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Fedorinova EE, Bulanov NM, Meshkov AD, Borodin OO, Smitienko IO, Chachilo EV, Nartov AA, Filatova AL, Naumov AV, Novikov PI, Moiseev SV. Clinical Manifestations and Prognosis of Giant Cell Arteritis: A Retrospective Cohort Study. DOKL BIOCHEM BIOPHYS 2024; 517:250-258. [PMID: 39002010 DOI: 10.1134/s1607672924700984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 07/15/2024]
Abstract
The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA). MATERIALS AND METHODS . A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan-Meier method. RESULTS . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0-54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. CONCLUSIONS : Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.
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Affiliation(s)
- E E Fedorinova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia.
| | - N M Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A D Meshkov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - O O Borodin
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - I O Smitienko
- International Institute of Postgraduate Medical Education, Moscow, Russia
| | - E V Chachilo
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A A Nartov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A L Filatova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
| | - A V Naumov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - P I Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - S V Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
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Aghayev A, Weber B, Lins de Carvalho T, Glaudemans AWJM, Nienhuis PH, van der Geest KSM, Slart RHJA. Multimodality imaging to assess diagnosis and evaluate complications of large vesselarteritis. J Nucl Cardiol 2024; 37:101864. [PMID: 38663459 PMCID: PMC11257818 DOI: 10.1016/j.nuclcard.2024.101864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/21/2024] [Accepted: 04/12/2024] [Indexed: 05/26/2024]
Abstract
Different types of vasculitis can be distinguished according to the blood vessel's size that is preferentially affected: large-vessel, medium-vessel, and small-vessel vasculitides. Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) are the main forms of large-vessel vasculitis, and may lead to lumen narrowing. Clinical manifestations of arterial narrowing on the short- and long term include vision loss, stroke, limb ischemia, and heart failure. Imaging tools are well established diagnostic tests for large-vessel vasculitis and may aid therapy monitoring in selected cases while providing important information regarding the occurrence of vascular damage, tissue and organ complications. This review aims to provide the current status of multimodality imaging for the diagnosis and identification of vascular complications in the field of large vessel vasculitis.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brittany Weber
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tiago Lins de Carvalho
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Pieter H Nienhuis
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
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Hankard A, Maalouf G, Laouni J, Espitia O, Agard C, De Boysson H, Aouba A, Sacré K, Papo T, Leroux G, Vautier M, Desbois AC, Domont F, Le Joncour A, Mirouse A, Chiche L, Skaff Y, Gaudric J, Boussouar S, Redheuil A, Bravetti M, Cacoub P, Saadoun D. Outcome and prognosis of isolated carotid vasculitis. J Autoimmun 2024; 146:103242. [PMID: 38761452 DOI: 10.1016/j.jaut.2024.103242] [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: 11/24/2023] [Revised: 04/12/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To assess the prognosis and outcome of patients with isolated carotid vasculitis. METHODS We performed a retrospective multicenter study of 36 patients (median age at diagnosis was 37 [IQR 27-45] years and 11 [31 %] patients were men) with initial presentation as isolated carotid vasculitis. Study endpoints included vascular complications, relapses, and progression to large vessel vasculitis (i.e. Giant cell arteritis or Takayasu). RESULTS The most frequent involvement was the left internal carotid artery (39 %), and 81 % had stenosis. After a median follow-up of 32 months [IQR 12-96], 21 (58 %) patients had a vascular event, including 31 % of new onset vascular lesions and 25 % of stroke/transient ischemic attack. Patients with stroke had less carotidynia at diagnosis (33 % vs 74 %, p = 0.046), higher significant carotid stenosis (i.e. > 50 %) (89 % vs. 30 %, p = 0.026) and higher severe carotid stenosis (i.e. >70 %) (67 % vs 19 %, p = 0.012), compared to those without stroke. Twenty (52 %) patients experienced relapses. High CRP at diagnosis was associated with relapses (p = 0.022). At the end of follow-up, 21 (58 %) patients were classified as having Takayasu arteritis, 13 (36 %) as isolated carotid vasculitis, and two (6 %) as giant cell arteritis. CONCLUSION Carotid vasculitis may occur as a topographically limited lesion and is associated with significant rate of vascular complications.
