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Amjadeen MS, Bhatt M, Arnfield E. Visualization of cranial giant cell arteritis with [ 18F]FDG PET/CT: A case report. Radiol Case Rep 2024; 19:4549-4553. [PMID: 39206339 PMCID: PMC11357830 DOI: 10.1016/j.radcr.2024.07.074] [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: 06/01/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024] Open
Abstract
Giant cell arteritis is a form of large vessel vasculitis which can present with nonspecific symptoms, and if left untreated can cause significant morbidity and/or death. Early diagnosis and management are therefore paramount. The use of [18F]FDG PET/CT in the evaluation of giant cell arteritis has increased in recent years, with newer generation PET scanners capturing the historically elusive cranial vessel inflammation in active vasculitis. We present a case of giant cell arteritis which was suspected on conventional imaging modalities, and subsequently evaluated with [18F]FDG PET/CT which revealed marked vascular inflammation involving both cranial and other large vessels.
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Affiliation(s)
- Muhammed Sarjoon Amjadeen
- Department of Nuclear Medicine and Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Manoj Bhatt
- Department of Nuclear Medicine and Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Evyn Arnfield
- Department of Nuclear Medicine and Specialised PET Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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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.
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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
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Sun E, Li X, Gruener AM, Chang JR, Henderson AD, Carey AR. Baseline Characteristics and Clinical Presentation of Biopsy-Proven Giant Cell Arteritis in White Compared with Black Patients. J Neuroophthalmol 2023; 43:504-508. [PMID: 36862509 DOI: 10.1097/wno.0000000000001817] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in the elderly and can lead to permanent vision loss if left untreated. Most earlier studies have evaluated GCA in primarily white populations, and GCA was traditionally thought to occur at nearly negligible frequency in black populations. Our previous study showed that GCA may occur at similar rates in white and black patients, but little is known about the presentation of GCA in black patients. The purpose of this study is to examine baseline presentation of biopsy-proven GCA (BP-GCA) in a tertiary care center-based population with a sizeable proportion of black patients. METHODS Retrospective study from a single academic institution of a previously described cohort of BP-GCA. Presenting symptoms, laboratory findings, and GCA Calculator Risk score were compared in black and white patients with BP-GCA. RESULTS Among 85 patients with biopsy-proven GCA, 71 (84%) were white and 12 (14%) were black. White patients had higher rates of elevated platelet count (34% vs 0%, P = 0.04), whereas black patients had higher rates of diabetes mellitus (67% vs 12%, P < 0.001). There were no statistically significant differences in age, gender, biopsy classification (active vs healed arteritis), cranial symptoms, visual symptoms/ophthalmic findings, rates of abnormal erythrocyte sedimentation rate or C-reactive protein, unintentional weight loss, polymyalgia rheumatica, or GCA risk calculator score. CONCLUSIONS Presenting features of GCA were similar between white and black patients in our cohort, except for rates of abnormal platelet level and diabetes. Physicians should feel comfortable relying on the usual clinical features for the diagnosis of GCA independent of race.
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Affiliation(s)
- Emily Sun
- Department of Ophthalmology (ES, ADH, ARC), Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Biostatistics (XL), Biostatistics Center, Johns Hopkins School of Public Health, Baltimore, Maryland; Department of Ophthalmology (AMG), Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Division of Clinical Neuroscience (AMG), School of Medicine, University of Nottingham, Nottingham, United Kingdom; and Keck School of Medicine of the University of Southern California (JRC), USC Roski Eye Institute, Los Angeles, California
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Jiang Z, Ji H, Dong J. Temporal artery biopsy for suspected giant cell arteritis: A mini review. Indian J Ophthalmol 2023; 71:3299-3304. [PMID: 37787225 PMCID: PMC10683700 DOI: 10.4103/ijo.ijo_3163_22] [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: 12/03/2022] [Revised: 05/23/2023] [Accepted: 06/16/2023] [Indexed: 10/04/2023] Open
Abstract
Giant cell arteritis (GCA) is a granulomatous inflammation involving medium and large vessels that can lead to serious clinical manifestations associated with tissue ischemia. Temporal artery biopsy (TAB) is currently the gold standard method for the diagnosis of GCA, with a specificity of 100% and a sensitivity of 77%. However, the false-negative rate for TAB ranges from 9% to 61%. False negatives may be related to the timing of biopsy, the length of specimen, and the existence of "skip lesions." We reviewed the relevant evidence for methods to improve the sensitivity and reduce the false-negative rate for TAB. To reduce the false-negative rate for TAB, it is recommended to perform TAB within 1 week of starting corticosteroid therapy. Although there is currently no consensus, we suggest that the temporal artery is cut to a length of 20‒30 mm and to prepare serial pathological sections. It is necessary to attach great importance to patients suspected of having GCA, and complete TAB should be performed as soon as possible while starting corticosteroid therapy promptly. We also discuss the clinical value of non-invasive vascular imaging technologies, such as DUS, CTA, MRA, and 18F-FDG-PET/CT, as auxiliary methods for GCA diagnosis that could partially replace TAB.
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Affiliation(s)
- Zhijian Jiang
- Department of Ophthalmology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Huiying Ji
- Department of Laboratory, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianhong Dong
- Department of Ophthalmology, Shanghai Xuhui Central Hospital, Shanghai, China
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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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Hansen MS, Klefter ON, Terslev L, Jensen MR, Brittain JM, Døhn UM, Faber C, Heegaard S, Wiencke AK, Subhi Y, Hamann S. Is Erythrocyte Sedimentation Rate Necessary for the Initial Diagnosis of Giant Cell Arteritis? Life (Basel) 2023; 13:693. [PMID: 36983848 PMCID: PMC10058337 DOI: 10.3390/life13030693] [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: 02/01/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Giant cell arteritis (GCA) is an ophthalmological emergency that can be difficult to diagnose and prompt treatment is vital. We investigated the sequential diagnostic value for patients with suspected GCA using three biochemical measures as they arrive to the clinician: first, platelet count, then C-reactive protein (CRP), and lastly, erythrocyte sedimentation rate (ESR). This retrospective cross-sectional study of consecutive patients with suspected GCA investigated platelet count, CRP, and ESR using diagnostic test accuracy statistics and odds ratios (ORs) in a sequential fashion. The diagnosis was established by experts at follow-up, considering clinical findings and tests including temporal artery biopsy. A total of 94 patients were included, of which 37 (40%) were diagnosed with GCA. Compared with those without GCA, patients with GCA had a higher platelet count (p < 0.001), CRP (p < 0.001), and ESR (p < 0.001). Platelet count demonstrated a low sensitivity (38%) and high specificity (88%); CRP, a high sensitivity (86%) and low specificity (56%); routine ESR, a high sensitivity (89%) and low specificity (47%); and age-adjusted ESR, a moderate sensitivity (65%) and moderate specificity (65%). Sequential analysis revealed that ESR did not provide additional value in evaluating risk of GCA. Initial biochemical evaluation can be based on platelet count and CRP, without waiting for ESR, which allows faster initial decision-making in GCA.
