1
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Zhu K, Lv F, Hou X, Wang F, Pang L, Zhong M. Thrombosis in vasculitis: An updated review of etiology, pathophysiology, and treatment. Heliyon 2024; 10:e30615. [PMID: 38975109 PMCID: PMC11225688 DOI: 10.1016/j.heliyon.2024.e30615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Thromboembolic disease is a complication of many vasculitides. A common observation is that thromboembolic events coincide with the period of vasculitic disease, but the mechanism by which this occurs remains unclear. Inflammatory thrombosis is now recognized as a symptom of arteritis rheumatic, and vasculitides such as Behçet's syndrome (BS), and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) or giant cell arteritis (GCA). This systematic review aimed to explain recent findings related to etiology, pathophysiology, and treatment methods for BS, AAV, and medium/large-vessel vasculitis. Methods A comprehensive literature search on English sources from PubMed, Scopus, MEDLINE, Science Direct, ProQuest, AIM, CINAHIL, and ELDIS databases was used to find the relevant articles and reports. The relevant papers (having full text) were obtained until June 2023. Two independent reviewers screened the titles and abstracts of the obtained articles, and a third arbitrator resolved disputes between the reviewers. Results and conclusion It is becoming increasingly clear that certain systemic inflammatory diseases, like vasculitis, are linked to a higher risk of both venous and arterial thrombosis. An increased incidence of thromboembolic disease in AAV has been noted, particularly during times of active disease. Growing evidence supports the use of immunosuppression in the management of venous thrombosis in vasculitis. These patients also have a higher risk of developing ischemic disease.
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Affiliation(s)
- Kai Zhu
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Feng Lv
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Xiangqian Hou
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Feng Wang
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Linbin Pang
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Miqian Zhong
- Department of Hematopathology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, 2530000, China
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2
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Mansueto G, Lanza G, Falleti J, Orabona P, Alaouieh D, Hong E, Girolami S, Montella M, Fisicaro F, Galdieri A, Singh P, Di Napoli M. Central and Peripheral Nervous System Complications of Vasculitis Syndromes from Pathology to Bedside: Part 2-Peripheral Nervous System. Curr Neurol Neurosci Rep 2023; 23:83-107. [PMID: 36820992 PMCID: PMC9947450 DOI: 10.1007/s11910-023-01249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE OF REVIEW Peripheral nervous system vasculitides (PNSV) are a heterogeneous group of disorders with a clinical subset that may differ in prognosis and therapy. We provide a comprehensive update on the clinical assessment, diagnosis, complications, treatment, and follow-up of PNSV. RECENT FINDINGS Progress in neuroimaging, molecular testing, and peripheral nerve biopsy has improved clinical assessment and decision-making of PNSV, also providing novel insights on how to prevent misdiagnosis and increase diagnostic certainty. Advances in imaging techniques, allowing to clearly display the vessel walls, have also enhanced the possibility to differentiate inflammatory from non-inflammatory vascular lesions, while recent histopathology data have identified the main morphological criteria for more accurate diagnosis and differential diagnoses. Overall, the identification of peculiar morphological findings tends to improve diagnostic accuracy by defining a clearer boundary between systemic and non-systemic neuropathies. Therefore, the definition of epineurium vessel wall damage, type of vascular lesion, characterization of lymphocyte populations, antibodies, and inflammatory factors, as well as the identification of direct nerve damage or degeneration, are the common goals for pathologists and clinicians, who will both benefit for data integration and findings translation. Nevertheless, to date, treatment is still largely empiric and, in some cases, unsatisfactory, thus often precluding precise prognostic prediction. In this context, new diagnostic techniques and multidisciplinary management will be essential in the proper diagnosis and prompt management of PNSV, as highlighted in the present review. Thirty to fifty percent of all patients with vasculitis have signs of polyneuropathy. Neuropathies associated with systemic vasculitis are best managed according to the guidelines of the underlying disease because appropriate workup and initiation of treatment can reduce morbidity. Steroids, or in severe or progressive cases, cyclophosphamide pulse therapy is the standard therapy in non-systemic vasculitic neuropathies. Some patients need long-term immunosuppression. The use of novel technologies for high-throughput genotyping will permit to determine the genetic influence of related phenotypes in patients with PNSV.
