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Müller F, Pfob CH, Wahle M. [Unclear cause of unilateral blindness with normal inflammation parameters]. Z Rheumatol 2024:10.1007/s00393-024-01531-w. [PMID: 38874771 DOI: 10.1007/s00393-024-01531-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] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
A 70-year-old female patient presented with unilateral blindness of the right eye. As C‑reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were inconspicuous, a nonarteritic embolic occlusion was assumed; however, after detailed anamnesis large vessel vasculitis (LVV) appeared more likely, which was confirmed by the subsequent imaging diagnostics. This rare case of LVV without an increase in one of the inflammatory parameters CRP or ESR highlights the importance of the medical history and targeted diagnostic procedures.
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Affiliation(s)
- Felix Müller
- 3. Med. Klinik, Sektion Rheumatologie & Klinische Immunologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - Christian Helmut Pfob
- Universitätsklinikum Augsburg, Nuklearmedizin, Medizinische Fakultät, Universität Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - Matthias Wahle
- 3. Med. Klinik, Sektion Rheumatologie & Klinische Immunologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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2
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Ness T, Nölle B. Giant Cell Arteritis. Klin Monbl Augenheilkd 2024; 241:644-652. [PMID: 38593832 DOI: 10.1055/a-2252-3371] [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: 04/11/2024]
Abstract
Giant cell arteritis (GCA) is the most common primary vasculitis and is associated with potential bilateral blindness. Neither clinical nor laboratory evidence is simple and unequivocal for this disease, which usually requires rapid and reliable diagnosis and therapy. The ophthalmologist should consider GCA with the following ocular symptoms: visual loss or visual field defects, transient visual disturbances (amaurosis fugax), diplopia, eye pain, or new onset head or jaw claudication. An immediate ophthalmological examination with slit lamp, ophthalmoscopy, and visual field, as well as color duplex ultrasound of the temporal artery should be performed. If there is sufficient clinical suspicion of GCA, corticosteroid therapy should be initiated immediately, with prompt referral to a rheumatologist/internist and, if necessary, temporal artery biopsy should be arranged. Numerous developments in modern imaging with colour duplex ultrasonography, MRI, and PET-CT have the potential to compete with the classical, well-established biopsy of a temporal artery. Early determination of ESR and CRP may support RZA diagnosis. Therapeutically, steroid-sparing immunosuppression with IL-6 blockade or methotrexate can be considered. These developments have led to a revision of both the classification criteria and the diagnostic and therapeutic recommendations of the American College of Rheumatologists and the European League against Rheumatism, which are summarised here for ophthalmology.
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Affiliation(s)
- Thomas Ness
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Bernhard Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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3
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Yinh JM, Ford JN, Jorge AM, Zonozi R. Case 7-2024: A 67-Year-Old Woman with Alternating Sixth Cranial Nerve Palsy. N Engl J Med 2024; 390:843-851. [PMID: 38416433 DOI: 10.1056/nejmcpc2312740] [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] [Indexed: 02/29/2024]
Affiliation(s)
- Janeth M Yinh
- From the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Massachusetts General Hospital, and the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Harvard Medical School - both in Boston; and Nephrology Associates of Northern Virginia, Fairfax, and Inova Fairfax Hospital, Falls Church - both in Virginia (R.Z.)
| | - Jeremy N Ford
- From the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Massachusetts General Hospital, and the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Harvard Medical School - both in Boston; and Nephrology Associates of Northern Virginia, Fairfax, and Inova Fairfax Hospital, Falls Church - both in Virginia (R.Z.)
| | - April M Jorge
- From the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Massachusetts General Hospital, and the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Harvard Medical School - both in Boston; and Nephrology Associates of Northern Virginia, Fairfax, and Inova Fairfax Hospital, Falls Church - both in Virginia (R.Z.)
| | - Reza Zonozi
- From the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Massachusetts General Hospital, and the Departments of Medicine (J.M.Y., A.M.J.) and Radiology (J.N.F.), Harvard Medical School - both in Boston; and Nephrology Associates of Northern Virginia, Fairfax, and Inova Fairfax Hospital, Falls Church - both in Virginia (R.Z.)