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Affiliation(s)
- Michael S. Hansen
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Oliver N. Klefter
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Mads R. Jensen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg & Frederiksberg Hospital, DK-2400 Copenhagen, Denmark
| | - Jane M. Brittain
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Uffe M. Døhn
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Eye Pathology Section, Department of Pathology, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Anne K. Wiencke
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
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Hansen MS, Terslev L, Jensen MR, Brittain JM, Døhn UM, Faber C, Heegaard S, Klefter ON, Kønig EB, Subhi Y, Wiencke AK, Hamann S. Comparison of temporal artery ultrasound versus biopsy in the diagnosis of giant cell arteritis. Eye (Lond) 2023; 37:344-349. [PMID: 35094027 PMCID: PMC9873813 DOI: 10.1038/s41433-022-01947-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/OBJECTIVES Giant cell arteritis (GCA) is a medical and ophthalmological emergency due to risk of stroke and sudden irreversible loss of vision. Fast and accurate diagnosis is important to prevent complications and long-term high dose glucocorticoids toxicity. Temporal artery biopsy is gold standard for diagnosing GCA. However, temporal artery ultrasound is a fast and non-invasive procedure which may provide a supplement or an alternative to biopsy. This study assesses the diagnostic performance of ultrasound and biopsy in the diagnosis of GCA. SUBJECTS/METHODS Examination results of patients suspected of having GCA in the period from August 2018 to June 2019 were reviewed. Patients underwent clinical examination and blood tests. Within a few days of starting glucocorticoid treatment, temporal ultrasound and unilateral biopsy were performed. Experienced physicians established the final clinical diagnosis at 6-months follow-up. RESULTS Seventy-eight patients underwent both ultrasound and biopsy. Thirty-five (45%) received the final clinical diagnosis of GCA. Compared with the final clinical diagnosis, biopsy had a sensitivity of 69% (51-83%) and a specificity of 100% (92-100%), and ultrasound a sensitivity of 63% (45-79%) and a specificity of 79% (64-94%). Area under the receiver operating characteristics curves were 0.84 and 0.71 for biopsy and ultrasound respectively (p = 0.048). False negative rate of ultrasound was 4 out of 78 (5%). CONCLUSION Sensitivity of ultrasound is almost on par with that of biopsy although the overall diagnostic accuracy of ultrasound was slightly lower. We find that ultrasound is a reliable tool for first line diagnosis of GCA.
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Affiliation(s)
- Michael Stormly Hansen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Mads Radmer Jensen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Jane Maestri Brittain
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Møller Døhn
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Eye Pathology Section, Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Bay Kønig
- Eye Pathology Section, Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Wiencke
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Vaiopoulos A, Kanakis M, Vaiopoulos G, Samanidis G, Kaklamanis P. Giant Cell Arteritis: Focusing on Current Aspects From the Clinic to Diagnosis and Treatment. Angiology 2022:33197221130564. [PMID: 36164723 DOI: 10.1177/00033197221130564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Giant cell arteritis (GCA) is a granulomatous arteritis involving large arteries, particularly the aorta and its major proximal branches, including the carotid and temporal arteries. GCA involves individuals over 50 years old. The etiopathogenesis of GCA may involve a genetic background triggered by unknown environmental factors (eg infections), the activation of dendritic cells as well as inflammatory and vascular remodeling. However, its pathogenetic mechanism still remains unclear, although progress has been made in recent years. In the past, inflammatory markers and arterial biopsy were considered as gold standard for the diagnosis of GCA. However, emerging imaging methods have been made more sensitive and specific for the diagnosis of GCA. Treatment includes biological and other modalities including interleukin-6 (IL-6) inhibitors.
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Affiliation(s)
- Aristeidis Vaiopoulos
- 2nd Department of Dermatology and Venereology, 69038Attikon University General Hospital, Athens, Greece
| | - Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Surgery Center, Athens, Greece
| | - George Vaiopoulos
- Department of Physiology, Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece
| | - George Samanidis
- First Department of Adult Cardiac Surgery, 69106Onassis Cardiac Surgery Center, Athens, Greece
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Dhanani U, Zhao MY, Charoenkijkajorn C, Pakravan M, Mortensen PW, Lee AG. Large-Vessel Vasculitis in Ophthalmology: Giant Cell Arteritis and Takayasu Arteritis. Asia Pac J Ophthalmol (Phila) 2022; 11:177-183. [PMID: 35533336 DOI: 10.1097/apo.0000000000000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
ABSTRACT Giant cell arteritis and Takayasu arteritis are large-vessel vasculitides that share multiple common features but also have significant differences in epidemiology, demographics, clinical presentation, evaluation, and treatment. Giant cell arteritis is more common in elderly patients of Caucasian descent versus Takayasu arteritis, which is more prevalent in younger patients of Asian descent. Although traditionally age has been the main criterion for differentiating the 2 etiologies, modifications in the diagnostic criteria have recognized the overlap between the 2 conditions. In this monograph, we review the diagnostic criteria for both conditions and describe the epidemiology, pathogenesis, histology, evaluation, and management for large-vessel vasculitis in ophthalmology. Additionally, we describe ocular imaging techniques that may be utilized by ophthalmologists to identify manifestations of large-vessel vasculiti- des in patients. Lastly, we compare and contrast the key clinical, laboratory, and pathologic features that might help ophthalmologists to differentiate the 2 entities.
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Affiliation(s)
- Ujalashah Dhanani
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, US
| | | | - Chaow Charoenkijkajorn
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Mohammad Pakravan
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Peter W Mortensen
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
- Departments of Ophthalmology, Neurology, and Neurosurgery, weill Cornell Medicine, New York, NY, US
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, US
- University of Texas MD Anderson Cancer Center, Houston, TX, US
- Texas A and M College of Medicine, Bryan, TX, US
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, US
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Soulages A, Sibon I, Vallat JM, Ellie E, Bourdain F, Duval F, Carla L, Martin-Négrier ML, Solé G, Laurent C, Monnier A, Le Masson G, Mathis S. Neurologic manifestations of giant cell arteritis. J Neurol 2022; 269:3430-3442. [DOI: 10.1007/s00415-022-10991-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
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Micieli JA, Grossniklaus HE, Peragallo JH. Masquerades of Giant Cell Arteritis Evident on Temporal Artery Biopsy. J Clin Rheumatol 2021; 27:e568-e574. [PMID: 31124922 DOI: 10.1097/rhu.0000000000001072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Literature Commentary. J Neuroophthalmol 2021. [PMID: 34415277 DOI: 10.1097/wno.0000000000001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this issue of the Journal of Neuro-Ophthalmology, M. Tariq Bhatti, MD, and Mark L. Moster, MD, discuss the following 6 articles: Mac Grory B, Schrag M, Biousse V, Furie KL, Gerhard-Herman M, Lavin PJ, Sobrin L, Tjoumakaris SI, Weyand CM, Yaghi S; American Heart Association Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Hypertension; and Council on Peripheral Vascular Disease. Management of central retinal artery occlusion: a scientific statement from the American Heart Association. Stroke. 2021;52:e282-e294.Lu Y, Brommer B, Tian X, Krishnan A, Meer M, Wang C, Vera DL, Zeng Q, Yu D, Bonkowski MS, Yang JH, Zhou S, Hoffmann EM, Karg MM, Schultz MB, Kane AE, Davidsohn N, Korobkina E, Chwalek K, Rajman LA, Church GM, Hochedlinger K, Gladyshev VN, Horvath S, Levine ME, Gregory-Ksander MS, Ksander BR, He Z, Sinclair DA. Reprogramming to recover youthful epigenetic information and restore vision. Nature. 2020;588:124-129.Sharshar T, Porcher R, Demeret S, Tranchant C, Gueguen A, Eymard B, Nadaj-Pakleza A, Spinazzi M, Grimaldi L, Birnbaum S, Friedman D, Clair B; MYACOR Study Group. Comparison of corticosteroid tapering regimens in myasthenia gravis: a randomized clinical trial. JAMA Neurol. 2021;78:426-433.Mollan SP, Mitchell JL, Ottridge RS, Aguiar M, Yiangou A, Alimajstorovic Z, Cartwright DM, Grech O, Lavery GG, Westgate CSJ, Vijay V, Scotton W, Wakerley BR, Matthews TD, Ansons A, Hickman SJ, Benzimra J, Rick C, Singhal R, Tahrani AA, Brock K, Frew E, Sinclair AJ. Effectiveness of bariatric surgery vs community weight management intervention for the treatment of idiopathic intracranial hypertension: a randomized clinical trial. JAMA Neurol. 2021;76:678-686.Beuker C, Wankner MC, Thomas C, Strecker JK, Schmidt-Pogoda A, Schwindt W, Schulte-Mecklenbeck A, Gross C, Wiendl H, Barth PJ, Eckert B, Meinel TR, Arnold M, Schaumberg J, Kruger S, Deb-Chatterji M, Magnus T, Rother J, Minnerup J. Characterization of extracranial giant cell arteritis with intracranial involvement and its rapidly progressive subtype. Ann Neurol. 2021;90:118-128.Chen BS, Meyer BI, Saindane AM, Bruce BB, Newman NJ, Biousse V. Prevalence of incidentally detected signs of intracranial hypertension on magnetic resonance imaging and their association with papilledema. JAMA Neurol. 2021;78:718-725.
