomized clinical trials have highlighted the efficacy of tocilizumab (TCZ), an interleukin-6 receptor inhibitor, in reducing disease flares and sparing GCs. However, the optimal treatment duration with TCZ is unknown and patients remain at risk of relapse after treatment discontinuation. An unmet therapeutic need persists for patients who are not candidates for TCZ, and for those who have inadequate response to this biologic. Therefore, investigations into alternative therapies such as targeting interleukin-17A, blocking T-cell activation or inhibiting the Janus kinase-signal transducer and activator of transcription pathway, showcase potential avenues for tailored treatments. SUMMARY While GCs remain the cornerstone of therapy, TCZ emerges as a promising GC-sparing agent. Ongoing research targeting different pathways implicated in GCA pathogenesis have led to encouraging results. However, the preliminary nature of these findings necessitates larger randomized controlled trials to establish their efficacy conclusively.
Collapse
Affiliation(s)
- Elena Galli
- Rheumatology Unit, Internal Medicine Department, ASST Settelaghi, Ospedale Di Circolo - Fondazione Macchi, Varese
- University of Modena and Reggio Emilia, Modena
| | - Francesco Muratore
- University of Modena and Reggio Emilia, Modena
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
22
|
Mumtaz S, Wilson C, Vibhute P, Eggenberger ER, Berianu F, Abril A. Central Retinal Artery Occlusion Associated with Takayasu Arteritis. Diagnostics (Basel) 2024; 14:1329. [PMID: 39001220 PMCID: PMC11240730 DOI: 10.3390/diagnostics14131329] [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: 06/11/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024] Open
Abstract
Takayasu arteritis is a chronic inflammatory vasculitis with granulomatous panarteritis particularly impacting large vessels including the aorta and its branches, especially the subclavian arteries, with clinical manifestation dependent on the involved artery. Sequelae of the active disease vary, including stenosis, occlusions, or aneurysmal dilatations of the large vessels. The prevalence of Takayasu arteritis is higher in the Asian population and in Japan, but quite low in the United States, varying from 0.9-8.4 per million people. Ocular manifestations are rare and lead to a delay in diagnosis and appropriate treatment. Ocular manifestations include Takayasu retinopathy, anterior ischemic optic neuropathy (AION), retinal artery occlusion (RAO) and retinal vein occlusion (RVO). We present two cases in which central retinal artery occlusion (CRAO) was associated with Takayasu arteritis. CRAO is an ophthalmic emergency with an incidence of 1.9 per 100,000 person years in the United States; only 5% of cases are arteritic, which can be observed with inflammatory vasculitides secondary to the formation of immune deposits.
Collapse
Affiliation(s)
- Sehreen Mumtaz
- Department of Rheumatology, Mayo Clinic Florida, Jacksonville, FL 32224, USA; (F.B.); (A.A.)
| | - Claire Wilson
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Prasanna Vibhute
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Eric R. Eggenberger
- Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Florentina Berianu
- Department of Rheumatology, Mayo Clinic Florida, Jacksonville, FL 32224, USA; (F.B.); (A.A.)
| | - Andy Abril
- Department of Rheumatology, Mayo Clinic Florida, Jacksonville, FL 32224, USA; (F.B.); (A.A.)
| |
Collapse
|
23
|
Guo S, Tian Y, Li J, Zeng X. A Glimpse into Humoral Response and Related Therapeutic Approaches of Takayasu's Arteritis. Int J Mol Sci 2024; 25:6528. [PMID: 38928233 PMCID: PMC11203527 DOI: 10.3390/ijms25126528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Takayasu's arteritis (TAK) manifests as an insidiously progressive and debilitating form of granulomatous inflammation including the aorta and its major branches. The precise etiology of TAK remains elusive, with current understanding suggesting an autoimmune origin primarily driven by T cells. Notably, a growing body of evidence bears testimony to the widespread effects of B cells on disease pathogenesis and progression. Distinct alterations in peripheral B cell subsets have been described in individuals with TAK. Advancements in technology have facilitated the identification of novel autoantibodies in TAK. Moreover, emerging data suggest that dysregulated signaling cascades downstream of B cell receptor families, including interactions with innate pattern recognition receptors such as toll-like receptors, as well as co-stimulatory molecules like CD40, CD80 and CD86, may result in the selection and proliferation of autoreactive B cell clones in TAK. Additionally, ectopic lymphoid neogenesis within the aortic wall of TAK patients exhibits functional characteristics. In recent decades, therapeutic interventions targeting B cells, notably utilizing the anti-CD20 monoclonal antibody rituximab, have demonstrated efficacy in TAK. Despite the importance of the humoral immune response, a systematic understanding of how autoreactive B cells contribute to the pathogenic process is still lacking. This review provides a comprehensive overview of the biological significance of B cell-mediated autoimmunity in TAK pathogenesis, as well as insights into therapeutic strategies targeting the humoral response. Furthermore, it examines the roles of T-helper and T follicular helper cells in humoral immunity and their potential contributions to disease mechanisms. We believe that further identification of the pathogenic role of autoimmune B cells and the underlying regulation system will lead to deeper personalized management of TAK patients. We believe that further elucidation of the pathogenic role of autoimmune B cells and the underlying regulatory mechanisms holds promise for the development of personalized approaches to managing TAK patients.
Collapse
Affiliation(s)
- Shuning Guo
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China; (S.G.); (Y.T.)
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing 100006, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing 100006, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100006, China
| | - Yixiao Tian
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China; (S.G.); (Y.T.)
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing 100006, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing 100006, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100006, China
| | - Jing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China; (S.G.); (Y.T.)
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing 100006, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing 100006, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100006, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China; (S.G.); (Y.T.)
