1
|
Guzel Dirim M, Mammadzada L, Senkal N, Medetalibeyoglu A, Kose M. Simultaneous pericardial and pleural effusion as a rare first manifestation of giant cell arteritis. Intern Emerg Med 2024; 19:1161-1162. [PMID: 37955786 DOI: 10.1007/s11739-023-03469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Merve Guzel Dirim
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Lamiya Mammadzada
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Naci Senkal
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alpay Medetalibeyoglu
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kose
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
2
|
Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Rossi P, Schleinitz N, Harlé JR, Jarrot PA, Kaplanski G, Berbis J, Granel B. Pericardial effusion in giant cell arteritis is associated with increased inflammatory markers: a retrospective cohort study. Rheumatol Int 2022; 42:2013-2018. [PMID: 35525874 DOI: 10.1007/s00296-022-05137-w] [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: 02/22/2022] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most frequent vasculitis affecting adults aged > 50 years. Cardiac involvement in GCA is considered rare, and only a few cases of pericarditis have been reported. The aim of this study was to determine the characteristics and prognosis of GCA patients suffering from pericardial involvement at diagnosis. METHODS We conducted a single-centre, retrospective chart review of patients with GCA in internal medicine departments (from 2000 to 2020). Patients were identified through a centralized hospital database. We retrospectively collected demographic, clinicobiological, histological, imaging, treatment and outcome data. Patients with pericardial effusion, defined as an effusion visible on the CT-scan performed at GCA diagnosis were compared to those without pericardial involvement. RESULTS Among the 250 patients with GCA, 23 patients (9.2%) had pericardial effusion on CT-scan. The comparison between the groups revealed similar distribution of age, gender, cranial symptoms and ocular ischaemic complications. Patients with pericardial effusion had a higher frequency of weight loss. They also had lower haemoglobin levels and higher platelet levels (p = 0.006 and p = 0.002, respectively), and they more frequently had positive temporal artery biopsy. There were no differences concerning the treatment, relapses, follow-up duration or deaths. CONCLUSIONS This case series sheds light on GCA as a cause of unexplained pericardial effusion or symptomatic pericarditis among adults aged > 50 years and elevated inflammatory biological markers. Fortunately, pericardial involvement is a benign GCA manifestation. In that context, the search for constitutional symptoms, cranial symptoms and associated signs of polymyalgia rheumatica is crucial for rapidly guiding GCA diagnosis.
Collapse
Affiliation(s)
- Quentin Gomes de Pinho
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France.
| | - Aurélie Daumas
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Gériatrie et Thérapeutique, Aix-Marseille Université (AMU), Marseille, France
| | - Audrey Benyamine
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Julien Bertolino
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Pascal Rossi
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Nicolas Schleinitz
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Jean-Robert Harlé
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Timone, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| | - Pierre André Jarrot
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Université (AMU), Marseille, France
| | - Gilles Kaplanski
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique, Aix-Marseille Université (AMU), Marseille, France
| | - Julie Berbis
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'étude et de Recherche sur les Service de Santé et la Qualité de vie, Aix-Marseille Université (AMU), Marseille, France
| | - Brigitte Granel
- Assistance Publique des Hôpitaux de Marseille (APHM), Hôpital Nord, Service de Médecine Interne, Aix-Marseille Université (AMU), Marseille, France
| |
Collapse
|
3
|
