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Sakai Y, Kanno A, Sato Y, Ito T, Matsumoto K, Ueno M, Sumitomo K, Furukawa K. A case of polymyalgia rheumatica complicated with giant thoracic aortic aneurysm with massive intraluminal thrombosis. Geriatr Gerontol Int 2024; 24:814-815. [PMID: 39004935 DOI: 10.1111/ggi.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/07/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Yuta Sakai
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Atsuhiro Kanno
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Yoshiaki Sato
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Takehito Ito
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Keiji Matsumoto
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Masamichi Ueno
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Kazuhiro Sumitomo
- Department of General Medicine, Tohoku Medical and Pharmaceutical University, Wakabayashi Hospital, Sendai, Japan
| | - Katsutoshi Furukawa
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Gallou S, Agard C, Dumont A, Deshayes S, Boutemy J, Maigné G, Martin Silva N, Nguyen A, Philip R, Espitia O, Aouba A, de Boysson H. Evolution and outcomes of aortic dilations in giant cell arteritis. Eur J Intern Med 2024:S0953-6205(24)00146-8. [PMID: 38580542 DOI: 10.1016/j.ejim.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES To identify factors associated with the progression of giant cell arteritis (GCA)-related or associated aortic dilations. METHODS In this retrospective study, 47 GCA patients with aortic dilation were longitudinally analyzed. Each patient underwent ≥2 imaging scans of the aorta during the follow-up. Three progression statuses of aortic dilations were distinguished: fast-progressive (FP) defined by a progression of the aortic diameter ≥5 mm/year or ≥1 cm/2 years, slow progressive (SP) by a progression of the aortic diameter >1 mm during the follow-up, and not progressive (NP) when aortic diameter remained stable. RESULTS Among the 47 patients with aortic dilation, the thoracic section was involved in 87 % of patients. Within a total follow-up of 89 [6-272] months, we identified 13 (28 %) patients with FP dilations, and 16 (34 %) and 18 (38 %) patients with SP and NP dilations, respectively. No differences regarding baseline characteristics, cardiovascular risk factors or treatments were observed among the 3 groups. However, FP patients more frequently showed atheromatous disease (p = 0.04), with a more frequent use of statins (p = 0.04) and antiplatelet agents (p = 0.02). Among the 27 (57 %) patients with aortitis, aortic dilation developed on an inflammatory segment in 23 (85 %). Among the FP patients who underwent aortic surgery with available histology (n = 3), all presented active vasculitis. CONCLUSION This study suggests that aortic inflammation, as well as atheromatous disease, might participate in the fast progression of aortic dilation in GCA.
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Affiliation(s)
- Sophie Gallou
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | | | - Alexandre Nguyen
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Rémi Philip
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France.
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Elfishawi MM, Kaymakci MS, J Achenbach S, S Crowson C, Kermani TA, M Weyand C, J Koster M, Warrington KJ. Reappraisal of large artery involvement in giant cell arteritis: a population-based cohort over 70 years. RMD Open 2024; 10:e003775. [PMID: 38331471 PMCID: PMC10860079 DOI: 10.1136/rmdopen-2023-003775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To evaluate the incidence and outcomes of large artery (LA) involvement among patients with giant cell arteritis (GCA) and to compare LA involvement to non-GCA patients. METHODS The study included Olmsted County, Minnesota, USA residents with incident GCA between 1950 and 2016 with follow-up through 31 December 2020, death or migration. A population-based age-matched/sex-matched comparator cohort without GCA was assembled. LA involvement included aortic aneurysm, dissection, stenosis in the aorta or its main branches diagnosed within 1 year prior to GCA or anytime afterwards. Cumulative incidence of LA involvement was estimated; Cox models were used. RESULTS The GCA cohort included 289 patients (77% females, 81% temporal artery biopsy positive), 106 with LA involvement.Reported cumulative incidences of LA involvement in GCA at 15 years were 14.8%, 30.2% and 49.2% for 1950-1974, 1975-1999 and 2000-2016, respectively (HR 3.48, 95% CI 1.67 to 7.27 for 2000-2016 vs 1950-1974).GCA patients had higher risk for LA involvement compared with non-GCA (HR 3.22, 95% CI 1.83 to 5.68 adjusted for age, sex, comorbidities). Thoracic aortic aneurysms were increased in GCA versus non GCA (HR 13.46, 95% CI 1.78 to 101.98) but not abdominal (HR 1.08, 95% CI 0.33 to 3.55).All-cause mortality in GCA patients improved over time (HR 0.62, 95% CI 0.41 to 0.93 in 2000-2016 vs 1950-1974) but remained significantly elevated in those with LA involvement (HR 1.89, 95% CI 1.39 to 2.56). CONCLUSIONS LA involvement in GCA has increased over time. Patients with GCA have higher incidences of LA involvement compared with non-GCA including thoracic but not abdominal aneurysms. Mortality is increased in patients with GCA and LA involvement highlighting the need for continued surveillance.