- National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing 100006, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing 100006, China
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100006, China
| |
Collapse
|
24
|
Claveau AM, Aldajani A, Giancaspro G, Ma F, Mardigyan V. Large-Vessel Vasculitis Presenting With Syncope and Complete Heart Block. Can J Cardiol 2024:S0828-282X(24)00432-X. [PMID: 38852846 DOI: 10.1016/j.cjca.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Anne-Marie Claveau
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
| | - Ahmed Aldajani
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada; Division of Cardiology, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Gianni Giancaspro
- Department of Radiology, Jewish General Hospital, Montréal, Québec, Canada
| | - Felix Ma
- Division of Cardiac Surgery, Department of Surgery, Jewish General Hospital, Montréal, Québec, Canada
| | - Vartan Mardigyan
- Division of Cardiology, Department of Medicine, Jewish General Hospital, Montréal, Québec, Canada
| |
Collapse
|
25
|
Loricera J, Tofade T, Prieto-Peña D, Romero-Yuste S, de Miguel E, Riveros-Frutos A, Ferraz-Amaro I, Labrador E, Maiz O, Becerra E, Narváez J, Galíndez-Agirregoikoa E, González-Fernández I, Urruticoechea-Arana A, Ramos-Calvo Á, López-Gutiérrez F, Castañeda S, Unizony S, Blanco R. Effectiveness of janus kinase inhibitors in relapsing giant cell arteritis in real-world clinical practice and review of the literature. Arthritis Res Ther 2024; 26:116. [PMID: 38840219 PMCID: PMC11151571 DOI: 10.1186/s13075-024-03314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/19/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND A substantial proportion of patients with giant cell arteritis (GCA) relapse despite standard therapy with glucocorticoids, methotrexate and tocilizumab. The Janus kinase/signal transducer and activator of transcription (JAK/STAT) signalling pathway is involved in the pathogenesis of GCA and JAK inhibitors (JAKi) could be a therapeutic alternative. We evaluated the effectiveness of JAKi in relapsing GCA patients in a real-world setting and reviewed available literature. METHODS Retrospective analysis of GCA patients treated with JAKi for relapsing disease at thirteen centers in Spain and one center in United States (01/2017-12/2022). Outcomes assessed included clinical remission, complete remission and safety. Clinical remission was defined as the absence of GCA signs and symptoms regardless of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values. Complete remission was defined as the absence of GCA signs and symptoms along with normal ESR and CRP values. A systematic literature search for other JAKi-treated GCA cases was conducted. RESULTS Thirty-five patients (86% females, mean age 72.3) with relapsing GCA received JAKi therapy (baricitinib, n = 15; tofacitinib, n = 10; upadacitinib, n = 10). Before JAKi therapy, 22 (63%) patients had received conventional synthetic immunosuppressants (e.g., methotrexate), and 30 (86%) biologics (e.g., tocilizumab). After a median (IQR) follow-up of 11 (6-15.5) months, 20 (57%) patients achieved and maintained clinical remission, 16 (46%) patients achieved and maintained complete remission, and 15 (43%) patients discontinued the initial JAKi due to relapse (n = 11 [31%]) or serious adverse events (n = 4 [11%]). A literature search identified another 36 JAKi-treated GCA cases with clinical improvement reported for the majority of them. CONCLUSIONS This real-world analysis and literature review suggest that JAKi could be effective in GCA, including in patients failing established glucocorticoid-sparing therapies such as tocilizumab and methotrexate. A phase III randomized controlled trial of upadacitinib is currently ongoing (ClinicalTrials.gov ID NCT03725202).
Collapse
Affiliation(s)
- Javier Loricera
- Department of Rheumatology, IDIVAL, Immunopathology Group, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, Santander, ES- 39008, Spain
| | - Toluwalase Tofade
- Neurology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Diana Prieto-Peña
- Department of Rheumatology, IDIVAL, Immunopathology Group, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, Santander, ES- 39008, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Eugenio de Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Anne Riveros-Frutos
- Department of Rheumatology, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Iván Ferraz-Amaro
- Department of Rheumatology, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Olga Maiz
- Department of Rheumatology, Hospital Universitario de Donosti, San Sebastián, Spain
| | - Elena Becerra
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | | | | | - Ángel Ramos-Calvo
- Department of Rheumatology, Complejo Hospitalario de Soria, Soria, Spain
| | - Fernando López-Gutiérrez
- Department of Rheumatology, IDIVAL, Immunopathology Group, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, Santander, ES- 39008, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain
| | - Sebastian Unizony
- Vasculitis and Glomerulonephritis Center, Rheumatology, Immunology and Allergy Division, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Ricardo Blanco
- Department of Rheumatology, IDIVAL, Immunopathology Group, Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, Santander, ES- 39008, Spain.
| |
Collapse
|
26
|
Alnaimat F, Alduradi H, Al-Qasem S, Ghazzal H, Alsarhan M. Giant cell arteritis: insights from a monocentric retrospective cohort study. Rheumatol Int 2024; 44:1013-1023. [PMID: 38502233 DOI: 10.1007/s00296-024-05540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/08/2024] [Indexed: 03/21/2024]
Abstract
Giant cell arteritis (GCA), more common in Northern European populations, has limited data in Arabcountries. Our study reports GCA's clinical manifestations in Jordan and reviews published research on GCA across Arab nations. In this retrospective analysis, GCA patients diagnosed from January 2007 to March 2019 at a Jordanian academic medical center were included through referrals for temporal artery biopsy (TAB). A comprehensive search in PubMed, Scopus, and the DOAJ (Directory of Open Access Journals) databases was conducted to identify all relevant English-language manuscripts from Arab countries on GCA without time limitations. Among 59 diagnosed GCA patients, 41 (69.5%) were clinically diagnosed with a negative TAB, and 19 (30.5%) had a positive result. Females comprised 74.6% (n = 44) with 1:3 male-female ratio. The mean age at diagnosis was 67.3 (± 9.5) years, with most presenting within two weeks (n = 40, 67.8%). Headache was reported by 54 patients (91.5%). Elevated ESR occurred in 51 patients (78%), with a mean of 81 ± 32.2 mm/hr. All received glucocorticoids for 13.1 ± 10 months. Azathioprine, Methotrexate, and Tocilizumab usage was 15.3% (n = 9), 8.5% (n = 5), and 3.4% (n = 2), respectively. Remission was observed in 57.6% (n=34), and 40.7% (n = 24) had a chronic clinical course on treatment. Males had higher biopsy-based diagnoses (p = .008), and biopsy-diagnosed patients were older (p = .043). The literature search yielded only 20 manuscripts originating in the Arab world. The predominant study types included case reports and retrospective analyses, with only one case series and onecase-control study.
Collapse
Affiliation(s)
- Fatima Alnaimat
- Department of Internal Medicine, Division of Rheumatology, University of Jordan, Amman, Jordan.
| | - Hamza Alduradi
- School of Nursing, The University of Jordan, Amman, Jordan
| | | | | | | |
Collapse
|
27
|
Bosch P, Espigol-Frigolé G, Cid MC, Mollan SP, Schmidt WA. Cranial involvement in giant cell arteritis. THE LANCET. RHEUMATOLOGY 2024; 6:e384-e396. [PMID: 38574747 DOI: 10.1016/s2665-9913(24)00024-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 04/06/2024]
Abstract
Since its first clinical description in 1890, extensive research has advanced our understanding of giant cell arteritis, leading to improvements in both diagnosis and management for affected patients. Imaging studies have shown that the disease frequently extends beyond the typical cranial arteries, also affecting large vessels such as the aorta and its proximal branches. Meanwhile, advances in comprehending the underlying pathophysiology of giant cell arteritis have given rise to numerous potential therapeutic agents, which aim to minimise the need for glucocorticoid treatment and prevent flares. Classification criteria for giant cell arteritis, as well as recommendations for management, imaging, and treat-to-target have been developed or updated in the last 5 years, and current research encompasses a broad spectrum covering basic, translational, and clinical research. In this Series paper, we aim to discuss the current understanding of giant cell arteritis with cranial manifestations, describe the clinical approach to this condition, and explore future directions in research and patient care.