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Abstract
PURPOSE OF REVIEW The aim of this study was to present the latest advances in giant cell arteritis (GCA) care, and recent national and international rheumatology societies guidance which influences clinical practice. RECENT FINDINGS Cranial ultrasound reduces diagnostic delay and improves clinical outcomes. Immediate high dose glucocorticoids remain the standard treatment for GCA. Controlled trial evidence using Tocilizumab, an interleukin-6 receptor antagonist, shows good clinical efficacy with steroid-sparing effects. SUMMARY Improved patient outcomes require formalizing pathways to diagnosis and closer liaison with rheumatology for long-term management with second-line therapies.
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Chévez-Barrios P. Is It Always Better to Get Faster Results in Temporal Artery Biopsies? JAMA Ophthalmol 2021; 139:413-414. [PMID: 33599697 DOI: 10.1001/jamaophthalmol.2020.6895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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15
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Simon S, Ninan J, Hissaria P. Diagnosis and management of giant cell arteritis: Major review. Clin Exp Ophthalmol 2021; 49:169-185. [PMID: 33426764 DOI: 10.1111/ceo.13897] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/06/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
Giant cell arteritis is a medical emergency because of the high risk of irreversible blindness and cerebrovascular accidents. While elevated inflammatory markers, temporal artery biopsy and modern imaging modalities are useful diagnostic aids, thorough history taking and clinical acumen still remain key elements in establishing a timely diagnosis. Glucocorticoids are the cornerstone of treatment but are associated with high relapse rates and side effects. Targeted biologic agents may open up new treatment approaches in the future.
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Affiliation(s)
- Sumu Simon
- Department of Ophthalmology and South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jem Ninan
- Department of Rheumatology, Modbury Public Hospital, Modbury, South Australia, Australia
| | - Pravin Hissaria
- Department of Immunology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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16
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Mackie SL, Brouwer E, Conway R, van der Geest KSM, Mehta P, Mollan SP, Neill L, Putman M, Robinson PC, Sattui SE. Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective. THE LANCET. RHEUMATOLOGY 2021; 3:e71-e82. [PMID: 33521671 PMCID: PMC7834492 DOI: 10.1016/s2665-9913(20)30386-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Giant cell arteritis, a common primary systemic vasculitis affecting older people, presents acutely as a medical emergency and requires rapid specialist assessment and treatment to prevent irreversible vision loss. Disruption of the health-care system caused by the COVID-19 pandemic exposed weak points in clinical pathways for diagnosis and treatment of giant cell arteritis, but has also permitted innovative solutions. The essential roles played by all professionals, including general practitioners and surgeons, in treating these patients have become evident. Patients must also be involved in the reshaping of clinical services. As an international group of authors involved in the care of patients with giant cell arteritis, we reflect in this Viewpoint on rapid service adaptations during the first peak of COVID-19, evaluate challenges, and consider implications for the future.
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Affiliation(s)
- Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, London, UK
- Department of Rheumatology, University College London Hospital NHS Trust, London, UK
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Philip C Robinson
- University of Queensland Faculty of Medicine, Brisbane, QLD, Australia
| | - Sebastian E Sattui
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
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17
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Estudio comparativo de la ecografía Doppler frente a la biopsia de arteria temporal en el diagnóstico de la arteritis de células gigantes. ACTA ACUST UNITED AC 2020; 16:313-318. [DOI: 10.1016/j.reuma.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 11/24/2022]
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18
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Sebastian A, Tomelleri A, Kayani A, Prieto-Pena D, Ranasinghe C, Dasgupta B. Probability-based algorithm using ultrasound and additional tests for suspected GCA in a fast-track clinic. RMD Open 2020; 6:e001297. [PMID: 32994361 PMCID: PMC7547539 DOI: 10.1136/rmdopen-2020-001297] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 09/05/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Clinical presentations of giant cell arteritis (GCA) are protean, and it is vital to make a secure diagnosis and exclude mimics for urgent referrals with suspected GCA. The main objective was to develop a joined-up, end-to-end, fast-track confirmatory/exclusionary, algorithmic process based on a probability score triage to drive subsequent investigations with ultrasound (US) and any appropriate additional tests as required. METHODS The algorithm was initiated by stratifying patients to low-risk category (LRC), intermediate-risk category (IRC) and high-risk category (HRC). Retrospective data was extracted from case records. The Southend pretest probability score (PTPS) overall showed a median score of 9 and a 75th percentile score of 12. We, therefore, classified LRC as PTPS <9, IRC 9-12 and HRC >12. GCA diagnosis was made by a combination of clinical, US, and laboratory findings. The algorithm was assessed in all referrals seen in 2018-2019 to test the diagnostic performance of US overall and in individual categories. RESULTS Of 354 referrals, 89 had GCA with cases categorised as LRC (151), IRC (137) and HRC (66). 250 had US, whereas 104 did not (score <7, and/or high probability of alternative diagnoses). In HRC, US showed sensitivity 94%, specificity 85%, accuracy 92% and GCA prevalence 80%. In LRC, US showed sensitivity undefined (0/0), specificity 98%, accuracy 98% and GCA prevalence 0%. In IRC, US showed sensitivity 100%, specificity 97%, accuracy 98% and GCA prevalence 26%. In the total population, US showed sensitivity 97%, specificity 97% and accuracy 97%. Prevalence of GCA overall was 25%. CONCLUSIONS The Southend PTPS successfully stratifies fast-track clinic referrals and excludes mimics. The algorithm interprets US in context, clarifies a diagnostic approach and identifies uncertainty, need for re-evaluation and alternative tests. Test performance of US is significantly enhanced with PTPS.