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Affiliation(s)
- Mohanad M Elfishawi
- Department of Internal Medicine, Division of Autoimmune and Rheumatic diseases, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Sara J Achenbach
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Tanaz A Kermani
- Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Reddy P, Nair KS, Kumar V, Bowen JM, Deyle DR, Pochettino A, Connolly HM, Anavekar NS. Thoracic Aortic Aneurysmal Disease: Comprehensive Recommendations for the Primary Care Physician. Mayo Clin Proc 2024; 99:111-123. [PMID: 38176819 DOI: 10.1016/j.mayocp.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 01/06/2024]
Abstract
Thoracic aortic aneurysm (TAA) is a commonly encountered disease that is defined as aortic dilation with an increase in diameter of at least 50% greater than the expected age- and sex-adjusted size. Thoracic aortic aneurysms are described by their size, location, morphology, and cause. Primary care clinicians and other noncardiologists are often the first point of contact for patients with TAA. This review is intended to provide them with basic information on the differential diagnosis, diagnostic evaluation, and medical and surgical management of TAAs. Management decisions depend on having as precise a diagnosis as possible. Fortunately, this can often be achieved with a stepwise diagnostic approach that incorporates imaging and targeted genetic testing. Our review includes recommendations. In this review, we discuss these issues at a basic level and include recommendations for patients considering pregnancy.
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Affiliation(s)
- Prajwal Reddy
- Department of Cardiology, Mayo Clinic, Rochester, MN.
| | - Kaavya S Nair
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO
| | - Vinayak Kumar
- Department of Cardiology, Mayo Clinic, Rochester, MN
| | - Juan M Bowen
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David R Deyle
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | | | | | - Nandan S Anavekar
- Department of Cardiology, Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN
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Lyne SA, Ruediger C, Lester S, Kaur G, Stamp L, Shanahan EM, Hill CL. Clinical phenotype and complications of large vessel giant cell arteritis: A systematic review and meta-analysis. Joint Bone Spine 2023; 90:105558. [PMID: 36858169 DOI: 10.1016/j.jbspin.2023.105558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Giant Cell Arteritis (GCA) is a heterogenous systemic granulomatous vasculitis involving the aorta and any of its major tributaries. Despite increased awareness of large vessel (LV) involvement, studies reporting incidence, clinical characteristics and complications of large-vessel GCA (LV-GCA) show conflicting results due to inconsistent disease definitions, differences in study methodologies and the broad spectrum of clinical presentations. The aim of this systematic literature review was to better define LV-GCA based on the available literature and identify distinguishing characteristics that may differentiate LV-GCA patients from those with limited cranial disease. METHODS Published studies indexed in MEDLINE and EMBASE were searched from database inception to 7th May 2021. Studies were included if they presented cohort or cross-sectional data on a minimum of 25 patients with LV-GCA. Control groups were included if data was available on patients with limited cranial GCA (C-GCA). Data was quantitatively synthesised with application of a random effects meta-regression model, using Stata. RESULTS The search yielded 3488 studies, of which 46 were included. Diagnostic criteria for LV-GCA differed between papers, but was typically dependent on imaging or histopathology. Patients with LV-GCA were generally younger at diagnosis compared to C-GCA patients (mean age difference -4.53 years), had longer delay to diagnosis (mean difference 3.03 months) and lower rates of positive temporal artery biopsy (OR: 0.52 [95% CI: 0.3, 0.91]). Fewer LV-GCA patients presented with cranial manifestations and only 53% met the 1990 ACR Classification Criteria for GCA. Vasculitis was detected most commonly in the thoracic aorta, followed by the subclavian, brachiocephalic trunk and axillary arteries. The mean cumulative prednisolone dose at 12-months was 6056.5mg for LV-GCA patients, relapse rates were similar between LV- and C-GCA patients, and 12% of deaths in LV-GCA patients could be directly attributed to an LV complication. CONCLUSION Patients with LV-GCA have distinct disease features when compared to C-GCA, and this has implications on diagnosis, treatment strategies and surveillance of long-term sequalae.
