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Pouncey AL, Yeldham G, Magan T, Lucenteforte E, Jaffer U, Virgili G. Halo sign on temporal artery ultrasound versus temporal artery biopsy for giant cell arteritis. Cochrane Database Syst Rev 2024; 2:CD013199. [PMID: 38323659 PMCID: PMC10848297 DOI: 10.1002/14651858.cd013199.pub2] [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] [Indexed: 02/08/2024]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a systemic, inflammatory vasculitis primarily affecting people over the age of 50 years. GCA is treated as a medical emergency due to the potential for sudden, irreversible visual loss. Temporal artery biopsy (TAB) is one of the five criteria of the American College of Rheumatology (ACR) 1990 classification, which is used to aid the diagnosis of GCA. TAB is an invasive test, and it can be slow to obtain a result due to delays in performing the procedure and the time taken for histopathologic assessment. Temporal artery ultrasonography (US) has been demonstrated to show findings in people with GCA such as the halo sign (a hypoechoic circumferential wall thickening due to oedema), stenosis or occlusion that can help to confirm a diagnosis more swiftly and less invasively, but requiring more subjective interpretation. This review will help to determine the role of these investigations in clinical practice. OBJECTIVES To evaluate the sensitivity and specificity of the halo sign on temporal artery US, using the ACR 1990 classification as a reference standard, to investigate whether US could be used as triage for TAB. To compare the accuracy of US with TAB in the subset of paired studies that have obtained both tests on the same patients, to investigate whether it could replace TAB as one of the criteria in the ACR 1990 classification. SEARCH METHODS We used standard Cochrane search methods for diagnostic accuracy. The date of the search was 13 September 2022. SELECTION CRITERIA We included all participants with clinically suspected GCA who were investigated for the presence of the halo sign on temporal artery US, using the ACR 1990 criteria as a reference standard. We included studies with participants with a prior diagnosis of polymyalgia rheumatica. We excluded studies if participants had had two or more weeks of steroid treatment prior to the investigations. We also included any comparative test accuracy studies of the halo sign on temporal artery US versus TAB, with use of the 1990 ACR diagnostic criteria as a reference standard. Although we have chosen to use this classification for the purpose of the meta-analysis, we accept that it incorporates unavoidable incorporation bias, as TAB is itself one of the five criteria. This increases the specificity of TAB, making it difficult to compare with US. We excluded case-control studies, as they overestimate accuracy, as well as case series in which all participants had a prior diagnosis of GCA, as they can only address sensitivity and not specificity. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for inclusion in the review. They extracted data using a standardised data collection form and employed the QUADAS-2 tool to assess methodological quality. As not enough studies reported data at our prespecified halo threshold of 0.3 mm, we fitted hierarchical summary receiver operating characteristic (ROC) models to estimate US sensitivity and also to compare US with TAB. We graded the certainty of the evidence using the GRADE approach. MAIN RESULTS Temporal artery ultrasound was investigated in 15 studies (617 participants with GCA out of 1479, 41.7%), with sample sizes ranging from 20 to 381 participants (median 69). There was wide variation in sensitivity with a median value of 0.78 (interquartile range (IQR) 0.45 to 0.83; range 0.03 to 1.00), while specificity was fair to good in most studies with a median value of 0.91 (IQR 0.78 to 1.00; range 0.40 to 1.00) and four studies with a specificity of 1.00. The hierarchical summary receiver operating characteristic (HSROC) estimate of sensitivity (95% confidence interval (CI)) at the high specificity of 0.95 was 0.51 (0.21 to 0.81), and 0.84 (0.58 to 0.95) at 0.80 specificity. We considered the evidence on sensitivity and specificity as of very low certainty due to risk of bias (-1), imprecision (-1), and inconsistency (-1). Only four studies reported data at a halo cut-off > 0.3 mm, finding the following sensitivities and specificities (95% CI): 0.80 (0.56 to 0.94) and 0.94 (0.81 to 0.99) in 55 participants; 0.10 (0.00 to 0.45) and 1.00 (0.84 to 1.00) in 31 participants; 0.73 (0.54 to 0.88) and 1.00 (0.93 to 1.00) in 82 participants; 0.83 (0.63 to 0.95) and 0.72 (0.64 to 0.79) in 182 participants. Data on a direct comparison of temporal artery US with biopsy were obtained from 11 studies (808 participants; 460 with GCA, 56.9%). The sensitivity of US ranged between 0.03 and 1.00 with a median of 0.75, while that of TAB ranged between 0.33 and 0.92 with a median of 0.73. The specificity was 1.00 in four studies for US and in seven for TAB. At high specificity (0.95), the sensitivity of US and TAB were 0.50 (95% CI 0.24 to 0.76) versus 0.80 (95% CI 0.57 to 0.93), respectively, and at low specificity (0.80) they were 0.73 (95% CI 0.49 to 0.88) versus 0.92 (95% CI 0.69 to 0.98). We considered the comparative evidence on the sensitivity of US versus TAB to be of very low certainty because specificity was overestimated for TAB since it is one of the criteria used in the reference standard (-1), together with downgrade due to risk of bias (-1), imprecision (-1), and inconsistency (-1) for both sensitivity and specificity. AUTHORS' CONCLUSIONS There is limited published evidence on the accuracy of temporal artery US for detecting GCA. Ultrasound seems to be moderately sensitive when the specificity is good, but data were heterogeneous across studies and either did not use the same halo thickness threshold or did not report it. We can draw no conclusions from accuracy studies on whether US can replace TAB for diagnosing GCA given the very low certainty of the evidence. Future research could consider using the 2016 revision of the ACR criteria as a reference standard, which will limit incorporation bias of TAB into the reference standard.