Collapse
Affiliation(s)
- Philipp Bosch
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.
| | - Georgina Espigol-Frigolé
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Insitut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Insitut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Wolfgang A Schmidt
- Department of Rheumatology, Immanuel Hospital Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| |
Collapse
|
28
|
Muhammad T, Hamdan Z, Ebrahim M, Ali B, Hamdan J. Takayasu arteritis presenting with large cerebral infarction in a 39-year-old Syrian woman: a case report. Ann Med Surg (Lond) 2024; 86:3762-3765. [PMID: 38846855 PMCID: PMC11152858 DOI: 10.1097/ms9.0000000000002098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/14/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction and importance Takayasu Arteritis (TA) is a rare chronic inflammatory disease of unknown etiology that primarily affects large vessels, such as the aorta and its major branches. The disease typically presents with diverse symptoms, depending on the site and degree of arterial lesions. Delayed diagnosis is common, especially in younger populations. Case presentation A 39-year-old Syrian female presented with an initial stroke. She had no prior medical history and was otherwise healthy. On examination, she had an absent left radial pulse, a carotid bruit, and muscle weakness. Blood tests showed an elevated ESR and CRP. Computed tomography of the brain revealed a right large cerebral infarction. Multislice computed tomography angiography showed diffuse arterial wall thickening, stenosis, and occlusion of several major vessels, including the left internal carotid artery, right internal carotid artery, and left subclavian artery. Clinical discussion The patient was diagnosed with TA based on the American College of Rheumatology criteria. She was treated with prednisolone, methotrexate, and aspirin, and her symptoms improved significantly. Conclusion This case highlights the importance of considering TA in the differential diagnosis of ischemic stroke, especially in young patients with atypical presentations. Early identification and management are essential to preclude critical sequelae.
Collapse
Affiliation(s)
| | | | | | | | - Jafar Hamdan
- Department of Otolaryngology, Military Hospital 601, Damascus, Syria
| |
Collapse
|
29
|
Kaymaz-Tahra S, Bayindir O, Ince B, Ozdemir İsik O, Kutu ME, Karakas O, Yildirim TD, Ademoglu Z, Ediboglu ED, Uludogan BCE, Ilgin C, Bilge NSY, Kasifoglu T, Akar S, Emmungil H, Onen F, Omma A, Kanitez NA, Yazici A, Cefle A, Inanc M, Aksu K, Keser G, Direskeneli H, Alibaz-Oner F. Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis. Semin Arthritis Rheum 2024; 66:152446. [PMID: 38669786 DOI: 10.1016/j.semarthrit.2024.152446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Immunosuppressive (IS) agents are recommended for the first-line treatment of patients with active Takayasu's arteritis (TAK) together with glucocorticoids (GCs). However, there is limited data comparing the efficacy and outcomes of different IS agents for this purpose. OBJECTIVES In this study, we aimed to compare the outcomes of two most frequently used first-line IS agents, namely methotrexate (MTX) and azathioprine (AZA) in TAK patients. METHODS TAK patients who received any IS agent in addition to GCs as the initial therapy were included in this multicentre, retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a matched analysis (cc match) using variables 'age', 'gender' and 'diffuse aortic involvement' was performed between patients who received MTX or AZA as the first-line IS treatment. RESULTS We recruited 301 patients (F/M: 260/41, mean age: 42.2 ± 13.3 years) from 10 tertiary centres. As the first-line IS agent, 204 (67.8 %) patients received MTX, and 77 (25.6 %) received AZA. Less frequently used IS agents included cyclophosphamide in 17 (5.6 %), leflunomide in 2 (0.5 %) and mycophenolate mofetil in one patient. The remission, relapse, radiographic progression and adverse effect rates were similar between patients who received MTX and AZA as the first-line IS agent. Vascular surgery rate was significantly higher in the AZA group (23% vs. 9 %, p = 0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was significantly higher in the MTX group (76% vs 62 %, p = 0.034). Similarly, the rate of vascular surgery was higher in AZA group in matched analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42 %, p = 0.34). IS therapy was discontinued in 18 (12 MTX, 6 AZA) patients during the follow-up period due to remission. Among those patients, two patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of a mean 69.4 (±50.9) months of follow-up. CONCLUSIONS Remission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.
Collapse
Affiliation(s)
- Sema Kaymaz-Tahra
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Bahceşehir University, Kadıkoy, Istanbul, Turkey.
| | - Ozun Bayindir
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burak Ince
- Department of Internal Medicine, Division of Rheumatology Istanbul, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozlem Ozdemir İsik
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Muhammet Emin Kutu
- Division of Rheumatology, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Karakas
- Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Tuba Demirci Yildirim
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Zeliha Ademoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Elif Durak Ediboglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
| | - Burcu Ceren Ekti Uludogan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Can Ilgin
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nazife Sule Yasar Bilge
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Timucin Kasifoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Servet Akar
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Katip Celebi University, Izmir, Turkey
| | - Hakan Emmungil
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Fatos Onen
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ahmet Omma
- Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Nilufer Alpay Kanitez
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Ayten Yazici
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Cefle
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Inanc
- Department of Internal Medicine, Division of Rheumatology Istanbul, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kenan Aksu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gokhan Keser
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
30
|
Liao H, Du J, Li F, Yang S, Qi G, Pan L. Elevated serum 25-hydroxyvitamin D: a potential indicator of remission in Takayasu arteritis patients with normal ESR and CRP levels. Clin Rheumatol 2024; 43:1979-1987. [PMID: 38598024 DOI: 10.1007/s10067-024-06957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE The goal of the present study was to investigate the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels and disease remission in Takayasu arteritis (TAK) patients. METHODS This retrospective study included 59 patients in the study group and 80 patients in the validation cohort with TAK. After 6 months of therapy, patients were re-evaluated, and serum 25(OH)D levels were compared before and after treatment. Correlations between changes in 25(OH)D levels and changes in disease activity scores (NIH, ITAS2010, ITAS.A) were analyzed. Additionally, a predictive cut-off value for disease remission was determined. RESULTS After 6 months of therapy, serum 25(OH)D levels in TAK patients significantly increased compared to baseline [(18.33 ± 7.25)µg/L vs (11.77 ± 4.14) µg/L] (P < 0.001). Positive correlations were observed between the increasing changes in the 25(OH)D level and the decreasing changes in the reduced NIH, ITAS2010, and ITAS.A scores (r = 0.455, P < 0.001; r = 0.495, P < 0.001; and r = 0.352 P = 0.006, respectively). A change of 8.45 µg/L in 25(OH)D level was identified as the predictive cut-off value for TAK remission (sensitivity 54.1%, specificity 90.9%, area under the curve = 0.741). Similarly for patients with normal baseline ESR, sensitivity is 68.0%, specificity is 92.3%, and area under the curve is 0.831, and for patients with normal baseline CRP, sensitivity is 58.3%, specificity is 90.0%, and area under the curve is 0.748. Validation in an additional 80 patients demonstrated a higher remission rate in those with a 25(OH)D level change > 8.45 µg/L. CONCLUSION Serum 25(OH)D levels significantly increased after treatment in TAK patients, and an increase of ≥ 8.45 µg/L was predictive of disease remission, especially in individuals with normal baseline ESR and/or CRP levels. Key Points • Following treatment, there was a significant increase in serum 25(OH)D levels among TAK patients. • The elevated changes in 25(OH)D levels before and after treatment demonstrated a positive correlation with the reduction in disease activity scores. • In patients with TAK before and after treatment, an elevation in serum 25(OH)D levels exceeding 8.45 µg/L serves as an indicator for disease remission, particularly prominent in individuals with normal baseline ESR and/or CRP levels.