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Affiliation(s)
- Alwin Sebastian
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Alessandro Tomelleri
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Abdul Kayani
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Diana Prieto-Pena
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
- Rheumatology, Marques de Valdecilla University Hospital, Santander, Spain
| | - Chavini Ranasinghe
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
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19
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Tobert V, Richardson L, Bradley KM, Chatterjee A. Giant cell arteritis: a pain in the neck. Age Ageing 2020; 49:891. [PMID: 32421190 DOI: 10.1093/ageing/afaa080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vanessa Tobert
- Oxford University Hospitals NHS Foundation Trust, Oxford, England
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20
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Sebastian A, van der Geest KSM, Coath F, Gondo P, Kayani A, Mackerness C, Hadebe B, Innes S, Jackson J, Dasgupta B. Halo score (temporal artery, its branches and axillary artery) as a diagnostic, prognostic and disease monitoring tool for Giant Cell Arteritis (GCA). BMC Rheumatol 2020; 4:35. [PMID: 32821876 PMCID: PMC7433165 DOI: 10.1186/s41927-020-00136-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Giant cell arteritis (GCA) is a common large vessel vasculitis of the elderly, often associated with sight loss. Glucocorticoids (GC remain the mainstay of treatment, although biologic treatments have been approved. Biomarkers predicting disease severity, relapse rates and damage are lacking in GCA.EULAR recommends ultrasound (US) as the first investigation for suspected GCA. The cardinal US finding, a non-compressible halo, is currently categorised as either negative or positive. However, the extent and severity of this finding may vary.In this study, we hypothesise whether the extent and severity of the halo sign [calculated as a single composite Halo score (HS)] of temporal and axillary arteries may be of diagnostic, prognostic and monitoring importance; whether baseline HS is linked to disease outcomes, relapses and damage; whether HS can stratify GCA patients for individual treatment needs; whether HS can function as an objective monitoring tool during follow up. METHODS This is a prospective, observational study. Suspected GCA Participants will be selected from the GCA FTC at the participating centres in the UK. Informed consent will be obtained, and patients managed as part of standard care. Patients with GCA will have HS (temporal and axillary arteries) measured at baseline and months 1,3,6 and 12 long with routine clinical assessments, blood sampling and patient-reported outcomes (EQ5D). Non-GCA patients will be discharged back to the referral team and will have a telephone interview in 6 months.We aim to recruit 272 suspected GCA referrals which should yield 68 patients (25% of referrals) with confirmed GCA. The recruitment will be completed in 1 year with an estimated total study period of 24 months. DISCUSSION The identification of prognostic factors in GCA is both timely and needed. A prognostic marker, such as the HS, could help to stratify GCA patients for an appropriate treatment regimen. Tocilizumab, an IL-6R blocking agent, switches off the acute phase response (C-Reactive Protein), making it difficult to measure the disease activity. Therefore, an independent HS, and changes in that score during treatment and follow-up, maybe a more objective measure of response compare to patient-reported symptoms and clinical assessment alone.
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Affiliation(s)
- Alwin Sebastian
- Rheumatology, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
- University of Essex, Colchester, UK
| | - Kornelis S. M. van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fiona Coath
- Norfolk and Norwich University hospitals NHS Foundation Trust, Colney Ln, Norwich, UK
| | - Prisca Gondo
- R&D, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Abdul Kayani
- Rheumatology, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Craig Mackerness
- R&D, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Bernard Hadebe
- R&D, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
| | - Sue Innes
- School of Sport, Rehabilitation and exercise sciences, Colchester campus, University of Essex, Colchester, UK
| | - Jo Jackson
- School of Sport, Rehabilitation and exercise sciences, Colchester campus, University of Essex, Colchester, UK
| | - Bhaskar Dasgupta
- Rheumatology, Mid and South Essex University Hospital Groups, Southend University Hospital, Westcliff-On-Sea, Essex, UK
- University of Essex, Colchester, UK
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21
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Lyons HS, Quick V, Sinclair AJ, Nagaraju S, Mollan SP. A new era for giant cell arteritis. Eye (Lond) 2020; 34:1013-1026. [PMID: 31582795 PMCID: PMC7253415 DOI: 10.1038/s41433-019-0608-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022] Open
Abstract
The landscape of the investigation and management of giant cell arteritis (GCA) is advancing. In this review we will outline the recent advances by searching the current English literature for relevant articles using key words of giant cell arteritis, temporal arteritis, Horton's disease, investigation, and treatment. Delay in diagnosis, diagnostic uncertainty and glucocorticoid (GC) morbidity are among the highest concerns of clinicians and patients in this disease area. The positive news is that fast track pathways, imaging techniques and new therapies are emerging for routine management of GCA. Future directions for intervention in the treatment paradigm will be discussed.
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Affiliation(s)
- H S Lyons
- Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - V Quick
- Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - A J Sinclair
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S Nagaraju
- Department of Histopathology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK
| | - S P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, B15 2WB, UK.
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22
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Aghdam KA, Sanjari MS, Manafi N, Khorramdel S, Alemzadeh SA, Navahi RAA. Temporal Artery Biopsy for Diagnosing Giant Cell Arteritis: A Ten-year Review. J Ophthalmic Vis Res 2020; 15:201-209. [PMID: 32308955 PMCID: PMC7151497 DOI: 10.18502/jovr.v15i2.6738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/23/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the use of temporal artery biopsy (TAB) in diagnosing giant cell arteritis (GCA) and to evaluate patients' clinical and laboratory characteristics. Methods We conducted a retrospective chart review of patients with suspected GCA who underwent TAB and had complete workup in a tertiary center in Iran between 2008 and 2017. The 2016 American College of Rheumatology (ACR) revised criteria for early diagnosis of GCA were used for each patient for inclusion in this study. Results The mean age of the 114 patients in this study was 65.54 ± 10.17 years. The mean overall score according to the 2016 ACR revised criteria was 4.17 ± 1.39, with 5.82 ± 1.28 for positive biopsies and 3.88 ± 1.19 for negative biopsies (p <0.001). Seventeen patients (14.9%) had a positive biopsy. Although the mean post-fixation specimen length in the biopsy-positive group (18.35 ± 6.9 mm) was longer than that in the biopsy-negative group (15.62 ± 8.4 mm), the difference was not statistically significant (P = 0.21). There was no statistically significant difference between the groups in terms of sex, serum hemoglobin, platelet count, and erythrocyte sedimentation rate. There were statistically significant differences between the biopsy-negative and biopsy-positive groups with respect to patients' age and C-reactive protein level (P< 001 and P = 0.012, respectively). Conclusion The majority of TABs were negative. Reducing the number of redundant biopsies is necessary to decrease workload and use of medical services. We suggest that the diagnosis of GCA should be dependent on clinical suspicion.
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Affiliation(s)
- Kaveh Abri Aghdam
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Navid Manafi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Khorramdel
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sayyed Amirpooya Alemzadeh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Roshanak Ali Akbar Navahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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23
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Czyz CN, Allen JB, Cahill KV, Nabavi CB, Foster JA. Effects of incision location on specimen quality and complications for temporal artery biopsy. Vascular 2019; 27:347-351. [PMID: 31313985 DOI: 10.1177/1708538118818618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Giant cell arteritis is a vision and potentially life-threatening condition requiring prompt and accurate diagnosis. The current gold standard of diagnosis is temporal artery biopsy. The purpose of this study is to review the technique of temporal biopsy in regard to incision placement, and to determine specimen quality and the incidence of complications, specifically seventh nerve injury. Methods Retrospective cohort study of 125 consecutive patients (137 biopsies) who underwent temporal artery biopsy. Variables concerning the procedure collected included laterality, incision placement, Doppler ultrasound utilization, length of intraoperative and pathologic specimens, result of the biopsy, motor nerve deficit, brow ptosis, and any intra or postoperative complications. Results The patient population was 73% female and 86% Caucasian. The average age at the time of the biopsy was 73.8 (range = 56–89, SD = 8.7). Doppler localization was used on 45% of patients. The mean intraoperative specimen length was 2.6 cm (range = 1.5–4.1, SD = 0.6) and fixed specimen length was 2.0 cm (range = 0.8–4.0, SD = 0.7). Biopsy results were positive in 18% of cases. There were no patients who displayed seventh nerve injury at one-week follow-up. One patient (0.7%) reported persistent anesthesia and one (0.7%) reported persistent paresthesia at the incision site. There were no other intraoperative or postoperative complications reported. Conclusions Placement of the incision at or posterior to the temporal hairline reduces the risk of seventh nerve injury. The posterior incision placement did not affect the quality of specimens or decrease the yield of biopsy results as compared to other studies. The overall complication rate (3%) was minimal and did not involve any motor nerve injury.