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Affiliation(s)
- A Hankard
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - G Maalouf
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - J Laouni
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - O Espitia
- Nantes University, CHU Nantes, Department of Internal Medicine, F-44000, Nantes, France
| | - C Agard
- Nantes University, CHU Nantes, Department of Internal Medicine, F-44000, Nantes, France
| | - H De Boysson
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - A Aouba
- Department of Internal Medicine, Caen University Hospital, Basse Normandie University, Caen, France
| | - K Sacré
- Department of Internal Medicine, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Plateforme de Cytométrie et d'Imagerie de Masse de Montpellier, IRCM, INSERM, Univ Montpellier, ICM, Montpellier, France; Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM, UMR1149, CNRS, ERL8252, Faculté de Médecine Site Bichat, Laboratoire d'Excellence Inflamex, Paris, France
| | - T Papo
- Department of Internal Medicine, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Plateforme de Cytométrie et d'Imagerie de Masse de Montpellier, IRCM, INSERM, Univ Montpellier, ICM, Montpellier, France; Université Paris Cité, Centre de Recherche sur l'Inflammation, INSERM, UMR1149, CNRS, ERL8252, Faculté de Médecine Site Bichat, Laboratoire d'Excellence Inflamex, Paris, France
| | - G Leroux
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - M Vautier
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - A C Desbois
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - F Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - A Le Joncour
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - A Mirouse
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - L Chiche
- Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Y Skaff
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - J Gaudric
- Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - S Boussouar
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - A Redheuil
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - M Bravetti
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - P Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France
| | - D Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Centre National de Références Maladies Autoimmunes et Systémiques Rares et Maladies Autoinflammatoires Rares, F-75013, Paris, France; Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, AP-HP, F-75651, Paris, France.
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Romero-Sanchez G, Dabiri M, Mossa-Basha M. Primary Large Vessel Vasculitis: Takayasu Arteritis and Giant Cell Arteritis. Neuroimaging Clin N Am 2024; 34:53-65. [PMID: 37951705 DOI: 10.1016/j.nic.2023.07.002] [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: 11/14/2023]
Abstract
Takayasu arteritis (TA) and Giant cell arteritis (GCA) are large vessel vasculitides, with TA targeting the aorta and its branches, and GCA targeting both large and medium-sized arteries. Early diagnosis of TA and GCA are of great importance, since delayed, inappropriate or no treatment can result in severe and permanent complications. Imaging plays a central role in establishing diagnosis, targeting lesions for confirmational diagnostic biopsy, specifically for GCA, and longitudinal disease evolution. In this article, we discuss imaging diagnosis of large artery vasculitis and the value of different imaging modalities.
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Affiliation(s)
- Griselda Romero-Sanchez
- Department of Radiology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Textitlan 21 Casa 11, Santa Ursula Xitla, Tlalpan, Mexico City 14420, Mexico
| | - Mona Dabiri
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Abi Avenue, Dolat St, Tehran 11369, Iran
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
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Dang X, Zhu Q, Zou Y, Han Y. Phlebitis in Takayasu arteritis: A case-based literature review. Int J Rheum Dis 2024; 27:e14762. [PMID: 37270684 DOI: 10.1111/1756-185x.14762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/09/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
Takayasu arteritis (TAK) is the main type of large vessel arteritis in young adults, which mainly affects the aorta and its main branches, leading to clinical manifestations such as syncope, intermittent limb claudication, hypertension, and abdominal pain. Among them, venous involvement is rarely reported. Here we show a case of TAK presenting as phlebitis. This was a 27-year-old woman, who initially admitted to our hospital with myalgia of the upper and lower extremities and night sweats. She was diagnosed as TAK according to the 1990 American College of Rheumatology TAK criteria. Surprisingly, vascular ultrasonography revealed wall thickening as indicated by macaroni sign of the multiple veins. TAK phlebitis appeared at the active phase, while disappearing rapidly at remission. Phlebitis might have a close relationship with disease activity. By retrospective study in our department, the estimated incidence rate of phlebitis might be 9.1% in TAK. With the literature review, it revealed that phlebitis might be an ignored manifestation in active TAK. However, due to the smaller sample size, it should be noted that a direct cause-effect relationship cannot be established.