Collapse
Affiliation(s)
- Hua Liao
- Department of Rheumatology and Immunology, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Rd., Beijing, 100029, China
| | - Juan Du
- Department of Rheumatology and Immunology, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Rd., Beijing, 100029, China
| | - Fengjuan Li
- Beijing AnZhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
| | - Shiyu Yang
- Department of Rheumatology and Immunology, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Rd., Beijing, 100029, China
| | - Guanming Qi
- Internal Medicine, Our Lady of Lourdes Memorial Hospital, Binghamton, NY, USA.
| | - Lili Pan
- Department of Rheumatology and Immunology, Beijing AnZhen Hospital, Capital Medical University, No. 2 Anzhen Rd., Beijing, 100029, China.
| |
Collapse
|
31
|
van der Geest KSM, Sandovici M, Bley TA, Stone JR, Slart RHJA, Brouwer E. Large vessel giant cell arteritis. THE LANCET. RHEUMATOLOGY 2024; 6:e397-e408. [PMID: 38574745 DOI: 10.1016/s2665-9913(23)00300-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 04/06/2024]
Abstract
Giant cell arteritis is the principal form of systemic vasculitis affecting people over 50. Large-vessel involvement, termed large vessel giant cell arteritis, mainly affects the aorta and its branches, often occurring alongside cranial giant cell arteritis, but large vessel giant cell arteritis without cranial giant cell arteritis can also occur. Patients mostly present with constitutional symptoms, with localising large vessel giant cell arteritis symptoms present in a minority of patients only. Large vessel giant cell arteritis is usually overlooked until clinicians seek to exclude it with imaging by ultrasonography, magnetic resonance angiography (MRA), computed tomography angiography (CTA), or [18F]fluorodeoxyglucose-PET-CT. Although the role of imaging in treatment monitoring remains uncertain, imaging by MRA or CTA is crucial for identifying aortic aneurysm formation during patient follow up. In this Series paper, we define the large vessel subset of giant cell arteritis and summarise its clinical challenges. Furthermore, we identify areas for future research regarding the management of large vessel giant cell arteritis.
Collapse
Affiliation(s)
- Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Netherlands; Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
32
|
Hamel C, Avard B, Isaac N, Jassal D, Kirkpatrick I, Leipsic J, Michaud A, Worrall J, Nguyen ET. Canadian Association of Radiologists Cardiovascular Imaging Referral Guideline. Can Assoc Radiol J 2024:8465371241246425. [PMID: 38733286 DOI: 10.1177/08465371241246425] [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: 05/13/2024] Open
Abstract
The Canadian Association of Radiologists (CAR) Cardiovascular Expert Panel is made up of physicians from the disciplines of radiology, cardiology, and emergency medicine, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 30 clinical/diagnostic scenarios, a rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 48 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 125 recommendation statements across the 30 scenarios (27 unique scenarios as 2 scenarios point to the CAR Thoracic Diagnostic Imaging Referral Guideline and the acute pericarditis subscenario is included under 2 main scenarios). This guideline presents the methods of development and the referral recommendations for acute chest pain syndromes, chronic chest pain, cardiovascular screening and risk stratification, pericardial syndromes, intracardiac/pericardial mass, suspected valvular disease cardiomyopathy, aorta, venous thrombosis, and peripheral vascular disease.
Collapse
Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | - Neil Isaac
- Department of Medical Imaging, North York General Hospital, Toronto, ON, Canada
| | - Davinder Jassal
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences University of Manitoba, Bergen Cardiac Care Centre St. Boniface Hospital, Winnipeg, MB, Canada
| | - Iain Kirkpatrick
- Max Rady College of Medicine, University of Manitoba, St. Boniface Hospital, Winnipeg, MB, Canada
| | - Jonathon Leipsic
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - James Worrall
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Elsie T Nguyen
- University Medical Imaging Toronto, University of Toronto, Toronto General Hospital, Peter Munk Cardiac Centre, Toronto, ON, Canada
| |
Collapse
|
33
|
Philip R, Nganoa C, De Boysson H, Aouba A. 18FDG PET/CT: an aid for the early diagnosis of paucisymptomatic polyarteritis nodosa. Rheumatology (Oxford) 2024; 63:e181-e182. [PMID: 38058205 DOI: 10.1093/rheumatology/kead655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Rémi Philip
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, Caen, France
- Normandie University, UNICAEN, CHU of Caen Normandie, Caen, France
| | - Catherine Nganoa
- Department of Nuclear Medicine, CHU of Caen Normandie, Caen, France
| | - Hubert De Boysson
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, Caen, France
- Normandie University, UNICAEN, CHU of Caen Normandie, Caen, France
| | - Achille Aouba
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, Caen, France
- Normandie University, UNICAEN, CHU of Caen Normandie, Caen, France
| |
Collapse
|
34
|
Kaymakci MS, Elfishawi MM, Langenfeld HE, Hanson AC, Crowson CS, Bois MC, Ghaffar U, Koster MJ, Specks U, Warrington KJ. Large vessel involvement in antineutrophil cytoplasmic antibody-associated vasculitis. Rheumatology (Oxford) 2024; 63:1682-1689. [PMID: 37672018 DOI: 10.1093/rheumatology/kead467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES ANCA-associated vasculitis (AAV) is currently categorized under the small vessel vasculitides. There is limited knowledge about large vessel involvement in AAV (L-AAV), mainly described in case reports and small series. L-AAV can involve temporal arteries (TA-AAV), aorta (A-AAV), and periaortic soft tissue (PA-AAV). We sought to characterize the features of patients with L-AAV. METHODS Patients older than 18 years at diagnosis of TA-AAV, A-AAV and PA-AAV seen at the Mayo Clinic, Rochester between 1 January 2000 and 31 December 2021 were identified through a proprietary medical text search algorithm. Patients were included if diagnosed with L-AAV, fulfilled 2022 ACR/EULAR classification criteria for GPA, MPA or EGPA, had positive ANCA test results, and had more than one outpatient or inpatient visit. RESULTS The study cohort consists of 36 patients with L-AAV. Of those, 23 had p-ANCA and/or MPO-ANCA, and 13 had c-ANCA and/or PR3-ANCA. Mean (s.d.) age at AAV diagnosis was 63.4 (12.79) years; 20 (56%) were male. Seventeen patients had TA-AAV, 10 had A-AAV and 9 had PA-AAV. Most patients (n = 25, 69%) were diagnosed with large vessel vasculitis and AAV within a 1-year timespan. Twenty-five (69%) patients had histopathological confirmation of AAV diagnosis in a location other than temporal artery, aorta or periaortic soft tissue. Glucocorticoids (36/36), rituximab (19/36) and methotrexate (18/36) were the most frequent treatments. CONCLUSION This is the largest single-centre cohort of patients with L-AAV to date. AAV can involve large arteries, albeit infrequent. AAV-targeted therapy should be considered in patients with L-AAV.