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4
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Kara M, Alp G, Koç AM. Diagnostic difficulties in polymyalgia rheumatica cases with normal erythrocyte sedimentation rate and C-reactive protein values. Medicine (Baltimore) 2023; 102:e35385. [PMID: 37773830 PMCID: PMC10545350 DOI: 10.1097/md.0000000000035385] [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: 05/15/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
Polymyalgia Rheumatica (PMR) is an inflammatory disease which does not have specific diagnostic tests or pathological symptoms and is identified based on clinical characteristics. Among acute phase reactants (APR), the erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) are laboratory findings used in diagnosis and follow-up. In this study, it was aimed to determine the incidence of normal ESH and CRP in patients diagnosed with PMR and identify the distinguishing characteristics of these patients. PMR patients who were clinically diagnosed at a single center were reviewed. After the presence of bursitis was demonstrated with ultrasonography in patients with normal ESR and CRP rates, they were accepted to have PMR. Among all 54 patients (63% female), ESR and CRP values were normal in 8 patients (14%), and serum amyloid A (SAA) was determined to be elevated in all these patients. In the comparisons of the groups with normal and high levels of ESR and CRP, it was found that the group with normal ESR and CRP values had a younger age of diagnosis (P = .027), a longer symptom duration (P < .001), and a lower comorbidity rate (P = .010). PMR patients can have normal ESR and CRP values at the time of their diagnosis. While bursitis can be demonstrated with ultrasonography in patients who are clinically evaluated to have PMR, APRs such as SAA other than ESR and CRP can also be used.
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Affiliation(s)
- Mete Kara
- University of Health Sciences Izmir Bozyaka Research and Training Hospital, Rheumatology Department, Izmir, Turkey
| | - Gülay Alp
- Izmir Katip Celebi University Izmir Atatürk Research and Training Hospital, Rheumatology Department, Izmir, Turkey
| | - Ali Murat Koç
- Izmir Katip Celebi University Izmir Atatürk Research and Training Hospital, Department of Radiology, Izmir, Turkey
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Bilton EJ, Mollan SP. Giant cell arteritis: reviewing the advancing diagnostics and management. Eye (Lond) 2023; 37:2365-2373. [PMID: 36788362 PMCID: PMC9927059 DOI: 10.1038/s41433-023-02433-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Giant Cell Arteritis (GCA) is well known to be a critical ischaemic disease that requires immediate medical recognition to initiate treatment and where one in five people still suffer visual loss. The immunopathophysiology has continued to be characterised, and the influencing of ageing in the development of GCA is beginning to be understood. Recent national and international guidelines have supported the directed use of cranial ultrasound to reduce diagnostic delay and improve clinical outcomes. Immediate high dose glucocorticoids remain the standard emergency treatment for GCA, with a number of targeted agents that have been shown in clinical trials to have superior clinical efficacy and steroid sparing effects. The aim of this review was to present the latest advances in GCA that have the potential to influence routine clinical practice.
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Affiliation(s)
- Edward J Bilton
- Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- INSIGHT Health Data Research hub for eye health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Susan P Mollan
- Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.
- INSIGHT Health Data Research hub for eye health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.