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Affiliation(s)
- Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza L. Miraglia 2, 80138, Naples, Italy.,Clinical Department of Laboratory Services and Public Health-Legal Medicine Unit, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138, Naples, Italy.,Pathology-Unit of Federico II University, Via S. Pansini 3, 80131, Naples, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.,Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018, Troina, Italy
| | - Jessica Falleti
- Pathology Unit, Sant'Anna E San Sebastiano Hospital, 81100, Caserta, Italy
| | - Pasquale Orabona
- Pathology Unit, Sant'Anna E San Sebastiano Hospital, 81100, Caserta, Italy
| | | | - Emily Hong
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Sara Girolami
- Neurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039, Sulmona, L'Aquila, Italy
| | - Marco Montella
- Mental and Physical Health and Preventive Medicine Department, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138, Naples, Italy
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
| | - Anna Galdieri
- AOU "Luigi Vanvitelli", Via Santa Maria Di Costantinopoli 104, 80138, Naples, Italy
| | - Puneetpal Singh
- Department of Human Genetics, Punjabi University, Patiala, 147002, Punjab, India
| | - Mario Di Napoli
- Neurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039, Sulmona, L'Aquila, Italy.
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3
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Samson M, Genet C, Corbera-Bellalta M, Greigert H, Espígol-Frigolé G, Gérard C, Cladière C, Alba-Rovira R, Ciudad M, Gabrielle PH, Creuzot-Garcher C, Tarris G, Martin L, Saas P, Audia S, Bonnotte B, Cid MC. Human monocyte-derived suppressive cells (HuMoSC) for cell therapy in giant cell arteritis. Front Immunol 2023; 14:1137794. [PMID: 36895571 PMCID: PMC9989212 DOI: 10.3389/fimmu.2023.1137794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction The pathogenesis of Giant Cell Arteritis (GCA) relies on vascular inflammation and vascular remodeling, the latter being poorly controlled by current treatments. Methods This study aimed to evaluate the effect of a novel cell therapy, Human Monocyte-derived Suppressor Cells (HuMoSC), on inflammation and vascular remodeling to improve GCA treatment. Fragments of temporal arteries (TAs) from GCA patients were cultured alone or in the presence of HuMoSCs or their supernatant. After five days, mRNA expression was measured in the TAs and proteins were measured in culture supernatant. The proliferation and migration capacity of vascular smooth muscle cells (VSMCs) were also analyzed with or without HuMoSC supernatant. Results Transcripts of genes implicated in vascular inflammation (CCL2, CCR2, CXCR3, HLADR), vascular remodeling (PDGF, PDGFR), angiogenesis (VEGF) and extracellular matrix composition (COL1A1, COL3A1 and FN1) were decreased in arteries treated with HuMoSCs or their supernatant. Likewise, concentrations of collagen-1 and VEGF were lower in the supernatants of TAs cultivated with HuMoSCs. In the presence of PDGF, the proliferation and migration of VSMCs were both decreased after treatment with HuMoSC supernatant. Study of the PDGF pathway suggests that HuMoSCs act through inhibition of mTOR activity. Finally, we show that HuMoSCs could be recruited in the arterial wall through the implication of CCR5 and its ligands. Conclusion Altogether, our results suggest that HuMoSCs or their supernatant could be useful to decrease vascular in flammation and remodeling in GCA, the latter being an unmet need in GCA treatment.
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Affiliation(s)
- Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Coraline Genet
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Marc Corbera-Bellalta
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Georgina Espígol-Frigolé
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Claire Gérard
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Claudie Cladière
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Roser Alba-Rovira
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
| | - Marion Ciudad
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | | | | | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Philippe Saas
- Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France.,Centre d'investigation clinique (CIC)-1431, INSERM, Besançon University Hospital, Etablissement Français du Sang (EFS), Besançon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France.,Université Bourgogne Franche-Comté, INSERM, Etablissement Français du Sang, Bourgogne Franche-Comté (EFS BFC), UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, France
| | - Maria C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CRB-CELLEX, Barcelona, Spain
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Vantaggio L, Pellicano C, Miglionico M, Cusano G, Visentini M. Might IgA be a Biomarker of Disease Activity in Takayasu Arteritis? Eur J Case Rep Intern Med 2022; 9:003664. [PMID: 36632539 PMCID: PMC9829015 DOI: 10.12890/2022_003664] [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: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
Takayasu arteritis is a systemic vasculitis of the large vessels and mainly affects Japanese and Southeast Asian women in the second and third decades of life. Inflammatory infiltrate affects the full thickness of the vessel wall, inducing progressive lumen stenosis and occlusion. The main biomarkers of disease activity are the ESR, CRP and serum levels of circulating cytokines. This case report describes the clinical history of a young woman with Takayasu disease with high serum levels of IgA at onset. IgA remained elevated with persistence of disease activity, and normalized only when the patient was treated with an anti-TNF agent (infliximab), which also induced a clinical response in the vasculitis. IgA levels, together with other inflammatory parameters, may be considered a biomarker of disease activity. LEARNING POINTS This case report highlights the need to increase the number of humoral markers used to assess disease course in Takayasu arteritis (TA).IgA may be considered a biomarker of TA disease activity.Serum IgA levels may be helpful to identify TA patients not responding to traditional therapy.