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Affiliation(s)
- Craig N Czyz
- 1 Division of Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth Doctors Hospital, Columbus, OH, USA.,2 Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, OH, USA
| | - John B Allen
- 3 Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
| | - Kenneth V Cahill
- 2 Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, OH, USA.,3 Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
| | - Cameron B Nabavi
- 2 Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, OH, USA.,3 Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
| | - Jill A Foster
- 2 Department of Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, OH, USA.,3 Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
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25
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Diagnostic performance of 18F-FDG PET-CT for large vessel involvement assessment in patients with suspected giant cell arteritis and negative temporal artery biopsy. Ann Nucl Med 2019; 33:512-520. [DOI: 10.1007/s12149-019-01358-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/07/2019] [Indexed: 12/15/2022]
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26
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Ing EB, Wang DN, Kirubarajan A, Benard-Seguin E, Ma J, Farmer JP, Belliveau MJ, Sholohov G, Torun N. Systematic Review of the Yield of Temporal Artery Biopsy for Suspected Giant Cell Arteritis. Neuroophthalmology 2019; 43:18-25. [PMID: 30723520 PMCID: PMC6351023 DOI: 10.1080/01658107.2018.1474372] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To determine the positive yield (utility rate) of temporal artery biopsy (TAB) in patients with suspected giant cell arteritis (GCA). STUDY DESIGN Systematic review (CRD42017078508) and meta-regression. MATERIALS AND METHODS All articles concerning TAB for suspected GCA with English language abstracts from 1998 to 2017 were retrieved. Articles were excluded if they exclusively reported positive TAB, or only cases of known GCA. Where available, the pre-specified predictors of age, sex, vision symptoms, jaw claudication, duration of steroid treatment prior to TAB, specimen length, bilateral TAB, and use of ultrasound/MRI (imaging) were recorded for meta-regression. RESULTS One hundred and thirteen articles met eligibility criteria. The I 2 was 92%, and with such high heterogeneity, meta-analysis is unsuitable. The median yield of TAB was 0.25 (95% confidence interval 0.21 to 0.27), with interquartile range 0.17 to 0.34. On univariate meta-regression age (coefficient 0.012, p = 0.025) was the only statistically significant patient factor associated with TAB yield. CONCLUSIONS Systematic review revealed high heterogeneity in the yield of TAB. The median utility rate of 25% and its interquartile range provides a benchmark for decisions regarding the under/overutilization of TAB and aids in the evaluation of non-invasive alternatives for the investigation of GCA.
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Affiliation(s)
- Edsel B. Ing
- University of Toronto Ophthalmology, Michael Garron Hospital, University of Toronto, Toronto, Canada
| | - Dan Ni Wang
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Jingyi Ma
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - James P. Farmer
- Department of Ophthalmology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
- Anatomic Pathology, University of Ottawa and Queens University, Ottawa, Canada
| | - Michel J. Belliveau
- Department of Ophthalmology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Nurhan Torun
- Harvard University Ophthalmology, Beth Israel Deaconness, Boston, Massachusetts, USA
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27
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Skanchy DF, Vickers A, Prospero Ponce CM, Lee AG. Ocular manifestations of giant cell arteritis. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2018.1560265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David F. Skanchy
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aroucha Vickers
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | | | - Andrew G. Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Division of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Ophthalmology, Texas A and M College of Medicine, College Station, TX, USA
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28
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Tian G, Chen W, Chen Q, Wang M, Zhao G, Li Z, Zhang J. Giant cell arteritis presenting as bilateral anterior ischemic optic neuropathy: a biopsy-proven case report in Chinese patient. BMC Ophthalmol 2018; 18:282. [PMID: 30376812 PMCID: PMC6208180 DOI: 10.1186/s12886-018-0953-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023] Open
Abstract
Background Giant cell arteritis (GCA) is a systemic vasculitis of medium and large-size vessels and can led to permanent visual loss in elderly patients. GCA is very rare among Asians. We report a Chinese patient presenting with acute bilateral anterior ischemic optic neuropathy, and the temporal artery biopsy proved the diagnose of GCA. Case presentation A 77-year-old Chinese man presented with sudden bilateral blindness for 5 days with a severe headache. Funduscopic examination revealed bilateral optic disc swollen with “chalky white” pallid appearance. The blood tests showed the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevated dramatically. The color duplex ultrasonography (CDUS) of the superficial temporal artery revealed the inflammation of the vessel wall as a “halo sign”. The temporal artery biopsy was perfumed and the pathology revealed luminal occlusion with multinuclear giant cell infiltration. The patient was treated with intravenous methylprednisolone for 3 days and oral prednisone weaning for 12 months. The visual acuity remained no light perception at one year follow-up. Conclusions Although very rare in Asian, GCA can led to permanent blindness in elderly Chinese caused by anterior ischemic optic neuropathy. The noninvasive CDUS might be a promising technique for diagnose GCA in highly suspected patients.
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Affiliation(s)
- Guohong Tian
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China. .,NHC Key Laboratory of Myopia, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - Weimin Chen
- Department of Neurology, Shanghai Deji Hospital, Shanghai, 200010, China
| | - Qian Chen
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Min Wang
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Guixian Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Zhenxin Li
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jiong Zhang
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, 200040, China
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29
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Gutteridge DH, Mastaglia FL. Recognition of giant cell arteritis in patients with polymyalgia rheumatica who have a stroke: a cautionary tale. Intern Med J 2018; 47:1199-1201. [PMID: 28994265 DOI: 10.1111/imj.13567] [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: 11/05/2016] [Accepted: 11/19/2016] [Indexed: 11/30/2022]
Abstract
An 82-year-old woman with polymyalgia rheumatica (PMR) on prednisone 7 mg daily was admitted to an acute stroke unit with a right homonymous hemianopia, a left posterior cerebral artery occlusion and occipital lobe infarct. She had raised inflammatory markers, did not have a temporal artery biopsy, and was discharged on the same dose of prednisone. After 21 months, off prednisone, her ophthalmologist, concerned about giant cell arteritis (GCA), restarted prednisone 40 mg daily, with rapid, profound visual improvement. After 3 days her general practitioner, noting normal baseline inflammatory markers, stopped treatment-with rapid visual reversion. It is critical to recognise GCA in patients with PMR admitted to a stroke unit and not to withdraw prematurely corticosteroids once commenced.
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Affiliation(s)
- Donald H Gutteridge
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Frank L Mastaglia
- West Australian Neuroscience Research Institute, QEII Medical Centre, Perth, Western Australia, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
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Aldasoro Cáceres V, Ibáñez Bosch R, Rivas Zavaleta N, Álvarez Rodríguez B, Intxausti Irazábal JJ, Jiménez de Aberasturi JRDD, Ruibal Escribano A, Maíz Alonso O, Calvo Alén J. Noninfectious aortitis: Experience with tocilizumab in a regional hospital. ACTA ACUST UNITED AC 2018; 15:e96-e98. [PMID: 29398465 DOI: 10.1016/j.reuma.2017.12.014] [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: 08/01/2017] [Revised: 12/16/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Describe patients with noninfectious aortitis and their response to treatment in a regional hospital. METHODS Review of patients with noninfectious aortitis, diagnostic technique used and immunosuppressive therapy received. RESULTS We report 8 patients (7 women and one man) diagnosed with aortitis by positron emission tomography (PET). The mean age was 69years (interquartile range [IQR] 62-72.2). Three months of treatment with tocilizumab improved symptoms, erythrocyte sedimentation rate and C-reactive protein level (P<.001 and P<.012, respectively) in the 6 patients in whom it was used. CONCLUSIONS Tocilizumab was an effective and safe treatment in those patients diagnosed with aortitis refractory to steroids and conventional immunosuppressive therapy.