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Affiliation(s)
| | - Geoffrey Yeldham
- Department of Ophthalmology, Cardiff & Vale University Health Board, Cardiff, UK
| | - Tejal Magan
- Kings College NHS Foundation Trust, London, UK
| | - Ersilia Lucenteforte
- Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Usman Jaffer
- Imperial College Healthcare NHS Trust, London, UK
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- IRCCS- Fondazione Bietti, Rome, Italy
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Jiang Z, Ji H, Dong J. Temporal artery biopsy for suspected giant cell arteritis: A mini review. Indian J Ophthalmol 2023; 71:3299-3304. [PMID: 37787225 PMCID: PMC10683700 DOI: 10.4103/ijo.ijo_3163_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/23/2023] [Accepted: 06/16/2023] [Indexed: 10/04/2023] Open
Abstract
Giant cell arteritis (GCA) is a granulomatous inflammation involving medium and large vessels that can lead to serious clinical manifestations associated with tissue ischemia. Temporal artery biopsy (TAB) is currently the gold standard method for the diagnosis of GCA, with a specificity of 100% and a sensitivity of 77%. However, the false-negative rate for TAB ranges from 9% to 61%. False negatives may be related to the timing of biopsy, the length of specimen, and the existence of "skip lesions." We reviewed the relevant evidence for methods to improve the sensitivity and reduce the false-negative rate for TAB. To reduce the false-negative rate for TAB, it is recommended to perform TAB within 1 week of starting corticosteroid therapy. Although there is currently no consensus, we suggest that the temporal artery is cut to a length of 20‒30 mm and to prepare serial pathological sections. It is necessary to attach great importance to patients suspected of having GCA, and complete TAB should be performed as soon as possible while starting corticosteroid therapy promptly. We also discuss the clinical value of non-invasive vascular imaging technologies, such as DUS, CTA, MRA, and 18F-FDG-PET/CT, as auxiliary methods for GCA diagnosis that could partially replace TAB.
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Affiliation(s)
- Zhijian Jiang
- Department of Ophthalmology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Huiying Ji
- Department of Laboratory, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jianhong Dong
- Department of Ophthalmology, Shanghai Xuhui Central Hospital, Shanghai, China
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3
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Idowu AB, Khandwala P, Tan IJ. Race and Gender on the Mortality of Giant Cell Arteritis in Hospitalized Patients: A 15-Year National Inpatient Study. Cureus 2023; 15:e46165. [PMID: 37905266 PMCID: PMC10613314 DOI: 10.7759/cureus.46165] [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: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Critical appraisal of mortality in giant cell arteritis (GCA) through a racial lens is imperative as gender and racial disparities remain a global healthcare concern. OBJECTIVE To analyze the impact of race and gender on the mortality of GCA in United States (US)-hospitalized patients. METHODS In this retrospective cohort study, the National Inpatient Sample (NIS) database from January 2003 to December 2018 was searched to identify all patients aged >18 years hospitalized with giant cell arteritis. Patients' baseline characteristics were summarized using descriptive statistics. Inferential statistics were done for categorical and continuous variables. Multivariate logistic regression, adjusting for patient and hospital-level cofounders was performed to find an association between race and outcomes of interest. RESULTS Over the 15-year study period, a total of 8,352 patients (72.7% White, 14.5% Black or African American, 7.6% Hispanic, 2.2% Asian, 0.4% Alaska Native, and 2.6% under-represented populations) were hospitalized for GCA. The mean age at diagnosis was 73.6 ± 0.12 years. Women represented 71.9% of GCA patients and had a lower risk of mortality (OR 0.463, 95% CI: 0.235 - 0.912, p <0.05). Patients with GCA were hospitalized for an average of 4.64 days ± 0.04 days and 0.55% died. The mortality rate was lowest in Black or African American (0.1%) populations and highest among Alaska Native patients (8%). Mortality was 68% lower in those who had temporal artery biopsy (OR 0.32, 95% CI: 0.16-0.64, p <0.05). CONCLUSION GCA disproportionally affected female patients, but mortality was higher in male patients. Alaska Native patients had the least number of hospitalizations but the highest in-hospital mortality rate. Black or African Americans had the lowest mortality rate.