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Affiliation(s)
- Suellen Anne Lyne
- University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia; Rheumatology Department, Level 5 the Tower Block, The Queen Elizabeth Hospital, 28, Woodville road, Woodville 5011, South Australia, Australia; Rheumatology Department, Flinders Medical Centre, Flinders Drive, Bedford Park 5042, South Australia, Australia.
| | - Carlee Ruediger
- University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia; Rheumatology Department, Level 5 the Tower Block, The Queen Elizabeth Hospital, 28, Woodville road, Woodville 5011, South Australia, Australia
| | - Susan Lester
- University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia; Rheumatology Department, Level 5 the Tower Block, The Queen Elizabeth Hospital, 28, Woodville road, Woodville 5011, South Australia, Australia
| | - Gursimran Kaur
- Rheumatology Department, Christchurch Hospital, 2, Riccarton avenue, Christchurch Central City, 4710 Christchurch, New Zealand
| | - Lisa Stamp
- Rheumatology Department, Christchurch Hospital, 2, Riccarton avenue, Christchurch Central City, 4710 Christchurch, New Zealand; University of Otago, Christchurch Hospital, 2, Riccarton avenue, Christchurch Central City, 4710 Christchurch, New Zealand
| | - Ernst Michael Shanahan
- Rheumatology Department, Flinders Medical Centre, Flinders Drive, Bedford Park 5042, South Australia, Australia; Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia
| | - Catherine Louise Hill
- University of Adelaide, North Terrace, Adelaide 5005, South Australia, Australia; Rheumatology Department, Level 5 the Tower Block, The Queen Elizabeth Hospital, 28, Woodville road, Woodville 5011, South Australia, Australia; Rheumatology Department, Royal Adelaide Hospital, Port Road, Adelaide 5000, South Australia, Australia
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Springer JM, Kermani TA. Recent advances in the treatment of giant cell arteritis. Best Pract Res Clin Rheumatol 2023; 37:101830. [PMID: 37328409 DOI: 10.1016/j.berh.2023.101830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 06/18/2023]
Abstract
Giant cell arteritis (GCA) is a systemic, granulomatous, large-vessel vasculitis that affects individuals over the age of 50 years. Morbidity from disease includes cranial manifestations which can cause irreversible blindness, while extra-cranial manifestations can cause vascular damage with large-artery stenosis, occlusions, aortitis, aneurysms, and dissections. Glucocorticoids while efficacious are associated with significant adverse effects. Furthermore, despite treatment with glucocorticoids, relapses are common. An understanding of the pathogenesis of GCA has led to the discovery of tocilizumab as an efficacious steroid-sparing therapy while additional therapeutic targets affecting different inflammatory pathways are under investigation. Surgical treatment may be indicated in cases of refractory ischemia or aortic complications but data on surgical outcomes are limited. Despite the recent advances, many unmet needs exist, including the identification of patients or subsets of GCA who would benefit from earlier initiation of adjunctive therapies, patients who may warrant long-term immunosuppression and medications that sustain permanent remission. The impact of medications like tocilizumab on long-term outcomes, including the development of aortic aneurysms and vascular damage also warrants investigation.
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Affiliation(s)
- Jason M Springer
- Vanderbilt University Medical Center, 1161 21st Avenue Sound, T3113 Medical Center North, Nashville, TN, 37232, USA.
| | - Tanaz A Kermani
- University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA, 90404, USA.
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Abishek J, Akintayo R, Isles C. Unexplained chest pain in a patient with giant cell arteritis? Think aortic dissection. J R Coll Physicians Edinb 2022; 52:124-127. [DOI: 10.1177/14782715221103685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Giant cell arteritis (GCA) is the commonest of the large-vessel vasculitides. Aortic inflammation in patients with GCA was first described over 80 years ago, but it has only been possible to study this systematically following the development of more sophisticated imaging techniques such as computed tomography angiography, magnetic resonance angiography and positron emission tomography. Both NICE and the European League Against Rheumatism (EULAR) recognise that aortic dissection may complicate GCA but stop short of recommending routine imaging. We report a case that highlights a possible need for large-vessel imaging at the time of diagnosis and during follow-up to enable earlier recognition of aortitis and associated complications including dissection.