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5
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Temporal Artery Vascular Diseases. J Clin Med 2022; 11:jcm11010275. [PMID: 35012016 PMCID: PMC8745856 DOI: 10.3390/jcm11010275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023] Open
Abstract
In the presence of temporal arteritis, clinicians often refer to the diagnosis of giant cell arteritis (GCA). However, differential diagnoses should also be evoked because other types of vascular diseases, vasculitis or not, may affect the temporal artery. Among vasculitis, Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is probably the most common, and typically affects the peri-adventitial small vessel of the temporal artery and sometimes mimics giant cell arteritis, however, other symptoms are frequently associated and more specific of ANCA-associated vasculitis prompt a search for ANCA. The Immunoglobulin G4-related disease (IgG4-RD) can cause temporal arteritis as well. Some infections can also affect the temporal artery, primarily an infection caused by the varicella-zoster virus (VZV), which has an arterial tropism that may play a role in triggering giant cell arteritis. Drugs, mainly checkpoint inhibitors that are used to treat cancer, can also trigger giant cell arteritis. Furthermore, the temporal artery can be affected by diseases other than vasculitis such as atherosclerosis, calcyphilaxis, aneurysm, or arteriovenous fistula. In this review, these different diseases affecting the temporal artery are described.
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6
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Greigert H, Zeller M, Putot A, Steinmetz E, Terriat B, Maza M, Falvo N, Muller G, Arnould L, Creuzot-Garcher C, Ramon A, Martin L, Tarris G, Ponnelle T, Audia S, Bonnotte B, Cottin Y, Samson M. Myocardial infarction during giant cell arteritis: A cohort study. Eur J Intern Med 2021; 89:30-38. [PMID: 33610415 DOI: 10.1016/j.ejim.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population affected by MI. METHODS In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December 2016 in Côte D'Or (France), we identified patients with MI by crossing data from the territorial myocardial infarction registry (Observatoire des Infarctus de Côte d'Or) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after matching for age, sex, cardiovascular risk factors and prior cardiovascular disease. MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch. GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before or after). RESULTS Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with 65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p = 0.080), and GCA diagnosis was the only identified triggering factor in 75% of GCA-related T2MI. GCA-unrelated MI were more frequently T1MI and occurred in patients who had received a higher cumulative dose of prednisone (p = 0.032). GCA was not associated with poorer one-year survival. CONCLUSIONS GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than coronaritis. GCA-unrelated MI are predominantly T1MI associated with atherothrombotic coronary artery disease.
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Affiliation(s)
- Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Department of Vascular Medicine, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | | | - Alain Putot
- PEC2, EA 7460 Dijon, France; Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Eric Steinmetz
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Béatrice Terriat
- Department of Vascular Medicine, Dijon University Hospital, Dijon, France
| | | | - Nicolas Falvo
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Géraldine Muller
- Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | - André Ramon
- Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | | | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Yves Cottin
- Cardiology Department, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France.