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Affiliation(s)
- Abiodun B Idowu
- Internal Medicine, Einstein Medical Center Philadelphia, Philadelphia, USA
| | - Pushti Khandwala
- Rheumatology, Einstein Medical Center Philadelphia, Philadelphia, USA
| | - Irene J Tan
- Rheumatology, Einstein Medical Center Philadelphia, Philadelphia, USA
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Zeb J, Zafar S, Irshad Z. Fatigue: It Is Not Always in the Head. Cureus 2023; 15:e39959. [PMID: 37415999 PMCID: PMC10320327 DOI: 10.7759/cureus.39959] [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: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
Fatigue is a common presenting complaint in patients seen in clinics and same-day emergency care. Although it has a simple presentation, it can be challenging to diagnose and manage, particularly when an underlying medical condition presents atypically as fatigue. Here we present an interesting case of giant cell arteritis (GCA) with only fatigue as the presenting complaint. GCA is the inflammation of medium and large vessels in the body, including the aortic arch and its branches. It typically manifests above the age of 50 with headaches, jaw claudication, temporal tenderness, arthralgia, night sweats, and unintentional weight loss. Early diagnosis and treatment are of paramount importance to prevent complications, particularly permanent blindness.
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Affiliation(s)
- Jehan Zeb
- Acute Medicine, University Hospital Coventry and Warwickshire, Coventry, GBR
| | - Sana Zafar
- Acute Internal Medicine, University Hospitals of Coventry and Warwickshire, NHS Trust, Coventry, GBR
| | - Zehra Irshad
- Endocrinology and Diabetes, University Hospital Coventry and Warwickshire, Coventry, GBR
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Szekeres D, Al Othman B. Current developments in the diagnosis and treatment of giant cell arteritis. Front Med (Lausanne) 2022; 9:1066503. [PMID: 36582285 PMCID: PMC9792614 DOI: 10.3389/fmed.2022.1066503] [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] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Giant cell arteritis is the most common vasculitis in adults above 50 years old. The disease is characterized by granulomatous inflammation of medium and large arteries, particularly the temporal artery, and is associated acutely with headache, claudication, and visual disturbances. Diagnosis of the disease is often complicated by its protean presentation and lack of consistently reliable testing. The utility of color doppler ultrasound at the point-of-care and FDG-PET in longitudinal evaluation remain under continued investigation. Novel techniques for risk assessment with Halo scoring and stratification through axillary vessel ultrasound are becoming commonplace. Moreover, the recent introduction of the biologic tocilizumab marks a paradigm shift toward using glucocorticoid-sparing strategies as the primary treatment modality. Notwithstanding these developments, patients continue to have substantial rates of relapse and biologic agents have their own side effect profile. Trials are underway to answer questions about optimal diagnostic modality, regiment choice, and duration.
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Affiliation(s)
- Denes Szekeres
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, United States
| | - Bayan Al Othman
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States,*Correspondence: Bayan Al Othman,
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Noumegni SR, Jousse-Joulin S, Hoffmann C, Cornec D, Devauchelle-Pensec V, Saraux A, Bressollette L. Comparison of halo and compression signs assessed by a high frequency ultrasound probe for the diagnosis of Giant Cell Arteritis. J Ultrasound 2022; 25:837-845. [PMID: 35426608 PMCID: PMC9705675 DOI: 10.1007/s40477-021-00618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/18/2021] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the diagnosis performances of halo and compression signs alone and combined, assessed by a high frequency 22-MHz probe, and test their agreement in giant cell arteritis (GCA). METHODS In this cross-sectional study on patients suspected with GCA, halo sign was defined as hypo or iso-echogenic circumferential aspect of the vessel wall in transverse or longitudinal view; and compression sign was defined as visibility of the vessel wall upon transducer-imposed compression of the artery. Agreement of the two signs was tested using the Cohen's kappa statistic. RESULTS A total of 80 patients (50% women) were included with a mean age of 74.4 years. Twenty participants (25%) were ultimately treated for GCA. Halo and compression signs have respective prevalences of 35% and 48%, with respective sensitivity and specificity of 80% and 80% for the halo sign; and 85% and 65% for the compression sign. The kappa coefficient for the global agreement of the two signs was 0.67 (95% confident interval: 0.54-0.85). Combination of the two signs give a sensitivity of 80% and a specificity of 81.7%. CONCLUSION Halo and compression signs assessed by a high frequency probe, show a good level of agreement for the diagnosis of GCA and improve ultrasound specificity when combined together.
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Affiliation(s)
- Steve Raoul Noumegni
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, EA 3878 GETBO, Brest, France.
- EA3878 (GETBO), Brest University, Brest, France.