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Ing E, Pagnoux C, Tyndel F, Sundaram A, Hershenfeld S, Ranalli P, Chow S, Le T, Lutchman C, Rutherford S, Lam K, Bedi H, Torun N. Lower ocular pulse amplitude with dynamic contour tonometry is associated with biopsy-proven giant cell arteritis. Can J Ophthalmol 2017; 53:215-221. [PMID: 29784156 DOI: 10.1016/j.jcjo.2017.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/29/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine the role of the ocular pulse amplitude (OPA) from Pascal dynamic contour tonometry in predicting the temporal artery biopsy (TABx) result in patients with suspected giant cell arteritis (GCA). DESIGN Prospective validation study. PARTICIPANTS Adults aged 50 years or older who underwent TABx from March 2015 to April 2017. METHODS Subjects on high-dose glucocorticoids more than 14 days or without serology before glucocorticoid initiation were excluded. The OPA from both eyes was obtained and averaged just before TABx of the predominantly symptomatic side. The variables chosen for the a priori prediction model were age, average OPA, and C-reactive protein (CRP). Erythrocyte sedimentation rate (ESR), platelets, jaw claudication, and eye findings were also recorded. In this study, subjects with a negative biopsy were considered not to have GCA, and contralateral biopsy was performed if the clinical suspicion for GCA remained high. An external validation set (XVAL) was obtained. RESULTS Of 109 TABx, 19 were positive and 90 were negative. On univariate logistic regression, the average OPA had 0.60 odds for positive TABx (p = 0.03), with no statistically significant difference in age, sex, CRP, ESR, or jaw claudication. In suspected GCA, an OPA of 1 mm Hg had positive likelihood ratio 4.74 and negative likelihood ratio 0.87 for positive TABx. Multivariate regression of the prediction model using optimal mathematical transforms (inverse OPA, log CRP, age >65 years) had area under the receiver operating characteristic curve (AUROC) = 0.85 and AUROCXVAL = 0.81. CONCLUSIONS OPA is lower in subjects with biopsy-proven GCA and is a statistically significant predictor of GCA.
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Affiliation(s)
- Edsel Ing
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, Ont.
| | - Christian Pagnoux
- Department of Medicine, Rheumatology, University of Toronto Medical School, Toronto, Ont
| | - Felix Tyndel
- Department of Medicine, Neurology, University of Toronto Medical School, Toronto, Ont
| | - Arun Sundaram
- Department of Medicine, Neurology, University of Toronto Medical School, Toronto, Ont
| | - Seymour Hershenfeld
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, Ont
| | - Paul Ranalli
- Department of Medicine, Neurology, University of Toronto Medical School, Toronto, Ont
| | - Shirley Chow
- Department of Medicine, Rheumatology, University of Toronto Medical School, Toronto, Ont
| | - Tran Le
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, Ont
| | - Carla Lutchman
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, Ont
| | - Susan Rutherford
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, Ont
| | - Kay Lam
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, Ont
| | - Harleen Bedi
- Department of Ophthalmology and Vision Sciences, University of Toronto Medical School, Toronto, Ont
| | - Nurhan Torun
- Harvard Medical School, Beth Israel Deaconess Hospital, Boston Department of Ophthalmology, Boston, MA
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Pellegrini F, Cirone D, Machin P, Foroozan R. Tempo(ral) was the heart of the matter. Surv Ophthalmol 2017; 64:433-438. [PMID: 29024675 DOI: 10.1016/j.survophthal.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
A 71-year-old woman was admitted with fever, headache, and weight loss associated with elevated inflammatory markers. She developed acute bilateral ophthalmoplegia and asymmetrical ptosis, rapidly followed by anterior ischemic optic neuropathy. Although the first temporal artery biopsy was negative, contralateral temporal artery biopsy revealed features consistent with giant cell arteritis. Even while under steroid therapy, she died a few days later from myocardial infarction. Acute bilateral complete ophthalmoplegia is a rare presentation of a limited number of possible diseases. Among these, giant cell arteritis should be suspected in the appropriate clinical scenario.
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Affiliation(s)
- Francesco Pellegrini
- Department of Ophthalmology, Neuro-Ophthalmology Service, "De Gironcoli" Hospital, Conegliano, Italy.
| | - Daniele Cirone
- Department of Ophthalmology, "Murri" Hospital, Fermo, Italy
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Pellegrini F, Prosdocimo G, Bonsanto D, Machin P, Foroozan R. Thick corneas, large pupils, and a giant problem. Surv Ophthalmol 2017. [PMID: 28623164 DOI: 10.1016/j.survophthal.2017.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An 87-year-old woman presented 1 month after uneventful cataract surgery with ipsilateral corneal edema. She was diagnosed with pseudophakic bullous keratopathy and scheduled for endothelial transplantation. A few days later, however, she presented with bilateral corneal edema, dilated pupils, and further reduction of visual acuity. Neuro-ophthalmic evaluation disclosed a bilateral ocular ischemic syndrome causing complete visual loss. Temporal artery biopsy was consistent with giant cell arteritis. Corneal decompensation should be considered as a rare presentation of giant cell arteritis, a diagnosis that ophthalmologists should suspect in any case of unilateral or bilateral ocular ischemic syndrome.
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Affiliation(s)
- Francesco Pellegrini
- Neuro-Ophthalmology Service, Department of Ophthalmology, "De Gironcoli" Hospital, Conegliano, Treviso, Italy.
| | - Giovanni Prosdocimo
- Neuro-Ophthalmology Service, Department of Ophthalmology, "De Gironcoli" Hospital, Conegliano, Treviso, Italy
| | - Daniela Bonsanto
- Neuro-Ophthalmology Service, Department of Ophthalmology, "De Gironcoli" Hospital, Conegliano, Treviso, Italy
| | - Pernicola Machin
- Pathology Unit, AULSS2 Marca Trevigiana, Conegliano Hospital, Conegliano, Treviso, Italy
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Srinivasan A, Kleinberg TT, Murchison AP, Bilyk JR. Laboratory Investigations for Diagnosis of Autoimmune and Inflammatory Periocular Disease: Part II. Ophthalmic Plast Reconstr Surg 2017; 33:1-8. [PMID: 27115208 DOI: 10.1097/iop.0000000000000701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To review the important laboratory serological investigations routinely performed for the diagnosis of autoimmune and inflammatory diseases of the orbit and ocular adnexa. METHODS Review of the literature as well as personal clinical experience of the authors. Due to the extensive nature of the topic, the review has been split into 2 parts. Part I covers thyroid eye disease, IgG4-related disease, and myasthenia gravis. In part II of the review, sarcoidosis, vasculitis, Sjögren syndrome, and giant cell arteritis will be discussed. RESULTS Several relatively specific serologic tests are available for the diagnosis of a variety of inflammatory and serologic diseases of the orbit. CONCLUSION In cases of limited orbital or sino-orbital disease, serologic testing may be negative in a significant number of patients. Specifically, the clinician should be wary of ruling out limited orbital sarcoid or sinoorbital granulomatosis with polyangiitis based on serologic testing alone. Part I of this review has covered serologic testing for thyroid eye disease, IgG4-related disease, and myasthenia gravis. In part II, the authors discuss serologic testing for sarcoidosis, vasculitis, Sjögren syndrome (SS), and giant cell arteritis (GCA).