- Transitional Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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Liozon E, Parreau S, Dumonteil S, Gondran G, Bezanahary H, Ly KH, Fauchais AL. New-onset giant cell arteritis with lower ESR and CRP level carries a similar ischemic risk to other forms of the disease but has an excellent late prognosis: a case-control study. Rheumatol Int 2023; 43:1323-1331. [PMID: 37024620 DOI: 10.1007/s00296-023-05299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Biopsy-proven giant cell arteritis (GCA) occasionally presents without acute-phase reaction. In this setting, GCA may be initially overlooked and glucocorticoid treatment unduly delayed, potentially increasing ischemic risk. PATIENTS AND METHODS From an inception cohort of patients with newly diagnosed, biopsy-verified GCA, we retrieved all cases without elevation of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level before starting glucocorticoid treatment. We compared the baseline features and outcomes of these patients and two additional patients recruited after GCA diagnosis with those of 42 randomly selected patients with high baseline ESR and CRP. RESULTS Of 396 patients, 14 (3.5%) had lower baseline values of both ESR and CRP. Lower baseline ESR and CRP were associated with fewer American College of Rheumatology criteria met (p < 0.001, 95% CI - 1.1; - 0.9), and less jaw claudication (p = 0.06, 95% CI 0.8; 44.9), but similar rates of permanent blindness (p = 1.0). Patients with lower ESR and CRP also showed obvious differences regarding mean blood cell counts and mean hemoglobin level, but also less anti-cardiolipin antibody positivity (p = 0.04, 95% CI 0.8; ∞) and hepatic cholestasis (p = 0.03, 95% CI 1.0; 422). Patients with lower ESR and CRP had fewer GCA relapses (p = 0.03, 95% CI - 1.1; - 0.1), fewer glucocorticoid-induced complications (p = 0.01, 95% CI - 2.0; - 0.1), and successfully stopped glucocorticoids sooner than the other patients (18.3 months vs 34 months in average, p = 0.02, 95% CI - 27;- 0.9). CONCLUSION Biopsy-proven GCA presenting with lower ESR and CRP is not an exceptional occurrence. It is clinically less typical but carries similar ischemic risk to other forms of the disease. Conversely, the late GCA prognosis of these patients is excellent.
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Affiliation(s)
- Eric Liozon
- Department of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France.
- Service de Médecine Interne A, CHRU Dupuytren, 16, Rue Bernard Descottes, 87042, Limoges, France.
| | - Simon Parreau
- Department of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Stéphanie Dumonteil
- Department of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Guillaume Gondran
- Department of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Holy Bezanahary
- Department of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Kim-Heang Ly
- Department of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Anne Laure Fauchais
- Department of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
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Hiyama R, Oiwa H, Kanou Y, Nishibe S, Kono T, Nomura E. A case of giant cell arteritis lacking typical symptoms presenting with recurrent cerebellar infarctions: A case report and case-based review. Mod Rheumatol Case Rep 2021; 6:220-225. [PMID: 34850091 DOI: 10.1093/mrcr/rxab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/03/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022]
Abstract
Giant cell arteritis (GCA) occasionally presents with ischaemic stroke. Generally, symptoms related to GCA or elevated levels of inflammation markers would be a clue for the diagnosis of GCA. However, we encountered a rare case of GCA that presented with recurrent cerebellar infarctions without symptoms related to GCA (headache, fever, or jaw claudication). Furthermore, C-reactive protein levels, measured at the time of two of the stroke attacks, were within the normal range. On physical examination, the temporal arteries were prominent and weakly pulsatile. Temporal artery ultrasonography showed halo signs, and temporal artery biopsy revealed GCA. To our knowledge, this is the first case of GCA presenting with recurrent ischaemic stroke lacking GCA features but diagnosed before death. Considering this case-based review, we suggest that GCA may have been missed in elderly patients with ischaemic stroke, especially in those with posterior circulation infarction. Therefore, physical examination of the temporal arteries, temporal artery ultrasonography, and vessel wall magnetic resonance imaging may be useful in those patients.