Collapse
Affiliation(s)
- Mahmut S Kaymakci
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohanad M Elfishawi
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew C Hanson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Umar Ghaffar
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Koster
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ulrich Specks
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
35
|
Misra DP. Comment on: Treatment efficacy and safety of adalimumab versus tocilizumab in patients with active and severe Takayasu arteritis. Rheumatology (Oxford) 2024; 63:e156-e157. [PMID: 38224547 DOI: 10.1093/rheumatology/keae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 01/17/2024] Open
Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| |
Collapse
|
36
|
Walton ZE, Patel NJ. Improvement of a giant cell arteritis prediction model. THE LANCET. RHEUMATOLOGY 2024; 6:e257-e258. [PMID: 38554719 DOI: 10.1016/s2665-9913(24)00083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Zandra E Walton
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
37
|
Kang MK, Hong Y, Kim YH, Park HK, Kim SK, Sohn JH, Kim J, Kwon KH, Cho SJ. Diagnosis, Treatment, and Follow-Up of Giant-Cell Arteritis: A Retrospective Multicenter Study. J Clin Neurol 2024; 20:306-314. [PMID: 38627226 PMCID: PMC11076186 DOI: 10.3988/jcn.2023.0169] [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: 05/11/2023] [Revised: 10/29/2023] [Accepted: 11/22/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND PURPOSE Giant-cell arteritis (GCA) is the most common type of vasculitis in the elderly and is associated with high risks of visual loss and recurrence. Owing to its rarity in Asian populations, the current clinical interventions for these patients are not well known. Here we aimed to characterize the current management status of patients with GCA using Korean multicenter data. METHODS This retrospective study analyzed medical records of patients with GCA at six Korean university hospitals from February 2009 to November 2022. GCA had originally been diagnosed based on the 1990 American College of Rheumatology (ACR) criteria, and cases were selected for inclusion in this study based on the 2022 ACR/European Alliance of Associations for Rheumatology criteria. We evaluated treatments, follow-up periods, and outcomes (relapse, remission, and adverse drug reactions) in patients with GCA with or without arteritic anterior ischemic optic neuropathy (AAION). RESULTS This study analyzed 18 patients with a median age of 75.5 years that included 12 females (66.7%). Seven patients (38.8%) had AAION. All patients initially received prednisolone treatment, while four (22.2%) underwent adjuvant treatment with methotrexate and azathioprine during prednisolone tapering. During the median follow-up of 3.5 months (interquartile range: 2.0-23.2 months), 4 patients (22.2%) had prednisolone-related adverse reactions, 2 (11.1%) relapsed, and 13 (72.3%) dropped out. Nine patients (50.0%) experienced remission, with this being sustained in four (36.4%). CONCLUSIONS This study observed high dropout rates and short follow-ups. Adverse effects of prednisolone were common, and relapses occurred in approximately one-tenth of Korean patients with GCA. Thus, optimizing GCA treatment necessitates regular monitoring and long-term follow-up.
Collapse
Affiliation(s)
- Mi-Kyoung Kang
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yooha Hong
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yoo Hwan Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine and Gyeonsang National University Hospital, Jinju, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jiyoung Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ki-Han Kwon
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
| |
Collapse
|
38
|
Sebastian A, van der Geest KSM, Tomelleri A, Macchioni P, Klinowski G, Salvarani C, Prieto-Peña D, Conticini E, Khurshid M, Dagna L, Brouwer E, Dasgupta B. Development of a diagnostic prediction model for giant cell arteritis by sequential application of Southend Giant Cell Arteritis Probability Score and ultrasonography: a prospective multicentre study. THE LANCET. RHEUMATOLOGY 2024; 6:e291-e299. [PMID: 38554720 DOI: 10.1016/s2665-9913(24)00027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Giant cell arteritis is a critically ischaemic disease with protean manifestations that require urgent diagnosis and treatment. European Alliance of Associations for Rheumatology (EULAR) recommendations advocate ultrasonography as the first investigation for suspected giant cell arteritis. We developed a prediction tool that sequentially combines clinical assessment, as determined by the Southend Giant Cell Arteritis Probability Score (SGCAPS), with results of quantitative ultrasonography. METHODS This prospective, multicentre, inception cohort study included consecutive patients with suspected new onset giant cell arteritis referred to fast-track clinics (seven centres in Italy, the Netherlands, Spain, and UK). Final clinical diagnosis was established at 6 months. SGCAPS and quantitative ultrasonography of temporal and axillary arteries with three scores (ie, halo count, halo score, and OMERACT GCA Score [OGUS]) were performed at diagnosis. We developed prediction models for diagnosis of giant cell arteritis by multivariable logistic regression analysis with SGCAPS and each of the three ultrasonographic scores as predicting variables. We obtained intraclass correlation coefficient for inter-rater and intra-rater reliability in a separate patient-based reliability exercise with five patients and five observers. FINDINGS Between Oct 1, 2019, and June 30, 2022, we recruited and followed up 229 patients (150 [66%] women and 79 [34%] men; mean age 71 years [SD 10]), of whom 84 were diagnosed with giant cell arteritis and 145 with giant cell arteritis mimics (controls) at 6 months. SGCAPS and all three ultrasonographic scores discriminated well between patients with and without giant cell arteritis. A reliability exercise showed that the inter-rater and intra-rater reliability was high for all three ultrasonographic scores. The prediction model combining SGCAPS with the halo count, which was termed HAS-GCA score, was the most accurate model, with an optimism-adjusted C statistic of 0·969 (95% CI 0·952 to 0·990). The HAS-GCA score could classify 169 (74%) of 229 patients into either the low or high probability groups, with misclassification observed in two (2%) of 105 patients in the low probability group and two (3%) of 64 of patients in the high probability group. A nomogram for easy application of the score in daily practice was created. INTERPRETATION A prediction tool for giant cell arteritis (the HAS-GCA score), combining SGCAPS and the halo count, reliably confirms and excludes giant cell arteritis from giant cell arteritis mimics in fast-track clinics. These findings require confirmation in an independent, multicentre study. FUNDING Royal College of Physicians of Ireland, FOREUM.