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Affiliation(s)
| | - Richard Akintayo
- Departments of Rheumatology, Dumfries Royal Infirmary, Dumfries, UK
| | - Chris Isles
- Departments of Medicine, Dumfries Royal Infirmary, Dumfries, UK
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Khan NA, Li D, Newstrom E, Barrios R, Attar M. Hidden in Plain Sight: Discovering Giant Cell Aortopathy During Surgical Mitral Valve Repair. JACC Case Rep 2022; 4:529-532. [PMID: 35573852 PMCID: PMC9091514 DOI: 10.1016/j.jaccas.2022.03.014] [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: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
Giant cell arteritis (GCA) is an inflammatory cranial and/or extracranial vasculitis. Although cranial GCA is widely recognized, extracranial GCA is underdiagnosed because of its nonspecific and atypical presentations. We report a case of asymptomatic extracranial GCA with ascending thoracic aortopathy discovered incidentally during surgical mitral valve repair. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Najah A. Khan
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Daniel Li
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Roberto Barrios
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, USA
| | - Mohammed Attar
- DeBakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, Texas, USA
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Sangha S, Lenert A, Dawoud S, Kaur A, Yazan H, Voigt MD, Lenert P. Atypical Large Vessel Vasculitis Presenting With Cholestatic Liver Abnormalities: Case-Based Review. J Clin Rheumatol 2021; 27:e561-e567. [PMID: 33065628 DOI: 10.1097/rhu.0000000000001596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Clinicians usually easily recognize cranial manifestations of giant cell arteritis (GCA) such as new-onset headache, jaw claudication, scalp tenderness, and abrupt changes in visual acuity or blindness; however, when presented with an aberrant clinical course, the diagnosis becomes more elusive. In addition to temporal arteries and other extracranial branches of the carotid arteries, large vessel vasculitis (LVV) can also affect other blood vessels including coronary arteries, aorta with its major branches, intracranial blood vessels, and hepatic arteries.Over time, the scope of the symptoms typically associated with LVV has broadened and includes cases of fever of unknown origin accompanied with other constitutional symptoms that can mimic a range of neoplastic and infectious diseases. In up to half of patients with atypical LVV, liver enzyme level elevations with a cholestatic pattern have been observed. Alkaline phosphatase level and γ-glutamyl transferase level elevations tend to be more prevalent in those LVV patients with vigorous inflammatory responses, particularly in those with fever and other nonspecific constitutional symptoms. These patients also have more profound anemia and thrombocytosis. With the exception of rare instances of vasculitides and granulomas affecting the liver tissue, liver biopsy is generally of little help and primarily shows nonspecific changes of fatty liver.In this article, we review 3 patients who were eventually diagnosed with atypical LVV. The diagnosis was confirmed with temporal artery biopsy in 2 patients and with positron emission tomography/computed tomography in 1 patient. The common hepatic abnormality observed in all patients was the elevation of alkaline phosphatase level, which tended to respond rapidly to initiation of immunosuppressive treatment.
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Affiliation(s)
| | | | | | | | - Hasan Yazan
- Gastroenterology and Hepatology, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Michael D Voigt
- Gastroenterology and Hepatology, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA
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Therkildsen P, de Thurah A, Nielsen BD, Hansen IT, Eldrup N, Nørgaard M, Hauge EM. Increased risk of thoracic aortic complications among patients with giant cell arteritis: a nationwide, population-based cohort study. Rheumatology (Oxford) 2021; 61:2931-2941. [PMID: 34918058 DOI: 10.1093/rheumatology/keab871] [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: 08/17/2021] [Revised: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the risk of aortic aneurysms (AA), aortic dissections (AD) and peripheral arterial disease (PAD) among patients with GCA. METHODS In this nationwide, population-based cohort study using Danish national health registries, we identified all incident GCA patients ≥50 years between 1996 and 2018 who redeemed three or more prescriptions for prednisolone. Index date was the date of redeeming the third prednisolone prescription. Case definition robustness was checked through sensitivity analysis. We included general population referents matched 1:10 by age, sex and calendar time. Using a pseudo-observation approach, we calculated 5-, 10- and 15-year cumulative incidence proportions (CIP) and relative risks (RR) of AA, AD and PAD with death as a competing risk. RESULTS We included 9908 GCA patients and 98 204 referents. The 15-year CIP of thoracic AA, abdominal AA, AD and PAD in the GCA cohort were 1.9% (95% CI 1.5, 2.2), 1.8% (1.4-2.2), 1.0% (0.7-1.2) and 4.8% (4.2-5.3). Compared with the referents, the 15-year RR were 11.2 (7.41-16.9) for thoracic AA, 6.86 (4.13-11.4) for AD, 1.04 (0.83-1.32) for abdominal AA and 1.53 (1.35-1.74) for PAD. Among GCA patients, female sex, age below 70 years and positive temporal artery findings were risk factors for developing thoracic AA. The median time to thoracic AA was 7.5 years (interquartile range 4.4-11.2) with a number needed to be screened of 250 (167-333), 91 (71-111) and 53 (45-67) after 5, 10 and 15 years. CONCLUSION Patients with GCA have a markedly increased risk of developing thoracic AA and AD, but no increased risk of abdominal AA.
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Affiliation(s)
- Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | | | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen
| | - Mette Nørgaard
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital.,Department of Clinical Medicine, Aarhus University, Aarhus
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Garvey TD, Koster MJ, Warrington KJ. My Treatment Approach to Giant Cell Arteritis. Mayo Clin Proc 2021; 96:1530-1545. [PMID: 34088416 DOI: 10.1016/j.mayocp.2021.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults 50 years or older. Expanded use of advanced arterial imaging has assisted both in the diagnosis of GCA and recognition of disease subsets. Although glucocorticoids have been the mainstay of treatment for almost 7 decades, new therapeutic options have emerged. This review aims to provide the clinician with a pragmatic approach to evaluating and managing patients with GCA while also addressing recent diagnostic and therapeutic developments.