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Affiliation(s)
- Ryuichiro Hiyama
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroshi Oiwa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yukari Kanou
- Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan
| | - Shiho Nishibe
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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9
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Bilici Salman R, Koca G, Gülbahar Ateş S, Yapar D, Babaoglu H, Satış H, Avanoglu Güler A, Karadeniz H, Ataş N, Küçük H, Akdemir ÜÖ, Haznedaroğlu Ş, Tufan A, Göker B, Paşaoğlu H, Atay LÖ, Öztürk MA. Diagnostic utility of serum biomarkers in large vessel vasculitis and their correlation with positron emission tomography. Mod Rheumatol 2021; 32:938-945. [PMID: 34918110 DOI: 10.1093/mr/roab074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/25/2021] [Accepted: 08/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the association between vascular inflammation, as detected by positron emission tomography (PET) imaging and interleukin-6 (IL-6), pentraxin3, and B-cell-activating factor (BAFF) in subjects with LVV. METHODS The study included newly diagnosed giant cell arteritis (GCA, n = 27) or Takayasu arteritis (n = 9) patients and healthy control (HC, n = 31) subjects. PET scan and blood samples were obtained before the introduction of treatments. IL-6, PTX3, and BAFF levels were determined quantitatively by enzyme-linked immunosorbent assay kits. RESULTS Thirty-six patients with LVV (20 females, 16 males; age 64.5 ± 16.6 years) and 31 HC (14 females, 17 males; age 37.1 ± 9.6 years) were included. Serum levels of IL-6, PTX3, and BAFF were increased in patients with newly diagnosed LVV compared with healthy control subjects. In receiver operating characteristics (ROC) analysis, serum IL-6 and BAFF provided excellent discrimination of newly diagnosed LVV patients from HC (area under the ROC curve of >0.90 and >0.80, respectively). None of the inflammatory markers correlated with vascular inflammatory activity determined by PET scanning. CONCLUSIONS Our results suggest that IL-6 and BAFF may serve as markers of large vessel vasculitis, while PTX3 is not useful. None of the inflammatory markers correlated with PET assessed vasculitis activity.
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Affiliation(s)
- Reyhan Bilici Salman
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey.,Department of Internal Medicine, Division of Rheumatology, Dıskapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Gülce Koca
- Biochemistry Department, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Seda Gülbahar Ateş
- Department of Nuclear Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yapar
- Department of Public Health, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hakan Babaoglu
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hasan Satış
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aslıhan Avanoglu Güler
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hazan Karadeniz
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nuh Ataş
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hamit Küçük
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ümit Özgür Akdemir
- Department of Nuclear Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Şeminur Haznedaroğlu
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hatice Paşaoğlu
- Biochemistry Department, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Lütfiye Özlem Atay
- Department of Nuclear Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Tombetti E, Hysa E, Mason JC, Cimmino MA, Camellino D. Blood Biomarkers for Monitoring and Prognosis of Large Vessel Vasculitides. Curr Rheumatol Rep 2021; 23:17. [PMID: 33569633 PMCID: PMC7875948 DOI: 10.1007/s11926-021-00980-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Large vessel vasculitides (LVVs) are inflammatory conditions of the wall of large-sized arteries, mainly represented by giant cell arteritis (GCA) and Takayasu arteritis (TA). The inflammatory process within the vessel wall can lead to serious consequences such as development of aneurysms, strokes and blindness; therefore, early diagnosis and follow-up of LVV are fundamental. However, the arterial wall is poorly accessible and blood biomarkers are intended to help physicians not only in disease diagnosis but also in monitoring and defining the prognosis of these conditions, thus assisting therapeutic decisions and favouring personalised management. The field is the object of intense research as the identification of reliable biomarkers is likely to shed light on the mechanisms of disease progression and arterial remodelling. In this review, we will discuss the role of blood biomarkers in LVVs in the light of the latest evidence. RECENT FINDINGS In clinical practice, the most widely performed laboratory investigations are the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). However, these indices may be within normal limits during disease relapse and they are not reliable in patients receiving interleukin-6 (IL-6) receptor inhibitors. New biomarkers struggle to gain traction in clinical practice and no molecule with good accuracy has been identified to date. IL-6, a pro-inflammatory cytokine that drives CRP synthesis and increases the ESR, is one of the most promising biomarkers in the field. IL-6 analysis is increasingly performed, and serum levels are more sensitive than ESR for active GCA and might reflect persistent inflammation with high risk of relapse in patients on IL-6 receptor inhibitors. A future with biomarkers that reflect different disease features is an important aspiration. Accordingly, intense effort is being made to identify IL-6-independent inflammatory biomarkers, such as S100 proteins, pentraxin-3 and osteopontin. Moreover, metalloproteinases such as MMP2/9 and angiogenic modulators such as VEGF, YLK-40 and angiopoietins are being studied as markers of arterial remodelling. Lastly, biomarkers indicating organ damage may guide prognostic stratification as well as emergency therapeutic decisions: the most promising biomarkers so far identified are NT-proBNP, which reflects myocardial strain; pentraxin-3, which has been associated with recent optic nerve ischemia; and endothelin-1, which is associated with ischaemic complications. Currently, the use of these molecules in clinical practice is limited because of their restricted availability, lack of sufficient studies supporting their validity and associated costs. Further evidence is required to better interpret their biological and clinical value.