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227 Brest, Brest, France
| | - Clément Hoffmann
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, EA 3878 GETBO, Brest, France
- EA3878 (GETBO), Brest University, Brest, France
| | - Divi Cornec
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227 Brest, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227 Brest, Brest, France
| | - Alain Saraux
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227 Brest, Brest, France
| | - Luc Bressollette
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, EA 3878 GETBO, Brest, France
- EA3878 (GETBO), Brest University, Brest, France
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Lacy A, Nelson R, Koyfman A, Long B. High risk and low prevalence diseases: Giant cell arteritis. Am J Emerg Med 2022; 58:135-140. [DOI: 10.1016/j.ajem.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
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Nagarajah R, Gupta R, Kumar S. Diagnostic use of ultrasound in giant cell arteritis in Counties Manukau district health board, New Zealand. Rheumatol Adv Pract 2022; 6:rkac040. [PMID: 35663155 PMCID: PMC9154064 DOI: 10.1093/rap/rkac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives A retrospective observational study was undertaken to assess the diagnostic performance (sensitivity and specificity) of colour duplex ultrasound (CDUS) compared with temporal artery biopsy (TAB) for the diagnosis of GCA in the Counties Manukau District Health Board (CMDHB), New Zealand using clinical diagnosis as the reference standard. Methods The study population included patients with clinically suspected GCA who were referred to Middlemore Hospital and underwent CDUS, TAB or both between January 2019 and December 2020. Results Sixty-nine patients were included in the study. Sixty-one percent were >75 years of age, with no cases <50 years of age and a female predominance of 71%. The sensitivity of CDUS was 26% (95% CI 10, 48) and specificity was 97% (95% CI 84, 100). The sensitivity of TAB was 57% (95% CI 34, 77) and specificity was 100%. CDUS had a positive predictive value of 86% (95% CI 42, 99) and a negative predictive value of 65% (95% CI 49, 78). Conclusion A positive CDUS in patients with a high risk for GCA may preclude the need for TAB due to the high specificity of CDUS in GCA. In contrast, patients with a high risk for GCA with a negative CDUS may still need TAB to confirm or exclude GCA. The duration from commencement of steroids to the time of CDUS is crucial in confirming GCA and, for this, shortening the waiting time in the CMDHB would be necessary to ensure adequate test performance in practice.
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Affiliation(s)
- Rathan Nagarajah
- Department of Internal medicine, Middlemore Hospital, Auckland, New Zealand
| | - Rajiv Gupta
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
| | - Sunil Kumar
- Department of Rheumatology, Middlemore Hospital, Auckland, New Zealand
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Utilization of the Revised American College of Rheumatology (rACR) Scoring to Avoid Unnecessary Temporal Artery Biopsies-A Case Series. Med Sci (Basel) 2022; 10:medsci10010011. [PMID: 35225944 PMCID: PMC8883987 DOI: 10.3390/medsci10010011] [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: 08/24/2021] [Revised: 01/01/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction: The American College of Rheumatology (ACR) criteria, and more recently the revised ACR criteria (rACR), are a scoring system developed to aid in the diagnosis of giant cell arteritis (GCA). Our aim was to investigate the value of the non-biopsy criteria of the original ACR criteria and rACR criteria to predict GCA, and investigate the utilization of such scores to avoid biopsy when a very high or very low likelihood of a positive temporal artery biopsy TAB was predicted. Method: We conducted a retrospective cohort study of 59 patients undergoing TAB from 2013 to 2017 in Beaumont Hospital, a tertiary referral centre in Dublin, Ireland. Demographic data, biochemical results, presenting features, and histology results were collected and collated. Results: Data were analysed from 53 patients and ACR scores were compiled. Seventeen scored < 3 and thirty-six scored 3−5. All 11 positive biopsies were in the 3−5 score range. Forty-five patients were analysed with rACR scores. Eight were excluded due to not meeting the inclusion criteria. Of the 11 positive biopsies, 2 were in the 3−4 score range, and 9 were in the ≥5 score range. In the ACR method, 36% of all biopsies scored as low-risk pre-biopsy. In the rACR method, 84.4% of all biopsies scored in the low- and intermediate-risk group pre-biopsy and 15.6% of all biopsies scored in the high-risk group pre-biopsy. Conclusions: This study illustrates the potential value of the rACR scoring system as a useful tool to categorize patients according to risk with a view to avoiding unnecessary TAB. The data suggest that a TAB has a helpful role in low- and intermediate-risk groups but is of minimal benefit in the high-risk group.
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Oerding C, Uhlmann F, Wollmann J, Kaden I, Wohlfarth K. Carotid Artery Stenosis and Ischemic Strokes in Patients with Giant Cell Arteritis: A Characteristic Pattern-Literature Review and Case Report. TH OPEN : COMPANION JOURNAL TO THROMBOSIS AND HAEMOSTASIS 2022; 6:e40-e49. [PMID: 35112048 PMCID: PMC8801894 DOI: 10.1055/a-1704-0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
Purpose Ischemic stroke is a relatively rare complication of giant cell arteritis often accompanied by vessel stenosis. Our purpose was to compare the location of internal carotid artery stenosis in GCA patients by performing a literature review suggesting a specific and characteristic pattern. Methods We performed a PubMed research including all articles and cited articles reporting cases and case series about giant cell arteritis patients with internal carotid artery stenosis and ischemic strokes. Results In this case series 39 cases were included. We found a clear tendency of giant cell arteritis-related stenosis to be in the intracranial segments (35/39 (89.7%)). Only in 8/39 (20.5%) patients there was further involvement of extracranial segments. Many cases (27/39 [69.2%]) showed a bilateral involvement. Discussion This literature review reveals a specific pattern of internal carotid artery involvement in patients with giant cell arteritis and ischemic strokes. To our knowledge this pattern has not been reported as a sign strongly pointing toward giant cell arteritis before. We have not found case reports mentioning other common types of vasculitis reporting this involvement pattern. Conclusion Internal carotid artery stenosis and ischemic stroke is a rare complication in patients with giant cell arteritis. Considering the characteristic features of bilateral distal internal carotid artery stenosis giant cell arteritis should be suspected which potentially leads to an early diagnosis and immunotherapy.