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Affiliation(s)
- Thomas D Garvey
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Matthew J Koster
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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de Boysson H, Espitia O, Samson M, Tieulié N, Bachmeyer C, Moulinet T, Dumont A, Deshayes S, Bonnotte B, Agard C, Aouba A. Giant cell arteritis-related aortic dissection: A multicenter retrospective study. Semin Arthritis Rheum 2021; 51:430-435. [PMID: 33690049 DOI: 10.1016/j.semarthrit.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To describe characteristics and outcomes of patients with giant cell arteritis (GCA)-related aortic dissection. PATIENTS AND METHODS We retrospectively included, through a nationwide GCA network, all patients who had an aortic dissection either revealing GCA or occurring during follow-up. RESULTS A total of 46 patients were included in this study. Aortic dissection was inaugural and led to GCA diagnosis in 21 patients, whereas it occurred during follow-up in the 25 others, at a median of 53 [1-265] months after GCA diagnosis. Large-vessel vasculitis (LVV) was diagnosed through imaging before or at the time of aortic dissection in 31 (67%) patients. In patients who developed an aortic dissection during follow-up, the aortic event occurred 22 [1-143] months post GCA diagnosis in the patients with previous aortitis, whereas it occurred after 72 [19-265] months in patients without previously diagnosed aortitis (p = 0.005). Aortic surgery was performed in 27 (59%) patients and 23 of them survived. A total of 15 (32%) patients died following the aortic dissection, including 11 who were not operated on. In a multivariate analysis, aortic surgery was the single predictor of survival (HR: 4.3; 95% CI: 1.47- 15.7; p = 0.007). CONCLUSION Patients with prior LVV are more prone to develop early aortic dissection and require close monitoring of aortic morphology. One third of patients died from the aortic dissection. Surgery remains the best predictive factor for survival.
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Affiliation(s)
- Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France.
| | - Olivier Espitia
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Maxime Samson
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Nathalie Tieulié
- Department of Internal Medicine, Nice University Hospital, Nice, France
| | | | - Thomas Moulinet
- Department of Internal Medicine, Nancy University Hospital, Nancy, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France
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Pugh D, Grayson P, Basu N, Dhaun N. Aortitis: recent advances, current concepts and future possibilities. Heart 2021; 107:1620-1629. [PMID: 33593995 DOI: 10.1136/heartjnl-2020-318085] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
Broadly defined, aortitis refers to inflammation of the aorta and incorporates both infectious and non-infectious aetiologies. As advanced imaging modalities are increasingly incorporated into clinical practice, the phenotypic spectrum associated with aortitis has widened. The primary large vessel vasculitides, giant cell arteritis and Takayasu arteritis, are the most common causes of non-infectious aortitis. Aortitis without systemic disease or involvement of other vascular territories is classified as clinically isolated aortitis. Periaortitis, where inflammation spreads beyond the aortic wall, is an important disease subset with a distinct group of aetiologies. Infectious aortitis can involve bacterial, viral or fungal pathogens and, while uncommon, can be devastating. Importantly, optimal management strategies and patient outcomes differ between aortitis subgroups highlighting the need for a thorough diagnostic workup. Monitoring disease activity over time is also challenging as normal inflammatory markers do not exclude significant vascular inflammation, particularly after starting treatment. Additional areas of unmet clinical need include clear disease classifications and improved short-term and long-term management strategies. Some of these calls are now being answered, particularly with regard to large vessel vasculitis where our understanding has advanced significantly in recent years. Work extrapolated from temporal artery histology has paved the way for targeted biological agents and, although glucocorticoids remain central to the management of non-infectious aortitis, these may allow reduced glucocorticoid reliance. Future work should seek to clarify disease definitions, improve diagnostic pathways and ultimately allow a more stratified approach to patient management.