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Affiliation(s)
- Enrico Tombetti
- Internal Medicine, Department of Biomedical and Clinical Sciences "Luigi Sacco", Milan, Italy
- Internal Medicine and Rheumatology, Sacco and Fatebenefratelli Hospitals, Milan, Italy
| | - Elvis Hysa
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Justin C Mason
- National Heart and Lung Institute, Imperial College London, London, UK
- Rheumatology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Marco A Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Dario Camellino
- Division of Rheumatology, Musculoskeletal System Department, La Colletta Hospital, Local Health Trust 3 Genoa, Via del Giappone 3, 16011, Arenzano, Italy.
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy.
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11
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Martins P, Teixeira V, Teixeira FJ, Canastro M, Palha A, Fonseca JE, Ponte C. Giant cell arteritis with normal inflammatory markers: case report and review of the literature. Clin Rheumatol 2020; 39:3115-3125. [DOI: 10.1007/s10067-020-05116-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022]
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12
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Treat to Target: A Valid Concept for Management of Polymyalgia Rheumatica and Giant Cell Arteritis? Rheum Dis Clin North Am 2019; 45:549-567. [PMID: 31564296 DOI: 10.1016/j.rdc.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common inflammatory diseases of the elderly. They have variable clinical courses and are usually treated with glucocorticoids (GCs). Relapses are frequent in both conditions. Physicians should balance the tradeoff of treatment-related adverse events and risk of relapse. The ultimate goal of treatment is control of the disease while maintaining patient well-being. A treat-to-target approach may achieve the aim of controlling inflammation and preserving patient's functioning and quality of life, and would require pursuit and evaluation of clinical, laboratory, imaging, and structural targets to tackle the different manifestations of GCA and PMR.
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13
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Bilateral simultaneous amaurosis as onset and unique symptom in giant cell arteritis. Acta Neurol Belg 2018; 118:321-322. [PMID: 29289985 DOI: 10.1007/s13760-017-0877-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
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14
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Abstract
PURPOSE OF REVIEW Giant cell arteritis (GCA) is the most common systemic vasculitis. GCA is categorized as a granulomatous vasculitis of large and medium size vessels. Majority of the symptoms and signs of GCA result from involvement of the aorta and its branches intra- and extracranial. Temporal artery biopsy continues to be the cardinal diagnostic procedure despite new imaging modalities for diagnosing GCA with cranial involvement. Great advances in awareness have led to improvement in preventing irreversible vision loss due to early diagnosis. RECENT FINDINGS The cause of GCA has not been elucidated but major progress has been made in the knowledge of its pathogenesis leading to new therapeutic targets, particularly inhibition of interleukin 6. IL 6 plays a key role in the regulation of TH17/Tregs imbalance in GCA and appears to correlate with clinical disease activity in GCA. All of this has led to the first FDA (food and drug administration) approved treatment for GCA, Tocilizumab. Abatacept and Ustekinumab are promising targets for therapy in LVV but still need further research. This paper is a review of the recent progress in the understanding of GCA pathogenesis, diagnosis, treatment, and prognosis.