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Affiliation(s)
- Clemens Oerding
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany,Address for correspondence Clemens Oerding, MD Department of Neurology, BG-Hospital BergmannstrostMerseburger Str. 165, 06112 Halle (Saale)Germany
| | - Frank Uhlmann
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
| | - Johannes Wollmann
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
| | - Ingmar Kaden
- Department of Radiology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
| | - Kai Wohlfarth
- Department of Neurology, BG-Hospital Bergmannstrost, Halle (Saale), Germany
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Alnaimat F, Mansour AT, Alduraidi H, Al-Qasem S, Hindi M, Rawashdeh T, Hassan E, Almustafa S, Hanbali R, Ababneh O. Clinical and technical determinants of positive temporal artery biopsy: a retrospective cohort study. Rheumatol Int 2021; 41:2157-2166. [PMID: 34661710 DOI: 10.1007/s00296-021-05028-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
Temporal artery biopsy (TAB) is one of the diagnostic tools to confirm the diagnosis of giant cell arteritis (GCA). We aim to evaluate the clinical and technical determinants of a positive biopsy. Demographics, clinical, technical, and laboratory data of all TAB's performed between 2007 and 2019 at a single academic medical center. 107 biopsies performed for 103 patients were included; 72.9% were female, and 27.1% were male. The mean age at the time of biopsy was 67.1 ± 9.3 years. One biopsy was excluded for lack of arterial tissue content. Of the remaining 106, 19.6% were positive. The length of the biopsy and the number of arterial cross-sections were not significantly associated with its result. A positive biopsy was seen more in patients with low albumin (p = 0.010) and hypothyroidism (p = 0.017) but less in those with prior glucocorticoids treatment (p = 0.028). Predictors of a positive biopsy included male gender [OR 4.029, 95% CI (1.330-12.209), p = 0.014]; elevated ESR [OR 3.998, 95% CI (1.908-6.787), p = 0.023]; polymyalgia rheumatica (PMR) symptoms [OR 5.121, 95% CI (2.094-9.872), p = 0.001]; and advancing in age (6.5% per every additional year), [OR 1.065, 95% CI (1.005-1.130), p = 0.033]. 53.7% of the patients were eventually diagnosed with GCA; 39.2% of them were based on positive biopsy. In conclusion, old age, male gender, elevated ESR, and PMR symptoms increase the odds of positive TAB. Technical factors, such as biopsy length and the number of cross-sections, did not influence eventual biopsy results, highlighting the pivotal role of the clinical presentation of the patients in selecting patients for TAB.
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Affiliation(s)
- Fatima Alnaimat
- Department of Internal Medicine, Division of Rheumatology/School of Medicine, University of Jordan, Amman, 11942, Jordan.
| | - Ahmad T Mansour
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA.,Department of Pathology/School of Medicine, University of Jordan, Amman, Jordan
| | | | - Soud Al-Qasem
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Hindi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Tala Rawashdeh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Eman Hassan
- Department of Internal Medicine, Division of Rheumatology/School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Sahar Almustafa
- Department of Pathology/School of Medicine, University of Jordan, Amman, Jordan
| | - Refat Hanbali
- Department of Internal Medicine, Division of Rheumatology/School of Medicine, University of Jordan, Amman, 11942, Jordan
| | - Osama Ababneh
- Department of Ophthalmology/School of Medicine, University of Jordan, Amman, Jordan
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Dimancea A, Guidoux C, Amarenco P. Minor Ischemic Stroke and a Smoldering Case of Giant-Cell Arteritis: A Case Report. Stroke 2021; 52:e749-e752. [PMID: 34619985 DOI: 10.1161/strokeaha.121.035432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Celine Guidoux
- Neurology Department, Bichat Claude-Bernard Hospital, Paris
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Cooper J. Introducing an ANP-led temporal artery biopsy service for patients with suspected giant cell arteritis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:512-519. [PMID: 33983820 DOI: 10.12968/bjon.2021.30.9.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Giant cell arteritis (GCA) is an uncommon autoimmune inflammatory vasculopathy that can lead to the destruction and occlusion of various arteries that consequently can cause serious complications such as stroke or sight loss. It is seen as a medical emergency. The most commonly affected vessel in GCA is the temporal artery in the side of the head, hence the condition is sometimes also referred to as 'temporal arteritis'. This article discusses the introduction of an advanced nurse practitioner-led temporal artery biopsy service.