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Affiliation(s)
- Dan Pugh
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Peter Grayson
- National Institute of Arthritis & Musculoskeletal & Skin Diseases, NIH, Bethesda, Maryland, USA
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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14
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Aghayev A, Bay CP, Tedeschi S, Monach PA, Campia U, Gerhard-Herman M, Steigner ML, Mitchell RN, Docken WP, DiCarli M. Clinically isolated aortitis: imaging features and clinical outcomes: comparison with giant cell arteritis and giant cell aortitis. Int J Cardiovasc Imaging 2020; 37:1433-1443. [PMID: 33128155 DOI: 10.1007/s10554-020-02087-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
(1) describe imaging features of CIA, (2) compare dilation rate and wall thickening of aortic aneurysms in patients with CIA versus those with giant cell arteritis/aortitis (GCA), (3) present clinical outcomes of CIA patients. Retrospective search of electronic records from 2004 to 2018 yielded 71 patients, 52 of whom were female, with a mean age of 67.5 ± 9.0 years old, with a new clinical diagnosis of cranial or extracranial GCA (GCA group), and giant cell aortitis revealed by the aortic biopsy (CIA group). Comparisons between groups were conducted using the Wilcoxon rank-sum and Fisher's exact tests. Survival from the date of initial diagnosis to the end of data collection was compared between the two groups through a log-rank test. CIA patients (n = 23; 32%) presented with cardiovascular symptoms, and none had systemic inflammatory symptoms. Inflammatory markers were significantly higher among GCA patients than among CIA patients (p < 0.0001). The CIA group demonstrated thoracic aortic aneurysms without wall thickening. None of the GCA patients (n = 48; 68%) had aneurysmal dilation in the aorta at the time of diagnosis. None of the four CIA patients had FDG uptake in the aorta, while nine out of 13 GCA patients had FDG uptake in the vessels. There was no statistically significant difference in the survival between the two groups (p = 0.12). CIA patients presented with cardiovascular symptoms and was characterized by aneurysm of the aorta without the involvement of the infrarenal aortic segment. The role of FDG-PET/CT in CIA is less certain, though none of the patients in this cohort had FDG uptake in the vessels.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul A Monach
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Umberto Campia
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marie Gerhard-Herman
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - William P Docken
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo DiCarli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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15
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Koster MJ, Warrington KJ, Matteson EL. Morbidity and Mortality of Large-Vessel Vasculitides. Curr Rheumatol Rep 2020; 22:86. [DOI: 10.1007/s11926-020-00963-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis. Mediators Inflamm 2020; 2020:3203241. [PMID: 33061825 PMCID: PMC7537685 DOI: 10.1155/2020/3203241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients. Monitoring GCA activity during tocilizumab (TCZ) treatment is an unmet need, since low serum levels of C-reactive protein (CRP) during treatment may underestimate disease activity. To date, few data are available on the role of different imaging techniques in monitoring GCA activity and response to treatment. We report herein a cohort of GCA patients treated with TCZ and followed up with multimodal imaging. Patients and Methods. We collected clinical, laboratory, and imaging data of 11 GCA patients treated with TCZ 162 mg subcutaneously every week. Disease activity was assessed at baseline and within 12 months from the start of treatment using different imaging techniques such as color Doppler ultrasonography (CDUS), magnetic resonance imaging/angiography (MRI/MRA), computed tomography angiography (CTA), and/or positron emission tomography (PET). Results Four patients were affected by cranial and 7 by LV-GCA. All patients were treated with oral glucocorticoids (GCs) (mean dose 55.68 mg ± 8.19 of prednisone or equivalent) in combination with TCZ. Treatment was preceded in 5 cases by 3 intravenous boluses of 1000 mg methylprednisolone. A significant decrease of the mean dose of oral GCs was observed between baseline and the last follow-up visit (4.65 ± 3.69 mg) (p = 0.003). TCZ treatment significantly decreased erythrocyte sedimentation rate (p < 0.01) and CRP levels (p < 0.01). At follow-up (mean 8.18 ± 3.63 months), all patients were in clinical and serological remission. Moreover, PET, CDUS, MRI/MRA, and CTA did not show any LVV finding. Conclusions Our study highlights TCZ efficacy in inducing GCA remission and its steroid-sparing effect. We highlighted a reliability of imaging procedures in the evaluation of disease activity and treatment response. A close disease monitoring with imaging techniques should be taken into account in GCA patients during TCZ treatment.
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Agard C, Bonnard G, Samson M, de Moreuil C, Lavigne C, Jégo P, Connault J, Artifoni M, Le Gallou T, Landron C, Roblot P, Magnant J, Belizna C, Maillot F, Diot E, Néel A, Hamidou M, Espitia O. Giant cell arteritis-related aortitis with positive or negative temporal artery biopsy: a French multicentre study. Scand J Rheumatol 2019; 48:474-481. [PMID: 31766965 DOI: 10.1080/03009742.2019.1661011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To compare the clinical presentation and outcome of giant cell arteritis (GCA)-related aortitis according to the results of temporal artery biopsy (TAB).Method: Patients with GCA-related aortitis diagnosed between 2000 and 2017, who underwent TAB, were retrospectively included from a French multicentre database. They all met at least three American College of Rheumatology criteria for the diagnosis of GCA. Aortitis was defined by aortic wall thickening > 2 mm on computed tomography scan and/or an aortic aneurysm, associated with an inflammatory syndrome. Patients were divided into two groups [positive and negative TAB (TAB+, TAB-)], which were compared regarding aortic imaging characteristics and aortic events, at aortitis diagnosis and during follow-up.Results: We included 56 patients with TAB+ (70%) and 24 with TAB- (30%). At aortitis diagnosis, patients with TAB- were significantly younger than those with TAB+ (67.7 ± 9 vs 72.3 ± 7 years, p = 0.022). Initial clinical signs of GCA, inflammatory parameters, and glucocorticoid therapy were similar in both groups. Coronary artery disease and/or lower limb peripheral arterial disease was more frequent in TAB- patients (25% vs 5.3%, p = 0.018). Aortic wall thickness and type of aortic involvement were not significantly different between groups. Diffuse arterial involvement from the aortic arch was more frequent in TAB- patients (29.1 vs 8.9%, p = 0.03). There were no differences between the groups regarding overall, aneurism-free, relapse-free, and aortic event-free survival.Conclusion: Among patients with GCA-related aortitis, those with TAB- are characterized by younger age and increased frequency of diffuse arterial involvement from the aortic arch compared to those with TAB+, without significant differences in terms of prognosis.