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Affiliation(s)
- Archana Srinivasan
- *Research Department, Wills Eye Hospital, Philadelphia, Pennsylvania, †Worcester Ophthalmology Associates, Worcester, Massachusetts, and ‡Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, U.S.A
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35
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[Guidelines from the DOG, RG and BVA: retinal artery occlusion : November 2016 status]. Ophthalmologe 2017; 114:120-131. [PMID: 28160122 DOI: 10.1007/s00347-016-0435-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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36
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Oh LJ, Wong E, Gill AJ, McCluskey P, Smith JEH. Value of temporal artery biopsy length in diagnosing giant cell arteritis. ANZ J Surg 2016; 88:191-195. [PMID: 27800647 DOI: 10.1111/ans.13822] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/05/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is considered an ophthalmological emergency with severe sight and life-threatening sequelae. Temporal artery biopsy (TAB) is the current gold standard for the diagnosis of GCA; however, the required length of biopsy remains an issue of contention in the literature. METHODS Retrospective case-control study of a consecutive cohort of 545 patients who had undergone TABs across five hospitals between 1 January 1992 and 1 January 2016. In patients with either positive or negative TABs, we collected age, sex, biopsy length and erythrocyte sedimentation rate (ESR). RESULTS A total of 538 patients were included in the final analysis. Of these, 23.4% of TABs were positive, with the average length being 17.6 mm. There was a significant difference in means for positive (19.9 mm) and negative (16.8 mm) biopsies (P = 0.0009). Each millimetre increase in TAB length increased the odds of a positive TAB by 3.4% (P = 0.024). A cut-off point of ≥15 mm increased the odds of a positive TAB by 2.25 compared with a TAB <15 mm (P = 0.003). We also found that ESR ≥50 mm/h was a very strong predictor for a positive TAB result (P < 0.0001). CONCLUSION Biopsy length and ESR were significant predictors of a pathological diagnosis of GCA. We also found that the optimal length threshold predictive for GCA was 15 mm in order to avoid a false-negative GCA diagnosis. Although TAB remains the gold standard for diagnosis, clinicians should refer to both clinical and pathological data to guide their management.
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Affiliation(s)
- Lawrence J Oh
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Opthalmology, The University of Sydney, Sydney, New South Wales, Australia
| | - Eugene Wong
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Opthalmology, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony J Gill
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Opthalmology, The University of Sydney, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Department of Opthalmology, The University of Sydney, Sydney, New South Wales, Australia.,Department of Opthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - James E H Smith
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Opthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
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Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are both more common among people of North European decent than among Mediterranean people. Women are 2-3 times more commonly affected. Giant cell arteritis and PMR are extremely rare before age 50 years. Polymyalgia rheumatica may be "isolated" or associated with GCA. There is increased expression of inflammatory cytokines in temporal arteries of PMR patients, without overt histological evidence of arteritis. One-third of "isolated" PMR patients have vascular uptake in positron emission tomography (PET) scans, suggesting clinically unrecognized, "hidden" GCA. Typical manifestations of GCA are headache, tenderness over temporal arteries, jaw claudication, PMR, acute vision loss, and low-grade fever. Bilateral aching of the shoulders with morning stiffness is typical for PMR. In both conditions sedimentation rate and C-reactive protein are elevated, and anemia and thrombocytosis may occur. Color duplex ultrasonography of the temporal arteries may aid in GCA diagnosis. Temporal artery biopsy showing vasculitis, often with giant cells, confirms GCA diagnosis. In cases with negative biopsy one must rely on the clinical presentation and laboratory abnormalities. The diagnosis of PMR is made primarily on clinical grounds. Other conditions that may mimic GCA or PMR must be excluded. Glucocorticoids are the treatment of choice for both conditions. Prompt treatment is crucial in GCA, to prevent irreversible complications of acute vision loss and stroke. Addition of low-dose aspirin may further prevent these complications. The average duration of treatment is 2-3 years, but some patients require a prolonged course of treatment, and some may develop disease-related or treatment-related complications. No steroid-sparing agent has been proven to be widely effective thus far, but some promising therapeutic agents are currently being studied.
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Affiliation(s)
- Gideon Nesher
- Department of Internal Medicine A and the Rheumatology Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Gabriel S Breuer
- Department of Internal Medicine A and the Rheumatology Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
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38
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Histologisch nachgewiesene Riesenzellarteriitis und Sehverlust. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lim NS, Singh N, Jain NS, Amjadi S, Chong CWK, Francis IC. The Temporal Arteritis Proforma: Should cough be included? Rheumatol Int 2016; 36:1701-1703. [PMID: 27592336 DOI: 10.1007/s00296-016-3553-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Nicole S Lim
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia
| | - Nandini Singh
- Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Neeranjali S Jain
- University of New South Wales, High Street, Kensignton, NSW, 2052, Australia
| | - Shahriar Amjadi
- University of New South Wales, High Street, Kensignton, NSW, 2052, Australia
| | - Calum W K Chong
- University of New South Wales, High Street, Kensignton, NSW, 2052, Australia
| | - Ian C Francis
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia. .,University of New South Wales, High Street, Kensignton, NSW, 2052, Australia.
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40
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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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Is all inflammation within temporal artery biopsies temporal arteritis? Hum Pathol 2016; 57:17-21. [PMID: 27445262 DOI: 10.1016/j.humpath.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/17/2016] [Accepted: 07/02/2016] [Indexed: 11/20/2022]
Abstract
Temporal arteritis peaks during the eighth decade, affecting patients with frequent comorbidities who are especially prone to adverse effects of corticosteroid therapy. Perivascular inflammation involving small periadventitial vessels is not uncommon in otherwise normal temporal artery biopsies (TABs). As ischemic events occur in patients with non-temporal artery--based inflammation, it has been recommended that any vascular inflammation within TABs be treated with corticosteroids. We sought to determine whether such patients are at increased risk for temporal arteritis-like adverse events compared with age-matched controls devoid of inflammatory infiltrates. TABs without transmural temporal arteritic damage accessioned between 2002 and 2012 were reviewed for inflammation (>15 perivascular lymphocytes) involving small blood vessels and/or temporal artery adventitia. Of 343 TABs, 278 (81%) were negative for transmural arteritis. Inflammation involving small vessels and/or temporal artery adventitia was present in 56 cases (20%). Age-matched controls were available for 39 cases. With a mean follow-up of 5 years (range, 1-11 years), 6/39 (15%) of patients developed stroke or cardiovascular events or died compared with 7/39 (18%) of age-matched controls. None of the patients with study-positive TAB had documented steroid therapy before or after TAB. Our results demonstrate that patients with inflammation involving only small vessels or temporal artery adventitia are not at increased risk for temporal arteritis-like adverse events, and suggest that the risks of protracted corticosteroid therapy in this elderly population likely exceed any potential benefits. We advise against diagnosing vasculitis in the absence of temporal arteritic damage.
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Abstract
BACKGROUND To identify clinical and laboratory factors contributing to the diagnosis of giant cell arteritis (GCA) and develop a diagnostic algorithm for the evaluation of GCA. METHODS Retrospective review of 213 consecutive cases of temporal artery biopsy (TAB) seen at a single academic center over a 10-year period (2000-2009). Pathologic specimens were re-reviewed and agreement between the original and second readings was assessed. A composite clinical suspicion score was created by adding 1 point for each of the following criteria: anterior extracranial circulation ischemia, new onset headache, abnormal laboratory results (erythrocyte sedimentation rate, C-reactive protein (CRP), or platelet count), jaw claudication, abnormal or tender superficial temporal artery, constitutional symptoms, and polymyalgia rheumatica; one point was subtracted if a comorbid condition could explain a criterion. RESULTS Of the 204 TABs analyzed, pathologic findings were confirmatory in 49 (24.0%) and suggestive in 12 (5.9%). TAB-positive patients were more likely to be older (age 75.2 ± 7.8 vs 69.7 ± 11.0 years, P = 0.0002), complain of jaw claudication (relative-risk = 3.26, P = 0.0014), and have thrombocytosis (relative-risk = 3.3, P = 0.0072) and elevated CRP (relative-risk = 1.8, P = 0.037). None of the patients with a clinical score less than 2 had a positive TAB. Diabetes mellitus and kidney disease were often the explanation for the symptoms and abnormal clinical finding(s) that led to a negative TAB. CONCLUSIONS We propose a clinical algorithm that is highly predictive for a positive TAB and can be valuable in the evaluation process of suspected cases of GCA.