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Affiliation(s)
- John Cooper
- Advanced Nurse Practitioner, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust
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14
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Noumegni SR, Hoffmann C, Jousse-Joulin S, Cornec D, Quentel H, Devauchelle-Pensec V, Saraux A, Bressollette L. Comparison of 18- and 22-MHz probes for the ultrasonographic diagnosis of giant cell arteritis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:546-553. [PMID: 33569788 DOI: 10.1002/jcu.22986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Little is known about the diagnostic concordance of images provided by ultrasound probes with emitting frequencies below or above 20 MHz for the diagnosis of giant cell arteritis (GCA). METHODS We compared, using Cohen's kappa statistic, data obtained with an 18-MHz and a 22-MHz probe for the ultrasonographic evaluation of temporal arteries in 80 patients referred for suspected GCA. RESULTS The halo sign was found in 25% of cases with the 18-MHz probe and in 35% with the 22-MHz probe. The compression sign was positive in 42% of cases with the 18-MHz probe and 48% with the 22-MHz probe. GCA was finally diagnosed in 20 patients (25%). The kappa coefficient of agreement was 0.76 (P < .001) for the halo sign, and 0.75 (P < .001) for the compression sign. CONCLUSIONS Images obtained by 18 MHz and 22-MHz frequency probes showed a good level of agreement for the diagnosis of GCA, but the 22-MHz probe yielded a correct diagnosis of GCA in 3 of the 7 patients in whom examination with the 18-MHz probe was negative.
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Affiliation(s)
- Steve Raoul Noumegni
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Clément Hoffmann
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227, Brest, France
| | - Divi Cornec
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227, Brest, France
| | - Hugo Quentel
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227, Brest, France
| | - Alain Saraux
- Rheumatology Department, Brest Teaching Hospital, Brest University, INSERM, LBAI, UMR1227, Brest, France
| | - Luc Bressollette
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France
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15
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Vincenten SCC, Mulleners WM. The quest for a headache pattern in giant cell arteritis: A cohort study. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/25158163211024134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: To help clinicians in the diagnostic approach of giant cell arteritis (GCA) by providing a better knowledge on headache patterns in GCA. Methods: Cross-sectional data of a cohort of 30 known GCA patients regarding symptoms, clinical signs, laboratory and pathology data were collected retrospectively. Results: Headache was experienced by the majority of our cohort (26/30; 87%) and the most common pattern reported was a continuous, unilateral pain centered in or around the temporal area (13/26; 50% of all headaches). Pain confined to the occiput or frontal areas of the head was rarely reported as well as migrainous or cluster-like headaches. Conclusion: This data suggests that the headache pattern in GCA is heterogeneous, but that the most common pattern is a continuous, unilateral, temporal headache. Several other patterns were infrequently reported and these should question the clinical diagnosis of GCA. A large prospective study will be necessary to further elaborate these findings.
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Affiliation(s)
- Sanne CC Vincenten
- Canisius Wilhelmina Ziekenhuis (CWZ), Department of Neurology (C19), Nijmegen, The Netherlands
| | - Wim M Mulleners
- Canisius Wilhelmina Ziekenhuis (CWZ), Department of Neurology (C19), Nijmegen, The Netherlands
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16
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Cherayil NR, Tamhankar MA. Neuro-Ophthalmology for Internists. Med Clin North Am 2021; 105:511-529. [PMID: 33926644 DOI: 10.1016/j.mcna.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuro-ophthalmology is the study of the neurologic underpinnings of vision and includes a fascinating variety of disorders that span the broad spectrum of ophthalmic and neurologic disease. This subspecialty relies heavily on accurate neuroanatomic localization and examination. This article discusses neuro-ophthalmic complaints that frequently present to the internist, including acute vision loss, double vision, and unequal pupils. It focuses on pertinent clinical features of the most common causes of these chief complaints and additionally highlights salient points of history, diagnosis, examination, and management with special emphasis on the signs and symptoms that should prompt expedited evaluation.
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Affiliation(s)
- Neena R Cherayil
- Department of Neurology, Northwestern University, 259 E. Erie St, Ste 1520, Chicago, IL 60611, USA; Department of Ophthalmology, Northwestern University, Chicago, IL, USA.
| | - Madhura A Tamhankar
- Department of Ophthalmology, University of Pennsylvania, 51 N 39th St, Philadelphia, PA 19104, USA
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17
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Abstract
Ischaemic optic neuropathy (ION) is a major cause of blindness. The clinical approach and management is a matter of debate for the treating neurologist and the ophthalmologist. Of the two broad varieties namely the posterior (PION) and anterior ischaemic optic neuropathy (AION), the arteritic variety of the AION (AAION) is usually due to giant cell arteritis. Giant cell arteritis may only present with visual loss in up to 25% of cases. AAION is a neuro-ophthalmic emergency. Early recognition and differentiation from AAION is imperative in order to prevent further devastating visual loss. A literature search was conducted on pubmed using key words as AAION, arteritic anterior ischaemic optic neuropathy, giant cell arteritis (GCA) and articles from the year 2000 till date were included. In any case very few reviews are available on AAION. The literature search on pubmed provided holistic overview about this clinical significant entity and the same is compiled in this review. Moreover the histopathologic features of a temporal artery biopsy have been described with its microscopic images. In any case reviews are mostly available on the Non arteritic variety of AION. This review recapitulates the diagnostic and management protocol of a patient presenting with AAION.