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7
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A 16-year-old girl with sudden heart failure and nephrotic syndrome associated with Takayasu's arteritis. Clin Res Cardiol 2021; 111:221-226. [PMID: 34156522 DOI: 10.1007/s00392-021-01893-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
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8
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Samson M, Bonnotte B. Ustekinumab For the Treatment of Giant Cell Arteritis: Comment on the Article by Matza et al. Arthritis Care Res (Hoboken) 2021; 73:1058-1059. [DOI: 10.1002/acr.24376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/07/2020] [Indexed: 12/30/2022]
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9
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Wu S, Kong X, Cui X, Chen H, Ma L, Dai X, Ji Z, Yan Y, Huang Q, Sun Y, Jiang L. Effectiveness and safety of tocilizumab in patients with refractory or severe Takayasu's arteritis: A prospective cohort study in a Chinese population. Joint Bone Spine 2021; 88:105186. [PMID: 33892193 DOI: 10.1016/j.jbspin.2021.105186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/26/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To assess the effectiveness and safety of tocilizumab (TCZ) in treating severe/refractory Takayasu's arteritis (TAK). METHODS A prospective cohort study was started on 1 November 2013 and terminated on 10 June 2020. Thirty-seven patients diagnosed as severe/refractory TAK, treated with TCZ combined with or without immunosuppressors were enrolled. Treatment response (complete remission (CR) and partial remission (PR)), imaging progression and side effects were analyzed at 6-month treatment. Disease flare was analyzed during the remaining follow-up. RESULTS The CR and RR rates were 70% and 88% at 6 months of TCZ treatment, respectively. Glucocorticoids was tapered from 30.0 (20.0-40.0) to 15.0 (10.0-15.0) mg/day at 6 months. Younger patients (≤26 years) (OR=14.6, 95% CI 1.27-170.4, P<0.05) and those with involvement of bilateral carotid arteries or vertebral arteries (OR=14.6, 95% CI 1.27-169.1, P<0.05) might show a better response to TCZ at 6 months. Combined therapy of immunosuppressors had no significant effects on the effectiveness of TCZ at 6 months. Among the total 23 patients with CR at 6 months, 14 cases discontinued TCZ therapy after 6 months, and disease flare was observed in six ones (43%), with medium flare at 7 (7-9.8) months. One patient (11%) who continued TCZ therapy suffered disease flare at 8 months. Infections were the most commonly observed side effects (38%), with four patients discontinuing TCZ treatment due to severe infections. CONCLUSION TCZ treatment achieved a favorable response with acceptable adverse effects for TAK.
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Affiliation(s)
- Sifan Wu
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Xiufang Kong
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Xiaomeng Cui
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Huiyong Chen
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Lili Ma
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China; Evidence-base Medicine Center, Fudan University, 200032 Shanghai, People's Republic of China
| | - Xiaomin Dai
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Zongfei Ji
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Yan Yan
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Qingrong Huang
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China
| | - Ying Sun
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China.
| | - Lindi Jiang
- Departments of Rheumatology, Zhongshan Hospital, Fudan University, 180, Fenglin Road, 200032 Shanghai, People's Republic of China; Evidence-base Medicine Center, Fudan University, 200032 Shanghai, People's Republic of China.
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10
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Saur SJ, Horger M, Henes J. Successful treatment with the IL12/IL23 antagonist ustekinumab in a patient with refractory Takayasu arteritis. Rheumatol Adv Pract 2021; 5:rkaa082. [PMID: 33604503 PMCID: PMC7878844 DOI: 10.1093/rap/rkaa082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Sebastian-Jonas Saur
- Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Hematology, Oncology, Immunology and Rheumatology), Centre for Interdisciplinary Clinical Immunology
| | - Marius Horger
- Department of Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Jörg Henes
- Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Hematology, Oncology, Immunology and Rheumatology), Centre for Interdisciplinary Clinical Immunology
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11
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Mertz P, Kleinmann JF, Lambert M, Puéchal X, Bonnin A, Boulon C, Diot E, Hachulla E, Harid N, Harle JR, Helder G, Kahn JE, Kone-Paut I, Lavigne C, Magy-Bertrand N, Maillard H, Martin T, Maurier F, Poindron V, Schleinitz N, Sibilia J, Arnaud L. Infliximab is an effective glucocorticoid-sparing treatment for Takayasu arteritis: Results of a multicenter open-label prospective study. Autoimmun Rev 2020; 19:102634. [DOI: 10.1016/j.autrev.2020.102634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
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12
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Mekinian A, Saadoun D, Vicaut E, Thietart S, Lioger B, Jego P, Bleibtreu A, Limal N, Connault J, Gottenberg JE, Lhorte P, Bertola JP, Delforge J, Ferreira-Maldent N, Perlat A, Talib Z, Vautier M, Savey L, Quiere I, Cacoub P, Fain O. Tocilizumab in treatment-naïve patients with Takayasu arteritis: TOCITAKA French prospective multicenter open-labeled trial. Arthritis Res Ther 2020; 22:218. [PMID: 32943098 PMCID: PMC7500024 DOI: 10.1186/s13075-020-02311-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives To assess long-term efficacy of tocilizumab in treatment-naive patients with Takayasu arteritis (TAK). Methods Prospective open-labeled trial in naïve patients with TAK who received steroids at the dose of 0.7 mg/kg/day and 7 infusions of 8 mg/kg/month of tocilizumab. The primary endpoint was the number of patients who discontinued steroids after 7 infusions of tocilizumab. Secondary endpoints included disease activity and the number of relapses during 18-month follow-up. Results Thirteen patients with TAK were included, with a median age of 32 years [19–45] and 12 (92%) females. Six (54%) patients met the primary end-point. A significant decrease of disease activity was observed after 6 months of tocilizumab therapy: decrease of median NIH scale (3 [3, 4] at baseline, versus 1 [0–2] after 6 months; p < 0.001), ITAS-2010 score (5 [2–7] versus 3 [0–8]; p = 0.002), and ITAS-A score (7 [4–10] versus 4 [1–15]; p = 0.0001)]. During the 12-month follow-up after tocilizumab discontinuation, a relapse occurred among 5 patients (45%) out of 11 in which achieved remission after 6 months of tocilizumab. Conclusion Tocilizumab seems an effective steroid sparing therapy in TAK, but maintenance therapy is necessary. Trial registration ClinicalTrials.gov NCT02101333. Registered on 02 April 2014.