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Affiliation(s)
- M Guevara
- Division of Rheumatology Louisiana State University, 1542 Tulane Ave., Box T4M-2, New Orleans, LA, 70112, USA.
| | - C S Kollipara
- Division of Rheumatology Louisiana State University, 1542 Tulane Ave., Box T4M-2, New Orleans, LA, 70112, USA
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15
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Sato H, Inoue M, Muraoka W, Kamatani T, Asoda S, Kawana H, Nakagawa T, Wajima K. Jaw claudication is the only clinical predictor of giant-cell arteritis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Manzo C. Widespread headache as the first clinical manifestation of giant cell arteritis in patients affected by polymyalgia rheumatica. Reumatologia 2016; 54:236-238. [PMID: 27994267 PMCID: PMC5149570 DOI: 10.5114/reum.2016.63663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/29/2016] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION In giant cell arteritis (GCA) headache of new onset due to inflammatory involvement of the temporal artery (TA) represents a diagnostic criterion. A widespread headache (WH) with scalp tenderness due to cranial arteritis can represent another manifestation of GCA. MATERIAL AND METHODS In 225 elderly patients with polymyalgia rheumatica (PMR) followed in our rheumatologic outpatient clinic from 2004 until June 2016, the frequency of WH as the first clinical manifestation of GCA was evaluated. RESULTS Among 26 patients with GCA+PMR (11.6% of total), 5 (23.07%) had WH as first clinical manifestation of GCA without TA. In all these patients TA colour duplex sonography (CDS) and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) with total body contrast-enhanced CT was consistent with the diagnosis of arteritis. TA biopsy was not performed. High doses of prednisone (1 mg/kg/day) led to the immediate and total disappearance of the headache. CONCLUSIONS The widespread headache should be considered as the first symptom GCA and in cases of suspicion of vasculitis patients should have a full diagnostics examination. Colour duplex sonography and FDG-PET with total body contrast-enhanced CT are useful tools for non-invasive diagnosis of GCA.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Department ASL NA 3 sud, Rheumatologic Outpatient Clinic hospital "Mariano Lauro", Sant'Agnello, Italy
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De Smit E, O’Sullivan E, Mackey DA, Hewitt AW. Giant cell arteritis: ophthalmic manifestations of a systemic disease. Graefes Arch Clin Exp Ophthalmol 2016; 254:2291-2306. [DOI: 10.1007/s00417-016-3434-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/19/2016] [Accepted: 06/27/2016] [Indexed: 11/30/2022] Open
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Parry-Jones AR, Ilozue C, du Plessis D, McKee D. Giant cell arteritis presenting as spinal cord infarction. Clin Neurol Neurosurg 2015; 135:54-6. [PMID: 26038276 DOI: 10.1016/j.clineuro.2015.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 03/26/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Adrian R Parry-Jones
- The University of Manchester, Manchester Academic Health Sciences Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK; Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK.
| | - Chinenye Ilozue
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
| | - Daniel du Plessis
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
| | - David McKee
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
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Response to Grzybowski and Justynska. Eye (Lond) 2013; 27:1419-20. [PMID: 24051408 DOI: 10.1038/eye.2013.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Grzybowski A, Justynska A. Giant cell arteritis with normal ESR and/or CRP is rare, but not unique! Eye (Lond) 2013; 27:1418-9. [PMID: 24051406 DOI: 10.1038/eye.2013.208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Grzybowski
- 1] Department of Ophthalmology, Poznań City Hospital, Poznań, Poland [2] Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
| | - A Justynska
- Department of Ophthalmology, L Rydygier's Specialist Hospital in Cracow, Cracow, Poland
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Fernández-Fernández FJ, Pía G, Sesma P. Giant cell arteritis with normal C-reactive protein and risk of ocular complications. Clin Rheumatol 2012; 31:1407. [PMID: 22907269 DOI: 10.1007/s10067-012-2065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 08/09/2012] [Indexed: 11/28/2022]
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