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Affiliation(s)
- Vidhi Bajpai
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, New Delhi, India
| | - Siddharth Madan
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, New Delhi, India
| | - Sarita Beri
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, New Delhi, India
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18
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Noumegni SR, Hoffmann C, Cornec D, Gestin S, Bressollette L, Jousse-Joulin S. Temporal Artery Ultrasound to Diagnose Giant Cell Arteritis: A Practical Guide. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:201-213. [PMID: 33143971 DOI: 10.1016/j.ultrasmedbio.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
The diagnostic modalities for giant cell arteritis (GCA) have evolved significantly in recent years. Among the different diagnostic tools developed, Doppler ultrasound of the temporal arteries, with a sensitivity and specificity reaching 69% and 82%, respectively, is now recognized as superior and, therefore, is a first-line diagnostic tool in GCA. Moreover, with the increasing development of new ultrasound technologies, the accuracy of Doppler ultrasound in GCA seems to be constantly improving. In this article, we describe in detail the scanning technique to perform while realizing Doppler ultrasound of temporal arteries to assess GCA, as well as the diagnostic performance of this tool according to current literature.
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Affiliation(s)
- Steve Raoul Noumegni
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France.
| | - Clément Hoffmann
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Divi Cornec
- Rheumatology Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Simon Gestin
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France
| | - Luc Bressollette
- Vascular Medicine Department, Brest Teaching Hospital, Brest University, Brest, France
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19
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Martis A, Hassan RS, Alburquerque AG, Kotte M, Martis A, Ahmed H. An interesting case of temporal arteritis that manifested as ptosis and diplopia. Oxf Med Case Reports 2020; 2020:omaa099. [PMID: 33269083 PMCID: PMC7685022 DOI: 10.1093/omcr/omaa099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/18/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
Abstract
Giant cell arteritis (GCA) or temporal arteritis is a granulomatous vasculitis that affects medium-to-large vessels seen primarily in older Caucasian populations. Here, we describe a 67-year-old male who presented with atypical symptoms of worsening headaches associated with left-sided pupil-sparing, isolated third nerve palsy, blurry vision, diplopia and myalgias in bilateral extremities. He was immediately started on intravenous Methylprednisolone for suspected GCA. Subsequent biopsy of the temporal arteries showed panarteritis without giant cells and disruption of the internal elastic lamina. His symptoms improved in a day following treatment and he was discharged on a Prednisone taper. At the time of writing this case, there are only two cases in the literature of ptosis as a presenting symptom in GCA, thus highlighting the importance of recognizing rare red flag symptoms such as ptosis and diplopia. More study is needed in the prognostic significance of these unusual clinical features.
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Affiliation(s)
- Anoka Martis
- Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Romesa Sajjad Hassan
- Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | | | - Manasa Kotte
- Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Anshu Martis
- Internal Medicine, Father Muller Medical College, Mangalore 575002, India
| | - Hassan Ahmed
- Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
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20
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L’OCT plein champ, une nouvelle technique pour le diagnostic d’artérite à cellules géantes. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Maldiney T, Greigert H, Martin L, Benoit E, Creuzot-Garcher C, Gabrielle PH, Chassot JM, Boccara C, Balvay D, Tavitian B, Clément O, Audia S, Bonnotte B, Samson M. Full-field optical coherence tomography for the diagnosis of giant cell arteritis. PLoS One 2020; 15:e0234165. [PMID: 32866179 PMCID: PMC7458309 DOI: 10.1371/journal.pone.0234165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/13/2020] [Indexed: 01/02/2023] Open
Abstract
Histopathological examination of temporal artery biopsy (TAB) remains the gold standard for the diagnosis of giant cell arteritis (GCA) but is associated with essential limitations that emphasize the need for an upgraded pathological process. This study pioneered the use of full-field optical coherence tomography (FF-OCT) for rapid and automated on-site pathological diagnosis of GCA. Sixteen TABs (12 negative and 4 positive for GCA) were selected according to major histopathological criteria of GCA following hematoxylin-eosin-saffron-staining for subsequent acquisition with FF-OCT to compare structural modifications of the artery cell wall and thickness of each tunica. Gabor filtering of FF-OCT images was then used to compute TAB orientation maps and validate a potential automated analysis of TAB sections. FF-OCT allowed both qualitative and quantitative visualization of the main structures of the temporal artery wall, from the internal elastic lamina to the vasa vasorum and red blood cells, unveiling a significant correlation with conventional histology. FF-OCT imaging of GCA TABs revealed destruction of the media with distinct remodeling of the whole arterial wall into a denser reticular fibrous neo-intima, which is distinctive of GCA pathogenesis and accessible through automated Gabor filtering. Rapid on-site FF-OCT TAB acquisition makes it possible to identify some characteristic pathological lesions of GCA within a few minutes, paving the way for potential machine intelligence-based or even non-invasive diagnosis of GCA.