Collapse
Affiliation(s)
- Alwin Sebastian
- Rheumatology, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Westcliff-on-sea, UK; School of Sport, Rehabilitation and Exercise science, University of Essex, Colchester, UK; Rheumatology, University Hospital Limerick, Dooradoyle, Ireland
| | - Kornelis S M van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Giulia Klinowski
- Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Modena, Italy
| | - Diana Prieto-Peña
- Rheumatology, Immunopathology, IDIVAL, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | | | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elisabeth Brouwer
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Westcliff-on-sea, UK; School of Sport, Rehabilitation and Exercise science, University of Essex, Colchester, UK; MTRC, Anglia Ruskin University, Chelmsford, UK.
| |
Collapse
|
39
|
Allam MN, Baba Ali N, Mahmoud AK, Scalia IG, Farina JM, Abbas MT, Pereyra M, Kamel MA, Awad KA, Wang Y, Barry T, Huang SS, Nguyen BD, Yang M, Jokerst CE, Martinez F, Ayoub C, Arsanjani R. Multi-Modality Imaging in Vasculitis. Diagnostics (Basel) 2024; 14:838. [PMID: 38667483 PMCID: PMC11049623 DOI: 10.3390/diagnostics14080838] [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: 02/29/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Systemic vasculitides are a rare and complex group of diseases that can affect multiple organ systems. Clinically, presentation may be vague and non-specific and as such, diagnosis and subsequent management are challenging. These entities are typically classified by the size of vessel involved, including large-vessel vasculitis (giant cell arteritis, Takayasu's arteritis, and clinically isolated aortitis), medium-vessel vasculitis (including polyarteritis nodosa and Kawasaki disease), and small-vessel vasculitis (granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis). There are also other systemic vasculitides that do not fit in to these categories, such as Behcet's disease, Cogan syndrome, and IgG4-related disease. Advances in medical imaging modalities have revolutionized the approach to diagnosis of these diseases. Specifically, color Doppler ultrasound, computed tomography and angiography, magnetic resonance imaging, positron emission tomography, or invasive catheterization as indicated have become fundamental in the work up of any patient with suspected systemic or localized vasculitis. This review presents the key diagnostic imaging modalities and their clinical utility in the evaluation of systemic vasculitis.
Collapse
Affiliation(s)
- Mohamed N. Allam
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Nima Baba Ali
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Ahmed K. Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Isabel G. Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Juan M. Farina
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Mohammed Tiseer Abbas
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Moaz A. Kamel
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Kamal A. Awad
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Yuxiang Wang
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Steve S. Huang
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA (B.D.N.)
| | - Ba D. Nguyen
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA (B.D.N.)
| | - Ming Yang
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA (B.D.N.)
| | | | - Felipe Martinez
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA (B.D.N.)
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA; (M.N.A.); (M.T.A.)
| |
Collapse
|
40
|
Stamatis P, Mohammad MA, Gisslander K, Merkel PA, Englund M, Turesson C, Erlinge D, Mohammad AJ. Myocardial infarction in a population-based cohort of patients with biopsy-confirmed giant cell arteritis in southern Sweden. RMD Open 2024; 10:e003960. [PMID: 38599652 PMCID: PMC11015192 DOI: 10.1136/rmdopen-2023-003960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To determine the incidence rate (IR) of myocardial infarction (MI), relative risk of MI, and impact of incident MI on mortality in individuals with biopsy-confirmed giant cell arteritis (GCA). METHODS MIs in individuals diagnosed with GCA 1998-2016 in Skåne, Sweden were identified by searching the SWEDEHEART register, a record of all patients receiving care for MI in a coronary care unit (CCU). The regional diagnosis database, with subsequent case review, identified GCA patients receiving care for MI outside of a CCU. A cohort of 10 reference subjects for each GCA case, matched for age, sex and area of residence, was used to calculate the incidence rate ratio (IRR) of MI in GCA to that in the general population. RESULTS The GCA cohort comprised 1134 individuals. During 7958 person-years of follow-up, 102 were diagnosed with incident MI, yielding an IR of 12.8 per 1000 person-years (95% CI 10.3 to 15.3). The IR was highest in the 30 days following GCA diagnosis and declined thereafter. The IRR of MI in GCA to that of the background population was 1.29 (95% CI 1.05 to 1.59). Mortality was higher in GCA patients who experienced incident MI than in those without MI (HR 2.8; 95% CI 2.2 to 3.6). CONCLUSIONS The highest incidence of MI occurs within the 30 days following diagnosis of GCA. Individuals with GCA have a moderately increased risk of MI compared with a reference population. Incident MI has a major impact on mortality in GCA.
Collapse
Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Sunderby Hospital, Luleå, Sweden
| | | | - Karl Gisslander
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund Universtiy, Malmö, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
41
|
Lamessa A, Birhanu A, Mekonnen G, Mohammed A, Woyimo TG, Asefa ET. Ischemic stroke as the first clinical manifestation of an initially undiagnosed case of Takayasu arteritis in a young woman from Ethiopia: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241241190. [PMID: 38585421 PMCID: PMC10999126 DOI: 10.1177/2050313x241241190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Takayasu arteritis (TAK) is a rare large-vessel vasculitis of unknown etiology that leads to arterial wall thickening, stenosis, and occlusion, which may complicate cerebrovascular ischemic events. Ischemic stroke is a potentially devastating complication of TAK at a young age, but the occurrence is still rarely reported in Ethiopia. Although it occurs late in the course of the condition, it may be the initial presentation and suggest an unfavorable prognosis. Herein, we address the case of a 25-year-old woman who presented to a university hospital while on follow-up after 2 years of stroke with deterioration in clinical symptoms, absent brachial artery pulses, and unrecordable blood pressure in both arms. At the time of admission in 2021, the contrast brain computed tomography scan revealed an ischemic infarction in the right middle cerebral artery territory. However, the etiology of the stroke could not be defined at that time due to ambiguity in the clinical picture and the inability of clinicians to incorporate TAK into the differential diagnosis, resulting in a delay in the early diagnosis of the case. Two years later, in 2023, she underwent computed tomography angiography and was diagnosed to have TAK based on American College of Rheumatology criteria, with Numano type IIb angiographic extent of disease, ischemic stroke, and stage II systemic hypertension. The patient was treated by a field of experts. This case highlights the need to consider TAK in the differential diagnosis of stroke in young patients in the absence of traditional risk factors; appropriate tests should be performed to confirm or rule out this diagnosis, and management should be modified accordingly.