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Affiliation(s)
- Arsene Mekinian
- Sorbonne Universités AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Faculté de Médecine Sorbonne Université, F-75012, Paris, France.
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National center for Autoimmune Systemic rare disease ; National center for Autoinflammatory diseases and amyloidosis, Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), INSERM, UMR_S 959, F-75013, Paris, France.,CNRS, FRE3632, F-75005, Paris, France.,CNRS, F-75013, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique Saint-Louis-Lariboisière, APHP, Hôpital Saint Louis, Paris, France
| | - Sara Thietart
- Sorbonne Universités AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Faculté de Médecine Sorbonne Université, F-75012, Paris, France
| | | | - Patrick Jego
- Service de Médecine Interne, CHU Rennes, Rennes, France
| | - Alexandre Bleibtreu
- AP-HP, service de médecine interne, Hôpital Jean Verdier, Faculté de Paris 13, 93000, Paris, France
| | - Nicolas Limal
- AP-HP, service de médecine interne, Hôpital Mondor, Université Paris Est-Créteil (UPEC), Paris, France
| | | | - Jacques-Eric Gottenberg
- Inserm UMR_1109, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France.,Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pauline Lhorte
- Service de Médecine Interne et vasculaire, CHU Montpellier, Montpellier, France
| | | | - Juliette Delforge
- AP-HP, service de médecine interne, Hôpital Jean Verdier, Faculté de Paris 13, 93000, Paris, France
| | | | | | - Zohra Talib
- Unité de Recherche Clinique Saint-Louis-Lariboisière, APHP, Hôpital Saint Louis, Paris, France
| | - Matthieu Vautier
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National center for Autoimmune Systemic rare disease ; National center for Autoinflammatory diseases and amyloidosis, Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), INSERM, UMR_S 959, F-75013, Paris, France.,CNRS, FRE3632, F-75005, Paris, France.,CNRS, F-75013, Paris, France
| | - Léa Savey
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National center for Autoimmune Systemic rare disease ; National center for Autoinflammatory diseases and amyloidosis, Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), INSERM, UMR_S 959, F-75013, Paris, France.,CNRS, FRE3632, F-75005, Paris, France.,CNRS, F-75013, Paris, France
| | - Isabelle Quiere
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Patrice Cacoub
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, National center for Autoimmune Systemic rare disease ; National center for Autoinflammatory diseases and amyloidosis, Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), INSERM, UMR_S 959, F-75013, Paris, France.,CNRS, FRE3632, F-75005, Paris, France.,CNRS, F-75013, Paris, France
| | - Olivier Fain
- Sorbonne Universités AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Faculté de Médecine Sorbonne Université, F-75012, Paris, France
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13
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Choi H, Kwon HC, Song JJ, Park YB, Lee SW. Association between the antineutrophil cytoplasmic antibody and late coronary arterial occlusive disease in patients with Takayasu arteritis. J Cardiol 2020; 76:407-412. [PMID: 32482328 DOI: 10.1016/j.jjcc.2020.04.010] [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: 01/28/2020] [Revised: 03/22/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND No study has provided evidence of the clinical significance of the antineutrophil cytoplasmic antibody (ANCA) in patients with Takayasu arteritis (TAK). Therefore, we investigated the frequency of ANCA positivity and its clinical implications in patients with TAK. METHODS We retrospectively reviewed the medical records of 121 patients with established TAK, who had results for ANCA status at diagnosis. We collected demographic and clinical data and the ANCA results at diagnosis. Additionally, we obtained information on patients' medications and complications during follow-up. Early coronary arterial occlusive disease (CAOD) and late CAOD were defined based on a 30-day interval after TAK classification. The chi-square test, Fisher's exact test, Mann-Whitney test, and Kaplan-Meier survival analysis were used to analyze the data. RESULTS The patients' mean age was 44.6 years, and 21 patients were men (17.4%). ANCA was detected in 8 patients (6.6%), of which 2 had both the myeloperoxidase ANCA (or perinuclear ANCA) and proteinase 3 ANCA (or cytoplasmic ANCA). Early CAOD was observed in 10 patients (8.3%), and late CAOD was found in 9 patients (7.4%). In the comparative analysis, the proportion of late CAOD exhibited a tendency to increase in the ANCA-positive group compared to that in the ANCA-negative group. Kaplan-Meier analysis showed that patients with ANCA exhibited a lower cumulative late CAOD-free survival rate than those without ANCA (p=0.012). When the algorithm for the classification of ANCA-associated vasculitis (AAV) proposed by the European Medicine Agency in 2007 was applied to 8 patients with ANCA, all were not reclassified as having AAV. CONCLUSIONS ANCA can be detected in a minority of patients with established TAK, and it may not contribute to the reclassification of AAV. Furthermore, ANCA positivity may be associated with late CAOD in patients with TAK.