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43
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[Could it be a stroke?]. MMW Fortschr Med 2016; 158:64-9; quiz 70. [PMID: 27221439 DOI: 10.1007/s15006-016-7658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Baseline clinical predictors of an ultimate giant cell arteritis diagnosis in patients referred to temporal artery biopsy. Clin Rheumatol 2016; 35:1817-22. [PMID: 26925851 DOI: 10.1007/s10067-016-3221-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 02/20/2016] [Accepted: 02/21/2016] [Indexed: 10/22/2022]
Abstract
The diagnosis of giant cell arteritis (GCA) is based on clinical grounds and confirmed by characteristic histological findings on temporal artery biopsy (TAB). Patients may be diagnosed with GCA based on clinical grounds only, despite negative histological findings. We aimed to investigate which baseline clinical and laboratory features best predict an ultimate diagnosis of giant cell arteritis among patients referred to TAB. We retrospectively analyzed 224 patients who underwent TAB in our hospital between 2000 and 2014. Patients were diagnosed with GCA if TAB was positive for GCA, or by clinical grounds only despite a negative biopsy, provided they fulfilled the American College of Rheumatology 1990 criteria. Baseline clinical and laboratory features were obtained from medical records. Predictors of an ultimate GCA diagnosis were investigated. Overall, 82 patients were diagnosed with GCA-57 had histological evidence of GCA and 25 were diagnosed with GCA despite a negative biopsy. One hundred and forty-two patients were not diagnosed with GCA. Predictors of an eventual diagnosis of GCA in a multivariate logistic regression analysis were headache (OR = 6; p < 0.001), jaw claudication (OR 4.5; p = 0.007), erythrocyte sedimentation rate (ESR) (OR = 1.5; p = 0.032) and platelet count (OR = 1.74; p = 0.004). Among patients referred to TAB, headache, jaw claudication, ESR, and thrombocyte levels are predictors for an ultimate diagnosis of GCA. These clinical and laboratory features should be considered when contemplating the diagnosis and treatment of GCA.
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Frohman L, Wong ABC, Matheos K, Leon-Alvarado LG, Danesh-Meyer HV. New developments in giant cell arteritis. Surv Ophthalmol 2016; 61:400-21. [PMID: 26774550 DOI: 10.1016/j.survophthal.2016.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 12/01/2022]
Abstract
Giant cell arteritis (GCA) is a medium-to-large vessel vasculitis with potentially sight- and life- threatening complications. Our understanding of the pathogenesis, diagnosis, and treatment of GCA has advanced rapidly in recent times. The validity of using the American College of Rheumatology guidelines for diagnosis of GCA in a clinical setting has been robustly challenged. Erythrocyte sedimentation rate, an important marker of inflammation, is lowered by the use of statins and nonsteroidal anti-inflammatory drugs. Conversely, it may be falsely elevated with a low hematocrit. Despite the emergence of new diagnostic modalities, temporal artery biopsy remains the gold standard. Evidence suggests that shorter biopsy lengths and biopsies done weeks to months after initiation of steroid therapy are still useful. New imaging techniques such as positron emission tomography have shown that vascular inflammation in GCA is more widespread than originally thought. GCA, Takayasu arteritis, and polymyalgia rheumatica are no longer thought to exist as distinct entities and are more likely parts of a spectrum of disease. A range of immunosuppressive drugs have been used in conjunction with corticosteroids to treat GCA. In particular, interleukin-6 inhibitors are showing promise as a therapy.
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Affiliation(s)
- Larry Frohman
- Department of Ophthalmology, Rutgers-New Jersey Medical School, New Jersey, USA; Department of Neurosciences, Rutgers-New Jersey Medical School, New Jersey, USA
| | - Aaron B C Wong
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Kaliopy Matheos
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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46
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Calvo Romero J. Giant cell arteritis: Diagnosis and treatment. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ocular pulse amplitude as a diagnostic adjunct in giant cell arteritis. Eye (Lond) 2015; 29:860-5; quiz 866. [PMID: 26088675 DOI: 10.1038/eye.2015.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/06/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To develop an algorithm based on the ocular pulse amplitude (OPA) to predict the probability of a positive temporal artery biopsy (TAB) result in the acute phase of suspected giant cell arteritis (GCA). METHODS Unilateral TAB was performed and ipsilateral OPA measurements were taken by Dynamic Contour Tonometry. Among the clinical signs and laboratory findings tested in univariate analyses, OPA, Erythrocyte Sedimentation Rate (ESR) and thrombocyte count showed a strong association with a positive TAB result. Algorithm parameters were categorized into three groups (OPA >3.5, 2.5-3.5, and <2.5 mm Hg; ESR <25, 25-60, and >60 mm/h; thrombocyte count <250'000, 250'000-500'000, and >500'000/μl). Score values (0, 1, and 2) were attributed to each group, resulting in a total score range from 0 to 6. A univariate logistic regression analysis using the GCA diagnosis as the dependent and the total score as the independent variate was fitted and probability estimates were calculated. RESULTS Thirty-one patients with suspected GCA undergoing TAB during an eighteen-month observation period were enrolled. Twenty patients showed histologically proven GCA. Four patients had score values ≤2, fourteen between 3 and 4, and thirteen of ≥5. The corresponding estimated probabilities of GCA were<7, 52.6, and >95%. CONCLUSION The present study confirms previous findings of reduced OPA levels, elevated ESR, and elevated thrombocyte counts in GCA. It indicates that a sum score based on OPA, ESR, and thrombocyte count can be helpful in predicting TAB results, especially at the upper and the lower end of the sum score range.
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48
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Calvo Romero JM. Giant cell arteritis: diagnosis and treatment. Rev Clin Esp 2015; 215:331-7. [PMID: 25957859 DOI: 10.1016/j.rce.2015.03.007] [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: 01/09/2015] [Revised: 02/27/2015] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
Giant cell arteritis is the most common primary systemic vasculitis in adults. The condition is granulomatous arteritis of large and medium vessels, which occurs almost exclusively in patients aged 50 years or more. This article reviews the diagnosis and treatment of the disease.
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Affiliation(s)
- J M Calvo Romero
- Servicio de Medicina Interna, Hospital Ciudad de Coria, Coria, Cáceres, España.
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49
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Chacko JG, Chacko JA, Salter MW. Review of Giant cell arteritis. Saudi J Ophthalmol 2014; 29:48-52. [PMID: 25859139 DOI: 10.1016/j.sjopt.2014.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/16/2014] [Accepted: 10/01/2014] [Indexed: 11/26/2022] Open
Abstract
Giant-cell arteritis (GCA) is a systemic autoimmune disease affecting primarily the elderly. Giant cell arteritis can cause sudden and potentially bilateral sequential vision loss in the elderly. Therefore, it is considered a medical emergency in ophthalmology and a significant cause of morbidity in an increasingly aging population. Ophthalmologists need to be able to recognize the classic symptoms and signs of this disease, and then be able to work-up and treat these patients in an efficient manner. An in-depth review of GCA from the literature as well as personal clinical experience follows.
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Affiliation(s)
- Joseph G Chacko
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, 4301 W. Markham, #523, Little Rock, AR 72205, USA
| | | | - Michael W Salter
- Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, 4301 W. Markham, #523, Little Rock, AR 72205, USA
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Confusion in giant cell arteritis - a diagnostic challenge. Can J Neurol Sci 2014; 41:535-7. [PMID: 24878487 DOI: 10.1017/s0317167100018667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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