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Affiliation(s)
- Thomas Maldiney
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
| | - Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
- University of Bourgogne-Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, Bourgogne-Franche-Comté, France
| | - Laurent Martin
- University of Bourgogne-Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, Bourgogne-Franche-Comté, France
- Department of Pathology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
| | | | - Catherine Creuzot-Garcher
- Department of Ophthalmology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
| | | | - Claude Boccara
- LLTech SAS, Paris, France
- Institut Langevin, ESPCI Paris, CNRS, PSL University, Paris, France
| | | | - Bertrand Tavitian
- Université de Paris, PARCC, INSERM, Paris, France
- Radiology Department, Hôpital Européen Georges Pompidou, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Clément
- Université de Paris, PARCC, INSERM, Paris, France
- Radiology Department, Hôpital Européen Georges Pompidou, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
- University of Bourgogne-Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, Bourgogne-Franche-Comté, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
- University of Bourgogne-Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, Bourgogne-Franche-Comté, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France
- University of Bourgogne-Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Dijon, Bourgogne-Franche-Comté, France
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22
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Aortic dissection and accelerated aneurysmal degeneration in a patient with giant cell arteritis. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:598-602. [PMID: 33163741 PMCID: PMC7599380 DOI: 10.1016/j.jvscit.2020.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/30/2020] [Indexed: 01/26/2023]
Abstract
Giant cell arteritis (GCA) is associated with nonatheromatous aortic pathology. Here we present a case in which a 76-year-old woman with a biopsy-proven history of GCA and a previous repair of her ascending aortic aneurysm presents with an acute dissection of a 4-cm aneurysm in the descending thoracic aorta. It was treated using endovascular techniques. This report adds to a growing body of evidence that GCA is a risk factor for aortic dissection and nonatheromatous aortic aneurysms.
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23
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Schwartz MN, Rimland CA, Quinn KA, Ferrada MA, Gribbons KB, Rosenblum JS, Goodspeed W, Novakovich E, Grayson PC. Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. J Rheumatol 2020; 47:1785-1792. [PMID: 32238516 DOI: 10.3899/jrheum.190828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the validity and clinical utility of the Brief Illness Perception Questionnaire (BIPQ) to measure illness perceptions in multiple forms of vasculitis. METHODS Patients with giant cell arteritis (GCA), Takayasu arteritis (TA), antineutrophil cytoplasmic antibody-associated vasculitis (AAV), and relapsing polychondritis (RP) were recruited into a prospective, observational cohort. Patients independently completed the BIPQ, Multidimensional Fatigue Inventory (MFI), Medical Outcomes Study 36-item Short Form survey (SF-36), and a patient global assessment (PtGA) at successive study visits. Physicians concurrently completed a physician global assessment (PGA) form. Illness perceptions, as assessed by the BIPQ, were compared to responses from the full-length Revised Illness Perception Questionnaire (IPQ-R) and to other clinical outcome measures. RESULTS There were 196 patients (GCA = 47, TA = 47, RP = 56, AAV = 46) evaluated over 454 visits. Illness perception scores in each domain were comparable between the BIPQ and IPQ-R (3.28 vs 3.47, P = 0.22). Illness perceptions differed by type of vasculitis, with the highest perceived psychological burden of disease in RP. The BIPQ was significantly associated with all other patient-reported outcome measures (rho = |0.50-0.70|, P < 0.0001), but did not correlate with PGA (rho = 0.13, P = 0.13). A change in the BIPQ composite score of ≥ 7 over successive visits was associated with concomitant change in the PtGA. Change in the MFI and BIPQ scores significantly correlated over time (rho = 0.38, P = 0.0008). CONCLUSION The BIPQ is an accurate and valid assessment tool to measure and monitor illness perceptions in patients with vasculitis. Use of the BIPQ as an outcome measure in clinical trials may provide complementary information to physician-based assessments.
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Affiliation(s)
- Mollie N Schwartz
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Casey A Rimland
- C.A. Rimland, PhD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina
| | - Kaitlin A Quinn
- K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and Division of Rheumatology, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Marcela A Ferrada
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - K Bates Gribbons
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Joel S Rosenblum
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Wendy Goodspeed
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Elaine Novakovich
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Peter C Grayson
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland;
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24
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Shastri M, Chouglay K, Newlands C. Re: Gillies temporal incision: an alternative approach to biopsy of the superficial temporal artery. Br J Oral Maxillofac Surg 2018; 56:433-434. [PMID: 29716750 DOI: 10.1016/j.bjoms.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Affiliation(s)
- M Shastri
- Department of Oral & Maxillofacial Surgery, Royal Surrey County Hospital, Guildford.
| | - K Chouglay
- Department of Oral & Maxillofacial Surgery, Royal Surrey County Hospital, Guildford.
| | - C Newlands
- Department of Oral & Maxillofacial Surgery, Royal Surrey County Hospital, Guildford.
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