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Affiliation(s)
- Hyeok Choi
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeok Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
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14
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Angelova Y, Sarwal A. Prednisone-Induced Psychosis, and Homicidal and Suicidal Attempts in a Man Recently Diagnosed with Temporal Arteritis. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200507-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Michaud M, Catros F, Gaches F. Usefulness of serum amyloid a protein dosage for monitoring patients receiving tocilizumab. Eur J Intern Med 2020; 74:115-116. [PMID: 31926783 DOI: 10.1016/j.ejim.2019.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Martin Michaud
- Department of Internal Medicine, Joseph Ducuing Hospital, 15 rue Varsovie, Toulouse 31076, France.
| | - Florian Catros
- Department of Internal Medicine, Joseph Ducuing Hospital, 15 rue Varsovie, Toulouse 31076, France
| | - Francis Gaches
- Department of Internal Medicine, Joseph Ducuing Hospital, 15 rue Varsovie, Toulouse 31076, France
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16
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Cui X, Dai X, Ma L, Yang C, Tan W, Zhang L, Zhang Z, Feng X, Wu R, Zou Y, Zhou Z, Lu Y, Wang Y, Wu M, Li S, Wang L, Lin H, Dong Z, Fu W, Sun X, Wang C, Ding J, Lv P, Lin J, Jiang L. Efficacy and safety of leflunomide treatment in Takayasu arteritis: Case series from the East China cohort. Semin Arthritis Rheum 2020; 50:59-65. [DOI: 10.1016/j.semarthrit.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/05/2019] [Accepted: 06/10/2019] [Indexed: 12/26/2022]
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17
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Yoshizaki T, Itoh S, Yamaguchi S, Numata T, Nambu A, Kimura N, Suto H, Okumura K, Sudo K, Yamaguchi A, Nakae S. IL-25 exacerbates autoimmune aortitis in IL-1 receptor antagonist-deficient mice. Sci Rep 2019; 9:17067. [PMID: 31745167 PMCID: PMC6864066 DOI: 10.1038/s41598-019-53633-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
IL-25, a member of the IL-17 family of cytokines, is known to enhance type 2 immune responses, but suppress type 3 (IL-17A)-mediated immune responses. Mice deficient in IL-1 receptor antagonist (Il1rn−/− mice) have excessive IL-1 signaling, resulting in spontaneous development of IL-1–, TNF– and IL-17A–dependent aortitis. We found that expression of II25 mRNA was increased in the aortae of Il1rn−/− mice, suggesting that IL-25 may suppress development of IL-1–, TNF– and IL-17A–dependent aortitis in Il1rn−/− mice by inhibiting type 3-mediated immune responses. However, we unexpectedly found that Il25−/−Il1rn−/− mice showed attenuated development of aortitis, accompanied by reduced accumulation of inflammatory cells such as dendritic cells, macrophages and neutrophils and reduced mRNA expression of Il17a and Tnfa—but not Il4 or Il13—in local lesions compared with Il1rn−/− mice. Tissue–, but not immune cell–, derived IL-25 was crucial for development of aortitis. IL-25 enhanced IL-1β and TNF production by IL-25 receptor–expressing dendritic cells and macrophages, respectively, at inflammatory sites of aortae of Il1rn−/− mice, contributing to exacerbation of development of IL-1–, TNF– and IL-17A–dependent aortitis in those mice. Our findings suggest that neutralization of IL-25 may be a potential therapeutic target for aortitis.