Fayyaz B, Rehman HJ. The Spectrum of Pericardial Involvement in Giant Cell Arteritis and Polymyalgia Rheumatica: A Systematic Review of Literature. J Clin Rheumatol 2021; 27:5-10. [PMID: 31483352 DOI: 10.1097/rhu.0000000000001140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a systemic vasculitis that commonly co-occurs with polymyalgia rheumatica (PMR) in elderly patients. Pericardial disease is an unusual manifestation of these inflammatory conditions, which has been reported only in case reports and small observational studies. However, no extensive research has been performed to study the demographics and clinical history of GCA or PMR patients with concomitant pericardial features. As a result, the medical evidence to help guide the physicians when evaluating such individuals is limited. OBJECTIVE To perform a systematic review of the medical literature in order to summarize the epidemiological and clinicopathological aspects of this unique association. METHODS We conducted an extensive search of PubMed, Cochrane Library, Ovid, Google Scholar, and gray literature to identify all the cases of GCA and PMR with pericardial involvement. The demographics, clinical features, and outcomes of the final cohort were reviewed and analyzed. RESULTS The analysis comprised 52 clinical cases (51 identified from 46 articles and 1 from the residents' clinic). These included 44 patients with GCA and 8 with PMR. The mean age at presentation was 69.5 years, with only 46% of patients older than 70 years. The most common abnormality was pericardial effusion (85%), and in 37%, the pericardial event was the initial disease manifestation. Although a significant proportion of the patients were symptomatic (69%), the classic cranial symptoms were present in only 40%. Overall, the outcome was good even in the presence of large-vessel disease, which is usually a poor prognostic factor in classic GCA. On group analysis, patients with PMR were more likely to develop cardiac tamponade (37.5%; odds ratio, 25.8; confidence interval, 2.2-297.5; p = 0.01), whereas those with GCA were more likely to have large-vessel vasculitis (43%; odds ratio, 5.18; confidence interval, 0.58-252.1; p = 0.04). CONCLUSIONS This study illustrates that patients with pericardial involvement represent a clinical phenotype of GCA (and possibly PMR), which is quite different from the cranial or large-vessel forms. These patients have a better prognosis likely due to younger age and presence of more overt symptoms resulting in early diagnosis.
Collapse
Affiliation(s)
- Beenish Fayyaz
- From the Department of Internal medicine, Greater Baltimore Medical Center, Towson
| | - Hafiz J Rehman
- Department of Geriatrics, University of Maryland, Baltimore, MD
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW We review the epidemiology, pathophysiology, and management of pericarditis most commonly complicating autoimmune and autoinflammatory conditions. RECENT FINDINGS Typically, pericarditis occurs in the context of a systemic flare of the underlying disease but infrequently, it is the presenting manifestation requiring a high index of suspicion to unravel the indolent cause. Pericardial involvement in rheumatic diseases encompasses a clinical spectrum to include acute, recurrent and incessant pericarditis, constrictive pericarditis, asymptomatic pericardial effusion, and pericardial tamponade. Direct evidence on the pathophysiology of pericarditis in the context of rheumatic diseases is scant. It is theorized that immune perturbations within pericardial tissue result from the underlying central immunopathology of the respective autoimmune or autoinflammatory disease. Pericarditis management depends on acuity, the underlying cause and epidemiological features such as patient's immune status and geographic prevalence of infections such as tuberculosis. Immunosuppressive medications including biologics such as interleukin 1 blockers emerge as possible steroid sparing agents for pericarditis treatment.
Collapse
Affiliation(s)
- Apostolos Kontzias
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA.
| | - Amir Barkhodari
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - QingPing Yao
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| |
Collapse
|
5
|
Georgakopoulou VE, Mermigkis D, Kairi O, Garmpi A, Tsiafaki X. Simultaneous Pleural and Pericardial Effusion as First Clinical Manifestations of Giant Cell Arteritis: A Case Report. Cureus 2020; 12:e10163. [PMID: 33014658 PMCID: PMC7526968 DOI: 10.7759/cureus.10163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of unknown aetiology occurring in the older patients and affecting mostly the cranial branches of the arteries originating from the aortic arch. GCA is associated with polymyalgia rheumatica (PMR). Clinical features of the disorder include headache, scalp tenderness, jaw claudication, temporal artery abnormalities on physical examination, vision changes, and symptoms associated to PMR. Systemic manifestations include fever, anorexia and weight loss while less rare manifestations are related to the nervous system, the respiratory system, the pericardium and extra-cranial large vessels. Here we report a rare case of simultaneous pleural and pericardial effusion as the first manifestations of GCA. The diagnosis was made with a temporal artery biopsy. Such a diagnosis should, therefore, be considered in older patients presenting with pleuropericardial manifestations, even in the absence of typical clinical features.