Collapse
Affiliation(s)
- Adugna Lamessa
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | | | | | | |
Collapse
|
42
|
Gallou S, Agard C, Dumont A, Deshayes S, Boutemy J, Maigné G, Martin Silva N, Nguyen A, Philip R, Espitia O, Aouba A, de Boysson H. Evolution and outcomes of aortic dilations in giant cell arteritis. Eur J Intern Med 2024:S0953-6205(24)00146-8. [PMID: 38580542 DOI: 10.1016/j.ejim.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES To identify factors associated with the progression of giant cell arteritis (GCA)-related or associated aortic dilations. METHODS In this retrospective study, 47 GCA patients with aortic dilation were longitudinally analyzed. Each patient underwent ≥2 imaging scans of the aorta during the follow-up. Three progression statuses of aortic dilations were distinguished: fast-progressive (FP) defined by a progression of the aortic diameter ≥5 mm/year or ≥1 cm/2 years, slow progressive (SP) by a progression of the aortic diameter >1 mm during the follow-up, and not progressive (NP) when aortic diameter remained stable. RESULTS Among the 47 patients with aortic dilation, the thoracic section was involved in 87 % of patients. Within a total follow-up of 89 [6-272] months, we identified 13 (28 %) patients with FP dilations, and 16 (34 %) and 18 (38 %) patients with SP and NP dilations, respectively. No differences regarding baseline characteristics, cardiovascular risk factors or treatments were observed among the 3 groups. However, FP patients more frequently showed atheromatous disease (p = 0.04), with a more frequent use of statins (p = 0.04) and antiplatelet agents (p = 0.02). Among the 27 (57 %) patients with aortitis, aortic dilation developed on an inflammatory segment in 23 (85 %). Among the FP patients who underwent aortic surgery with available histology (n = 3), all presented active vasculitis. CONCLUSION This study suggests that aortic inflammation, as well as atheromatous disease, might participate in the fast progression of aortic dilation in GCA.
Collapse
Affiliation(s)
- Sophie Gallou
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | | | - Alexandre Nguyen
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Rémi Philip
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France.
| |
Collapse
|
43
|
Roubille C. [Management of cardiovascular comorbidities in immune-mediated inflammatory diseases]. Rev Med Interne 2024; 45:194-199. [PMID: 37981509 DOI: 10.1016/j.revmed.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023]
Abstract
Patients with chronic inflammatory and autoimmune diseases are at increased cardiovascular risk, which is the cause of persistent excess mortality despite increasingly effective specific treatment of the inflammatory and/or autoimmune disease. This increased cardiovascular risk is multifactorial, associated with accelerated atherosclerosis related to systemic inflammation, but also secondary to traditional cardiovascular risk factors and to the therapies used to control systemic inflammation. This justifies a coordinated, personalized management of cardiovascular risk in patients with chronic inflammatory and autoimmune diseases, based not only on the treatment of their disease to achieve the lowest level of activity, but also on the screening and management of their cardiovascular comorbidities and modifiable cardiovascular risk factors.
Collapse
Affiliation(s)
- C Roubille
- Département de médecine interne, CHU de Lapeyronie, Montpellier, France; Inserm, PhyMedExp, CNRS, CHRU Montpellier, université de Montpellier, Montpellier, France; Université de Montpellier, Montpellier, France.
| |
Collapse
|
44
|
Zolio L, Francis PA, Ferdowsi N. PEG-GCSF-induced aortitis in a patient with breast cancer: distinguishing between infective and immune-mediated aortitis. Med J Aust 2024; 220:307-309. [PMID: 38379291 DOI: 10.5694/mja2.52237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/03/2023] [Indexed: 02/22/2024]
Affiliation(s)
- Luigi Zolio
- St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Prudence A Francis
- St Vincent's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | | |
Collapse
|
45
|
Sugihara T, Yoshifuji H, Uchida HA, Maejima Y, Watanabe Y, Tanemoto K, Umezawa N, Manabe Y, Ishizaki J, Shirai T, Nagafuchi H, Hasegawa H, Niiro H, Ishii T, Nakaoka Y, Harigai M. Establishing clinical remission criteria for giant cell arteritis: Results of a Delphi exercise carried out by an expert panel of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis. Mod Rheumatol 2024; 34:568-575. [PMID: 37225423 DOI: 10.1093/mr/road046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop a proposal for giant cell arteritis remission criteria in order to implement a treat-to-target algorithm. METHODS A task force consisting of 10 rheumatologists, 3 cardiologists, 1 nephrologist, and 1 cardiac surgeon was established in the Large-vessel Vasculitis Group of the Japanese Research Committee of the Ministry of Health, Labour and Welfare for Intractable Vasculitis to conduct a Delphi survey of remission criteria for giant cell arteritis. The survey was circulated among the members over four reiterations with four face-to-face meetings. Items with a mean score of ≥4 were extracted as items for defining remission criteria. RESULTS An initial literature review yielded a total of 117 candidate items for disease activity domains and treatment/comorbidity domains of remission criteria, of which 35 were extracted as disease activity domains (systematic symptoms, signs and symptoms of cranial and large-vessel area, inflammatory markers, and imaging findings). For the treatment/comorbidity domain, ≤5 mg/day of prednisolone 1 year after starting glucocorticoids was extracted. The definition of achievement of remission was the disappearance of active disease in the disease activity domain, normalization of inflammatory markers, and ≤5 mg/day of prednisolone. CONCLUSION We developed proposals for remission criteria to guide the implementation of a treat-to-target algorithm for giant cell arteritis.
Collapse
Affiliation(s)
- Takahiko Sugihara
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiko Watanabe
- First Department of Physiology, Kawasaki Medical School, Kurashiki, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Natsuka Umezawa
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Manabe
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
| | - Jun Ishizaki
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tsuyoshi Shirai
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroko Nagafuchi
- Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitoshi Hasegawa
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroaki Niiro
- Department of Medical Education, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomonori Ishii
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|
46
|
Moisii P, Jari I, Naum AG, Butcovan D, Tinica G. Takayasu's Arteritis: A Special Case Report and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:456. [PMID: 38541182 PMCID: PMC10971973 DOI: 10.3390/medicina60030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
Background: Takayasu's arteritis is a rare type of vasculitis with severe complications like stroke, ischemic heart disease, pulmonary hypertension, secondary hypertension, and aneurysms. Diagnosis is achieved using clinical and angiographic criteria. Treatment is medical and surgical, but unfortunately, the outcome is limited. Case presentation: A 34-year-old Caucasian woman had an ischemic stroke (2009). She was diagnosed with Takayasu's arteritis and received treatment with methotrexate, prednisolone, and antiplatelet agents, with a mild improvement in clinical state. After 6 years (2015), she experienced an ascending aorta aneurysm, pulmonary hypertension, and mild aortic regurgitation. Surgical treatment solved both the ascending aorta aneurysm and left carotid artery stenosis (ultrasound in 2009 and computed tomography angiogram in 2014). Morphopathology revealed a typical case of Takayasu's arteritis. Tumor necrosis factor inhibitors (TNF inhibitors) were prescribed with methotrexate. At 48 years old (2023), she developed coronary heart disease (angina, electrocardiogram); echocardiography revealed severe pulmonary hypertension, and angiography revealed normal coronary arteries, abdominal aorta pseudoaneurysm, and arterial-venous fistula originating in the right coronary artery with drainage in the medium pulmonary artery. The patient refused surgical/interventional treatment. She again received TNF inhibitors, methotrexate, antiplatelet agents, and statins. Conclusions: This case report presented a severe form of Takayasu's arteritis. Our patient had multiple arterial complications, as previously mentioned. She received immunosuppressive treatment, medication targeted to coronary heart disease, and surgical therapy.