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Affiliation(s)
- Takamichi Yoshizaki
- Laboratory of Systems Biology, Center for Experimental Medicine and Systems Biology, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan.,Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, 330-8503, Japan
| | - Satoshi Itoh
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, 330-8503, Japan
| | - Sachiko Yamaguchi
- Laboratory of Systems Biology, Center for Experimental Medicine and Systems Biology, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan
| | - Takafumi Numata
- Laboratory of Systems Biology, Center for Experimental Medicine and Systems Biology, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan.,Department of Dermatology, Tokyo Medical University, Tokyo, 160-0023, Japan
| | - Aya Nambu
- Laboratory of Systems Biology, Center for Experimental Medicine and Systems Biology, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan
| | - Naoyuki Kimura
- Laboratory of Systems Biology, Center for Experimental Medicine and Systems Biology, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan.,Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, 330-8503, Japan
| | - Hajime Suto
- Atopy Research Center, Juntendo University School of Medicine, Tokyo, 113-8412, Japan
| | - Ko Okumura
- Atopy Research Center, Juntendo University School of Medicine, Tokyo, 113-8412, Japan
| | - Katsuko Sudo
- Animal Research Center, Tokyo Medical University, Tokyo, 160-8402, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, 330-8503, Japan
| | - Susumu Nakae
- Laboratory of Systems Biology, Center for Experimental Medicine and Systems Biology, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan. .,Precursory Research for Embryonic Science and Technology (PRESTO), Japan Science and Technology Agency, Saitama, 332-0012, Japan.
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18
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19
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Acosta-Herrera M, González-Gay MA, Martín J, Márquez A. Leveraging Genetic Findings for Precision Medicine in Vasculitis. Front Immunol 2019; 10:1796. [PMID: 31428096 PMCID: PMC6687877 DOI: 10.3389/fimmu.2019.01796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
Vasculitides are a heterogeneous group of low frequent disorders, mainly characterized by the inflammation of blood vessels that narrows or occlude the lumen and limits the blood flow, leading eventually to significant tissue and organ damage. These disorders are classified depending on the size of the affected blood vessels in large, medium, and small vessel vasculitis. Currently, it is known that these syndromes show a complex etiology in which both environmental and genetic factors play a major role in their development. So far, these conditions are not curable and the therapeutic approaches are mainly symptomatic. Moreover, a percentage of the patients do not adequately respond to standard treatments. Over the last years, numerous genetic studies have been carried out to identify susceptibility loci and biological pathways involved in vasculitis pathogenesis as well as potential genetic predictors of treatment response. The ultimate goal of these studies is to identify new therapeutic targets and to improve the use of existing drugs to achieve more effective treatments. This review will focus on the main advances made in the field of genetics and pharmacogenetics of vasculitis and their potential application for ameliorating long-term outcomes in patient management and in the development of precision medicine.
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Affiliation(s)
| | - Miguel A González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina "López-Neyra," CSIC, Granada, Spain
| | - Ana Márquez
- Instituto de Parasitología y Biomedicina "López-Neyra," CSIC, Granada, Spain.,Systemic Autoimmune Disease Unit, Hospital Clínico San Cecilio, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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20
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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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Akiyama M, Kaneko Y, Takeuchi T. Does microbiome contribute to HLA-B52-positive Takayasu arteritis? Mod Rheumatol 2019; 30:213-217. [DOI: 10.1080/14397595.2019.1584146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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22
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Yarkan Tuğsal H, Zengin B, Kenar G, Can G, Ünlü M, Önen F, Birlik M. Infliximab-associated focal segmental glomerulosclerosis in a patient with ankylosing spondylitis. Rheumatol Int 2019; 39:561-567. [PMID: 30673815 DOI: 10.1007/s00296-019-04241-8] [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: 09/17/2018] [Accepted: 01/16/2019] [Indexed: 12/26/2022]
Abstract
The introduction of tumor necrosis factor-alpha (TNF-α)-targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of spondyloarthritis (SpA). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects ranging from common ones including infections to uncommon renal complications. This report describes a case of infliximab-induced focal segmental glomerulosclerosis (FSGS) in a 40-year-old female patient with ankylosing spondylitis (AS) who presented with asymptomatic proteinuria and microscopic hematuria. To the best of our knowledge, this is the second reported case of FSGS attributed to infliximab (IFX). A review of the English literature was conducted for cases of possible IFX-associated renal disorders in patients with SpA and SpA spectrum diseases. In this respect, the reported renal pathologies were IgA nephropathy, crescentic glomerulonephritis, acute renal artery occlusion, acute tubulointerstitial nephritis (ATIN), FSGS, and membranous glomerulopathy. Furthermore, partial or complete resolution was reported after cessation of therapy. In conclusion, although renal complications of TNF inhibitors (TNFi) are uncommon, spot urine evaluation may be recommended in the follow-up of patients treated with TNFi.