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Affiliation(s)
- C Agard
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - G Bonnard
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon, University of Burgundy, Dijon, France
| | - C de Moreuil
- Department of Internal Medicine, University Hospital of Brest, University of Bretagne Occidentale, Brest, France
| | - C Lavigne
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - P Jégo
- Department of Internal Medicine, University Hospital of Rennes, Rennes University, Rennes, France
| | - J Connault
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Artifoni
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - T Le Gallou
- Department of Internal Medicine, University Hospital of Rennes, Rennes University, Rennes, France
| | - C Landron
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers University, Poitiers, France
| | - P Roblot
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers University, Poitiers, France
| | - J Magnant
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - C Belizna
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - F Maillot
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - E Diot
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - A Néel
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Hamidou
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - O Espitia
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
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18
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Abstract
Diagnosis of the inflammatory aortopathies and importantly, their distinction in the later stages of disease from genetically mediated or acquired (degenerative) aortopathy remains a challenging clinical problem. Historically, the diagnosis of inflammatory aortopathy has required tissue sampling and pathological assessment. Although histological diagnosis remains an important diagnostic criterion, the ability to obtain sufficient tissue samples is problematic and requires invasive approaches that pose important risk. Continuing refinement in the capabilities of multimodality imaging, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography provides important insights into the broad spectrum of disease which comprise the inflammatory aortopathies. This review examines the current and emerging role of multimodality imaging in the evaluation of aortitis.
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Affiliation(s)
- John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Delaval L, Daumas A, Samson M, Ebbo M, De Boysson H, Liozon E, Dupuy H, Puyade M, Blockmans D, Benhamou Y, Sacré K, Berezne A, Devilliers H, Pugnet G, Maurier F, Zénone T, de Moreuil C, Lifermann F, Arnaud L, Espitia O, Deroux A, Grobost V, Lazaro E, Agard C, Balageas A, Bouiller K, Durel CA, Humbert S, Rieu V, Roriz M, Souchaud-Debouverie O, Vinzio S, Nguyen Y, Régent A, Guillevin L, Terrier B. Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years. Autoimmun Rev 2019; 18:714-720. [PMID: 31059846 DOI: 10.1016/j.autrev.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Age at onset of large-vessel vasculitis (LVV) is commonly used to distinguish giant cell arteritis (GCA) and Takayasu arteritis (TA). However, LVV between age 50 and 60 years may be difficult to classify. METHODS We conducted a retrospective study including LVV aged between 50 and 60 years at onset (LVV50-60, cases) and compared them to LVV aged over 60 years (LVV>60, controls). LVV was defined histologically and/or morphologically. Controls fulfilled ACR 1990 criteria for GCA or presented isolated aortitis. RESULTS We included 183 LVV50-60 and 183 gender-matched LVV>60. LVV50-60 had more frequent peripheral limb manifestations (23 vs. 5%), and less frequent cephalic (73 vs. 90%) and ocular signs (17 vs. 27%) than LVV>60. Compared to LVV>60, CT angiography and PET/CT scan were more frequently abnormal in LVV50-60 (74 vs. 38%, and 90 vs. 72%, respectively), with aorta being more frequently involved (78 vs. 47%). By multivariate analysis, absence of cephalic symptoms, presence of peripheral limb ischemia and aorta involvement, and increased CRP level were significantly associated with LVV50-60 presentation compared to LVV>60. At last follow-up, compared to LVV>60, LVV50-60 received significantly more lines of treatment (2 vs. 1), more frequent biologics (12 vs. 3%), had more surgery (10 vs. 0%), and had higher prednisone dose (8.8 vs. 6.5 mg/d) at last follow-up, CONCLUSION: LVV onset between 50 and 60 years identifies a subset of patients with more frequent aorta and peripheral vascular involvement and more refractory disease compared to patients with LVV onset after 60.