Collapse
Affiliation(s)
- Paloma Moisii
- 1st Medical Department, “Gr. T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- “Promedicanon” Cardiology Office, 15 Prisacii Valley, Valea Lupului, 707410 Iasi, Romania
| | - Irina Jari
- 2nd Surgical Department, “Gr. T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
- “Sf. Spiridon” Emergency Hospital, Radiology and Medical Imaging Clinique, 1st Independentei Avenue, 700111 Iasi, Romania
| | - Alexandru Gratian Naum
- 2nd Morphofunctional Sciences Department, Biophysics and Medical Physics, “Gr. T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
- “Neolife” Medical Center, 52 Carol I Avenue, 700503 Iasi, Romania
| | - Doina Butcovan
- 1st Morpho-Functional Sciences Department, “Gr. T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
- Pathology Department, “Prof. Dr. George Georgescu” Institute of Cardiovascular Diseases, 50 Carol I Avenue, 700503 Iasi, Romania
| | - Grigore Tinica
- 1st Surgery Department—Cardiac Surgery, “Gr. T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
- Cardiac Surgery Department, “Prof. Dr. George Georgescu” Institute of Cardiovascular Diseases, 50 Carol I Avenue, 700503 Iasi, Romania
| |
Collapse
|
47
|
Ilic I, Koulas I, El Khoury L. Navigating the Diagnostic Challenges of Giant Cell Arteritis in a General Rheumatology Practice: Time for a Change. J Clin Rheumatol 2024:00124743-990000000-00192. [PMID: 38446427 DOI: 10.1097/rhu.0000000000002070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
|
48
|
Peron Filho F, Moreira ADS, Janes ALF, de Souza AWS. Effectiveness and safety of adalimumab compared with leflunomide in patients with Takayasu arteritis: a retrospective cohort study. RMD Open 2024; 10:e003992. [PMID: 38443091 PMCID: PMC11146362 DOI: 10.1136/rmdopen-2023-003992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the effectiveness and safety of adalimumab (ADA) compared with leflunomide (LEF) in patients with Takayasu arteritis (TAK). METHOD A retrospective cohort study was performed with the following inclusion criteria: the fulfilment of the 2022 American College Classification/European Alliance of Associations for Rheumatology criteria for TAK, age ≥18 years, and written informed consent. Forty-four patients were treated with LEF (n=28) or ADA (n=16) therapy due to relapsing/refractory disease or toxicity from previous therapy. Patients were evaluated at baseline (T0), at a median of 7.0 months (T1) and at 15.0 months of follow-up (T2). Data regarding disease activity, daily dose of prednisone, side effects and angiographic progression were analysed. RESULTS LEF and ADA groups had similar features on the baseline visit. However, intravenous methylprednisolone was more frequently prescribed for the ADA group (p=0.019). On T1 and T2 visits, complete response rates were similar for ADA and LEF groups (75.0% and 88.5%; p=0.397 and 62.5% vs 78.3%; p=0.307), respectively. The differences remained non-significant after adjusting for baseline variables by propensity score matching. Although the ADA group had a higher median daily prednisone on visit T1 (p=0.004), it was similar on visit T2 (p=0.595). Similar rates of angiographic progression were observed in ADA and LEF groups (40% vs 25%; p=0.467). Mild-to-moderate adverse events were observed only in the LEF group (17.9%). CONCLUSION LEF and ADA had comparable outcomes after a median of 15.0 months of follow-up. However, withdrawal from therapy and mild-to-moderate adverse events were only observed in the LEF group.
Collapse
Affiliation(s)
- Faustino Peron Filho
- Rheumatology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Andressa de Souza Moreira
- Rheumatology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Anna Larissa Faria Janes
- Rheumatology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Alexandre W S de Souza
- Rheumatology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, Brazil
| |
Collapse
|
49
|
Guarda M, Hurst PD, Kaymakci M, Warrington KJ, Koster MJ. Positive Temporal Artery Ultrasound and Biopsy After 5 Months of High-Dose Glucocorticoids. J Rheumatol 2024; 51:326-327. [PMID: 37967905 DOI: 10.3899/jrheum.2023-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- Max Guarda
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic
| | - Philip D Hurst
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mahmut Kaymakci
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic
| | | | - Matthew J Koster
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic;
| |
Collapse
|
50
|
Souza Pedreira AL, Leite de Castro Flores M, Barreto Santiago M. Interleukin 6 Levels and Disease Activity in Takayasu Arteritis: A Systematic Review With Meta-analysis. J Clin Rheumatol 2024; 30:58-64. [PMID: 38190729 DOI: 10.1097/rhu.0000000000002053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Various studies have suggested interleukin 6 (IL-6) as a potential biomarker for detecting disease activity in Takayasu arteritis. METHODS A systematic review and meta-analysis was performed to assess differences in IL-6 levels in patients with active (aTA) and inactive Takayasu arteritis (iTA), as well as healthy controls (HCs), using validated activity scores. Study quality and the risk of bias were assessed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and the Newcastle-Ottawa and Joanna Briggs checklist, respectively. For the meta-analysis, we pooled the raw mean IL-6 levels in each group and then estimated and pooled the crude mean differences between the groups. We applied a random-effects model in all analyses. RESULTS Of the 93 eligible articles, 10 were included after removing duplicates and studies that met the exclusion criteria. Overall, 1825 patients with a mean age ranging from 24 to 40.6 years were included. The pooled levels of IL-6 increased depending on disease activity as follows: HCs: 3.08 (95% confidence interval [CI], 0.88-5.28), iTA: 7.21 (3.61-10.82), and aTA: 22.67 (12.44-32.91) pg/mL. Patients with aTA had higher IL-6 levels than HCs (21.52 [95% CI, -0.43 to 43.47]) and those with iTA (16.69 [95% CI, 5.32-28.06]), whereas IL-6 levels were not different between HCs and patients with iTA (3.62 [95% CI, -13.18 to 20.42]). CONCLUSIONS Interleukin 6 levels are significantly increased in patients with aTA compared with those with iTA and HCs but not in patients with iTA compared with HCs. More studies are needed to establish the IL-6 cutoff value for assessing disease activity.
Collapse
|