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Affiliation(s)
- Handan Yarkan Tuğsal
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey.
| | - Berrin Zengin
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gökçe Kenar
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gerçek Can
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mehtat Ünlü
- Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Fatoş Önen
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Wong SPY, Mok CC, Lau CS, Yip ML, Tam LS, Ying KY, Ng WL, Ng KH, Leung MH, Lee TY, To CH, Lee KL, Wan MC, Yu KL, Wong PCH, Sung CK, Lee KF, Kun EWL. Clinical presentation, treatment and outcome of Takayasu's arteritis in southern Chinese: a multicenter retrospective study. Rheumatol Int 2018; 38:2263-2270. [PMID: 30182290 DOI: 10.1007/s00296-018-4150-x] [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: 06/19/2018] [Accepted: 08/27/2018] [Indexed: 01/25/2023]
Abstract
To study the clinical presentation, treatment and outcome of southern Chinese patients with Takayasu's arteritis (TA). This is a retrospective chart review study of 78 patients managed in 14 public hospitals in Hong Kong between the years 2000 and 2010. Patients were identified from the hospital registry using the ICD-10 diagnostic code of the disease. The classification of TA was based on the American College of Rheumatology (ACR) or modified Ichikawa's criteria. Demographic data, clinical presentation, angiographic findings, pattern of vascular involvement (Numano's classification), treatment and outcome of these patients were presented. 78 patients were studied (82% women, age at presentation 34.2 ± 14 years). The estimated point prevalence of TA was 11/million population. The commonest initial manifestations were hypertension (62%) and vascular ischemic symptoms (38%). Systemic symptoms occurred in nine (12%) patients only. The proportion of patients fulfilling the angiographic subtypes of the Numano's classification was: types I (13%), IIa (4%), IIb (12%), III (12%), IV (20%) and V (39%), respectively. Thirty-two patients (41%) were treated with high-dose glucocorticoids (GCs) and 22 patients (28%) received additional non-GC immunosuppressive drugs. Vascular complications occurred in 26 (33%) patients and revascularization surgery was performed in 23(29%) patients. Three (4%) patients died of vascular complication at a median of 8 years after disease onset. TA is rare in southern Chinese patients of Hong Kong. Most patients present with ischemic symptoms during the stenotic phase of the disease. Although mortality is low, a significant proportion of patients developed vascular stenosis that required surgical interventions. More awareness of TA as a differential diagnosis of non-specific systemic symptoms with elevated inflammatory markers in younger patients is needed for earlier diagnosis.
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Affiliation(s)
- Stella Pui Yan Wong
- Department of Medicine, Tseung Kwan O Hospital, 2, Po Ning Lane, Hang Hau, Kowloon, Hong Kong SAR, China.
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man Lung Yip
- Tung Wah Groups of Hospital Integrated Diagnostic and Medical Centre, Kowloon, Hong Kong SAR, China
| | - Lai Shan Tam
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - King Yee Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Woon Leung Ng
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Kam Hung Ng
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China
| | - Moon Ho Leung
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Tsz Yan Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Chi Hung To
- Department of Medicine, Pok Oi Hospital, Hong Kong SAR, China
| | - Ka Lai Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Man Choi Wan
- Department of Medicine, Ruttonjee Hospital, Hong Kong SAR, China
| | - Ka Lung Yu
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Priscilla Ching Han Wong
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Chi Keung Sung
- Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China
| | - Kwok Fai Lee
- Department of Medicine, Yan Chai Hospital, Hong Kong SAR, China
| | - Emily Wai Lin Kun
- Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China
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Efficacy of tocilizumab in Takayasu arteritis: Multicenter retrospective study of 46 patients. J Autoimmun 2018; 91:55-60. [DOI: 10.1016/j.jaut.2018.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/31/2018] [Accepted: 04/05/2018] [Indexed: 01/15/2023]
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