Collapse
Affiliation(s)
- Vasiliki E Georgakopoulou
- Pulmonology Department, Laiko General Hospital, Athens, GRC.,1st Pulmonology Department, Sismanogleio Hospital, Athens, GRC
| | | | - Ourania Kairi
- Intensive Care Unit, Sismanogleio Hospital, Athens, GRC
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Xanthi Tsiafaki
- 1st Pulmonology Department, Sismanogleio Hospital, Athens, GRC
| |
Collapse
|
6
|
Rubenstein E, Maldini C, Gonzalez-Chiappe S, Chevret S, Mahr A. Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: a systematic literature review and meta-analysis. Rheumatology (Oxford) 2020; 59:1011-1020. [PMID: 31529073 DOI: 10.1093/rheumatology/kez385] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Temporal artery biopsy (TAB) is a reference test for the diagnosis of GCA but reveals inflammatory changes only in a subset of patients. The lack of knowledge of TAB sensitivity hampers comparisons with non-invasive techniques such as temporal artery ultrasonography. We performed a systematic literature review and meta-analysis to estimate the sensitivity of TAB in GCA and to identify factors that may influence the estimate. METHODS A systematic literature review involved searching electronic databases and cross-references. Eligibility criteria included publications reporting at least 30 GCA cases fulfilling the original or modified 1990 ACR classification criteria. The pooled proportion of TAB-positive GCA cases was calculated by using aggregated-data meta-analysis with a random-effects model and assessment of heterogeneity with the I2 statistic. Subgroup analyses and meta-regression were used to examine the effect of patient and study characteristics on TAB positivity. RESULTS Among 3820 publications screened, 32 studies (3092 patients) published during 1993-2017 were analysed. The pooled proportion of TAB-positive GCA cases was 77.3% (95% CI: 71.8, 81.9%), with high between-study heterogeneity (I2 = 90%). The proportion of TAB-positive cases was slightly higher in publications before than in 2012 and after (P = 0.001). CONCLUSION The estimated sensitivity of 77% provides indirect evidence that TAB is not less sensitive than temporal artery imaging. The unexplained high between-study heterogeneity could result from differences in TAB sampling, processing or interpretation. The decrease in TAB-positive GCA cases over time could reflect an increasing propensity for clinicians to accept a GCA diagnosis without proof by TAB.
Collapse
Affiliation(s)
- Emma Rubenstein
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
| | - Carla Maldini
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
| | | | - Sylvie Chevret
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
- ECSTRRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France
| |
Collapse
|
7
|
Tiosano S, Adler Y, Azrielant S, Yavne Y, Gendelman O, Ben-Ami Shor D, Comaneshter D, Shalom G, Cohen AD, Amital H. Pericarditis among giant cell arteritis patients: From myth to reality. Clin Cardiol 2018; 41:623-627. [PMID: 29746000 DOI: 10.1002/clc.22927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Giant cell arteritis (GCA) is an inflammatory disease of unknown etiology affecting adults age > 50 years. GCA (also known as temporal arteritis) is a vasculitis of large and medium-size vessels that involves the extracranial branches of the carotid artery. Common manifestations include constitutional symptoms, headache, jaw claudication, scalp tenderness, and vision loss. Cardiac involvement in GCA is considered to be as low as 5%, and < 30 cases of pericarditis among GCA patients have been reported in the literature. The aim of this study was to evaluate the association between GCA and pericarditis by conducting a cross-sectional study utilizing the database of the largest healthcare provider in Israel. HYPOTHESIS GCA is associated with pericarditis. METHODS The proportion of past documentation of pericarditis among patients diagnosed with GCA was compared with that of their age- and sex-matched controls. Univariate analysis was performed using the χ2 and t tests; multivariate analysis was performed using logistic regression. RESULTS The study included 4329 GCA patients and 21 611 controls. GCA patients had higher rates of cardiovascular risk factors. Pericarditis was observed in 53 GCA patients and 72 controls (1.22% vs 0.33%, respectively; P < 0.001), significantly higher among GCA patients in comparison with controls. A significant interaction was found between GCA, pericarditis, and young age (<70 years). CONCLUSIONS The study showed an independent association between GCA and pericarditis, especially among young patients. Proper screening should be applied whenever a suspicion arises as to the existence of comorbidity in patients with either disease.
Collapse
Affiliation(s)
- Shmuel Tiosano
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Adler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Management, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Shir Azrielant
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yarden Yavne
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Gendelman
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Ben-Ami Shor
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Guy Shalom
- Department of Dermatology and Venereology, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|