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Affiliation(s)
- Xin Dang
- Department of Rheumatology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qingqing Zhu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuzhen Zou
- Department of Rheumatology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yongmei Han
- Department of Rheumatology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Takayasu arteritis and large-vessel giant cell arteritis in Italian population. Comprehensive analysis from a single institutional cohort of 184 cases. Semin Arthritis Rheum 2023; 59:152173. [PMID: 36780709 DOI: 10.1016/j.semarthrit.2023.152173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To compare clinical and imaging characteristics in patients with Takayasu arteritis (TAK) and large vessel-giant cell arteritis (LV-GCA) in an Italian population. METHODS We conducted a retrospective monocenter study comparing characteristics and outcomes of a cohort of 59 patients with TAK and a cohort of 127 patients with LV-GCA diagnosed between 1996 and 2016. Most of them (92%) were followed up for at least 24 months at Reggio Emilia Hospital (Italy). We also reviewed the literature discussing the results of the published manuscripts comparing LV-GCA to TAK RESULTS: LV-GCA patients had a higher prevalence of males (p = 0.003), and more frequently presented with cranial symptoms (p = 0.001), fever ≥38 °C (p = 0.007), polymyalgia rheumatica (p = 0.001), and hypertension (p = 0.001), and they had higher ESR levels at diagnosis (p = 0.0001). Differently, TAK patients had longer delay to diagnosis from the beginning of symptoms (p = 0.048), they presented more frequently with loss of pulses of large arteries (p = 0.0001), vascular bruits (p = 0.001), limb claudication (p = 0.003), myocardial infarction/angina (p = 0.03), and hypertension induced by renal artery stenosis (p = 0.001). Regarding treatment, TAK patients received a higher total and at 1 year cumulative prednisone doses (p = 0.0001 and p = 0.001, respectively), they had a longer duration of prednisone therapy (p = 0.008), and received during follow-up more frequently traditional immunosuppressants (p = 0.0001) and biological agents (p = 0.0001). Flares were more frequently observed in TAK patient (p = 0.001), while no differences were observed for long-term remission. New vascular procedures during the follow-up were more frequently performed in TAK patients (p = 0.0001). Regarding imaging at diagnosis, TAK patients had more frequently vascular stenosis/occlusion (p = 0.0001) and a higher number of vessels with structural damage per person (p = 0.0001), while LV-GCA patients had a higher number of inflamed vessels per person (p = 0.0001). Comparing the involved vascular districts at diagnosis for the presence of vessel inflammation and/or arterial damage, patients with LV-GCA had a more frequent involvement of thoracic and abdominal aorta (p = 0.024 and p = 0.007, respectively), and axillary, iliac and femoral arteries (p = 0.018, p = 0.002, and p = 0.0001. respectively), while in TAK patients, brachiocephalic, celiac, mesenteric and renal arteries were more frequently involved (p = 0.011, p = 0.019, p = 0.019, and p = 0.005, respectively). At imaging arterial damage at diagnosis was more frequently observed in TAK patients, specifically at common carotid, brachiocephalic, and subclavian arteries (p = 0.0001, p = 0.006, p = 0.0001, respectively) and descending aorta (p = 0.022). Regarding imaging during the follow-up, TAK patients developed more frequently new vascular stenosis/occlusion (p = 0.0001) and new vascular thickening (p = 0.002), no differences were observed for the development of new dilatation/aneurysm between the two vasculitides. CONCLUSION Patients with TAK and LV-GCA show a number of similarities and also differences. Indeed, it is unclear whether they are part of the same disease spectrum or they are different conditions. As more information regarding the pathogenesis and etiology becomes known, answers to these questions are like to be forthcoming.