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Affiliation(s)
- Laure Delaval
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Aurélie Daumas
- Department of Internal Medecine, La Timone University Hospital, Marseille, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Mikael Ebbo
- Department of Internal Medecine, La Timone University Hospital, Marseille, France
| | - Hubert De Boysson
- Department of Internal Medecine, Caen University Hospital, University of Caen-Basse Normandie, France
| | - Eric Liozon
- Department of Internal Medecine, Limoges University Hospital, France
| | - Henry Dupuy
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Mathieu Puyade
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | - Daniel Blockmans
- Clinical department of general internal medicine department, University Hospitals Leuven, Belgium
| | - Ygal Benhamou
- Department of Internal Medecine, 1 rue de Germont, Rouen, France
| | - Karim Sacré
- Department of Internal Medecine, Bichat Hospital, Paris, France
| | - Alice Berezne
- Department of Internal Medecine, CHR Annecy-Genevois, Annecy, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, CHU Dijon Bourgogne, Inserm CIC 1432, Clinical Epidemiology Unit, Dijon, France
| | - Grégory Pugnet
- Department of Internal Medecine, CHU de Toulouse, UMR 1027 Inserm-Université de Toulouse, France
| | - François Maurier
- Department of Internal Medicine, Hôpital Belle Isle, Metz, France
| | - Thierry Zénone
- Internal Medicine Department, Valence Hospital, Valence, France
| | - Claire de Moreuil
- Department of Internal Medecine and pneumology, CHU Brest, La Cavale Blanche Hospital, Brest Cedex, France
| | | | - Laurent Arnaud
- Department of Rheumatology, CHU Strasbourg, INSERM UMR-S1109, RESO, Strasbourg University, F-67000 Strasbourg, France
| | - Olivier Espitia
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Alban Deroux
- Grenoble University Hospital, Division of Internal Medicine, Grenoble F-38043, France
| | - Vincent Grobost
- Internal Medicine Department, University Hospital, Clermont-Ferrand, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Kevin Bouiller
- Department of internal medicine, CHU Jean Minjoz, Besancon, France
| | | | | | - Virginie Rieu
- Internal Medicine Department, University Hospital, Clermont-Ferrand, France
| | - Mélanie Roriz
- Department of Internal Medicine, Hôpital Lariboisière, Paris, France
| | | | - Stéphane Vinzio
- Department of Internal Medicine Groupe Hospitalier Mutualiste of Grenoble, Grenoble, France
| | - Yann Nguyen
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Alexis Régent
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France.
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Soler RJ, Fabre D, Watkins AC, Fadel E, Mercier O, Haulon S. Hybrid treatment of a giant thoracic aneurysm in a 38 year-old woman. J Vasc Surg 2018; 69:1591-1595. [PMID: 30583900 DOI: 10.1016/j.jvs.2018.09.038] [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: 07/23/2018] [Accepted: 09/28/2018] [Indexed: 10/27/2022]
Abstract
A 38-year-old woman, with no comorbidities, presented to an outside institution with a 10-cm aortic arch and descending thoracic aortic aneurysm. After an aborted attempt at hybrid repair, she underwent successful, staged repair with zone 1 thoracic endovascular aortic repair and open aneurysmal sac revision. The patient made an uneventful recovery with computed tomographic evidence of complete aneurysmal exclusion. This case demonstrates many of the techniques and issues in the evolving field of aortic arch repair.
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Affiliation(s)
- Raphael J Soler
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France; Department of Vascular and Endovascular Surgery, Hôpital La Timone, Aix-Marseille Université, Marseille, France
| | - Dominique Fabre
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | - Amelia Claire Watkins
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France; Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Elie Fadel
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | - Olaf Mercier
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | - Stéphan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France.
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21
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van der Geest KSM, Sandovici M, van Sleen Y, Sanders JS, Bos NA, Abdulahad WH, Stegeman CA, Heeringa P, Rutgers A, Kallenberg CGM, Boots AMH, Brouwer E. Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis? Arthritis Rheumatol 2018; 70:1366-1376. [PMID: 29648680 PMCID: PMC6175064 DOI: 10.1002/art.40520] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/29/2018] [Indexed: 12/14/2022]
Abstract
Giant cell arteritis (GCA) is an autoimmune vasculitis affecting large and medium‐sized arteries. Ample evidence indicates that GCA is a heterogeneous disease in terms of symptoms, immune pathology, and response to treatment. In the current review, we discuss the evidence for disease subsets in GCA. We describe clinical and immunologic characteristics that may impact the risk of cranial ischemic symptoms, relapse rates, and long‐term glucocorticoid requirements in patients with GCA. In addition, we discuss both proven and putative immunologic targets for therapy in patients with GCA who have an unfavorable prognosis. Finally, we provide recommendations for further research on disease subsets in GCA.
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Affiliation(s)
| | - Maria Sandovici
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Yannick van Sleen
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Stephan Sanders
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Nicolaas A Bos
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Wayel H Abdulahad
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Coen A Stegeman
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Heeringa
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Abraham Rutgers
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Cees G M Kallenberg
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke M H Boots
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth Brouwer
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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22
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Kermani TA, Warrington KJ. Prognosis and monitoring of giant cell arteritis and associated complications. Expert Rev Clin Immunol 2018; 14:379-388. [DOI: 10.1080/1744666x.2018.1467758] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Tanaz A. Kermani
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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