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Moreel L, Betrains A, Molenberghs G, Vanderschueren S, Blockmans D. Epidemiology and predictors of relapse in giant cell arteritis: A systematic review and meta-analysis. Joint Bone Spine 2023; 90:105494. [PMID: 36410684 DOI: 10.1016/j.jbspin.2022.105494] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the timing of relapse, the prevalence of multiple relapses and the predictors of relapse in patients with giant cell arteritis (GCA). METHODS PubMed, Embase and Cochrane databases were searched from inception till November, 30 2021. Outcome measures include cumulative relapse rate (CRR) of first relapse at year 1, 2, and 5 after treatment initiation, CRR of second and third relapse and predictors of relapse. RESULTS Thirty studies (2595 patients) were included for timing of relapse, 16 studies (1947 patients) for prevalence of multiple relapses and 40 studies (4213 patients) for predictors of relapse. One-year, 2-year and 5-year CRRs were 32% [95% confidence interval (CI) 22-43%], 44% [95% CI 31-59%], and 47% [95% CI 27-67%], respectively. The duration of scheduled glucocorticoid therapy was negatively associated with the 1-year CRR (P=0.03). CRR of second and third relapse were 30% [95% CI 21-40] and 17% [95% CI 8-33%], respectively. Female sex (OR 1.43) and large vessel involvement (OR 2.04) were predictors of relapse. CONCLUSION Relapse occurred in almost half of GCA patients mainly during the first two years after diagnosis. One in three patients had multiple relapses. The optimal glucocorticoid tapering schedule, which seeks a balance between the lowest relapse risk and the shortest glucocorticoid duration, needs to be determined in future studies. Longer scheduled glucocorticoid therapy or early introduction of glucocorticoid-sparing agents may be warranted in female patients and patients with large vessel involvement.
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Affiliation(s)
- Lien Moreel
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
| | - Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University of Leuven and Hasselt University, Leuven, Belgium
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Belgium
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Dammacco R, Cimino L, De Simone L, Alessio G, Dammacco F. Ocular Manifestations in an Italian Cohort of Patients with Takayasu Arteritis. Ocul Immunol Inflamm 2022:1-10. [PMID: 35584335 DOI: 10.1080/09273948.2022.2072348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We describe ophthalmic manifestations, therapy, and outcomes in 16 patients with Takayasu arteritis (TA). METHODS Takayasu retinopathy was detected in 15 eyes of 9 patients and hypertensive retinopathy in 14 eyes of 7 patients. RESULTS Visual acuity was normal in 7 eyes, 20/40 to 20/200 in 20 eyes, counting fingers in 2 eyes, hand motion in 2 eyes, and no light perception in 1 eye. Glucocorticoids associated with immunosuppressive agents induced a sustained remission in 13 patients. Three relapsing-refractory patients were given the monoclonal antibody tocilizumab, which led to partial and complete response in 1 and 2 patients respectively. Steroid-induced cataracts developed in 4 patients. Restenosis and the consequent recurrence of visual symptoms were detected in 2 of 9 patients who underwent a patency procedure for their stenotic lesions. CONCLUSIONS Ocular manifestations were a common feature (37.2%) in our cohort of TA patients and were frequently responsible for severe visual deterioration. ABBREVIATIONS BCVA: best-corrected visual acuity; FFA: fundus fluorescein angiography; GC: glucocorticoids; HR: hypertensive retinopathy; ITAS: Indian Takayasu activity score; OCT: optical coherence tomography; TA: Takayasu arteritis; TR: Takayasu retinopathy.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro," Medical School, Bari, Italy
| | - Luca Cimino
- Department of Surgery, Medicine,Dentistry and Morphological Sciences, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro," Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro," Medical School, Bari, Italy
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Matsumoto K, Suzuki K, Yoshimoto K, Ishigaki S, Yoshida H, Magi M, Matsumoto Y, Kaneko Y, Takeuchi T. Interleukin-1 pathway in active large vessel vasculitis patients with a poor prognosis: a longitudinal transcriptome analysis. Clin Transl Immunology 2021; 10:e1307. [PMID: 34249359 PMCID: PMC8251870 DOI: 10.1002/cti2.1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/14/2021] [Accepted: 06/08/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives Large vessel vasculitis (LVV) is characterised by a high relapse rate. Because accurate assessment of the LVV disease status can be difficult, an accurate prognostic marker for initial risk stratification is required. We conducted a comprehensive longitudinal investigation of next‐generation RNA‐sequencing data for patients with LVV to explore useful biomarkers associated with clinical characteristics. Methods Key molecular pathways relevant to LVV pathogenesis were identified by examining the whole blood RNA from patients with LVV and healthy controls (HCs). The data were examined by pathway analysis and weighted gene correlation network analysis (WGCNA) to identify functional gene sets that were differentially expressed between LVV patients and HCs, and associated with clinical features. We then compared the expression of the selected genes during week 0, week 6, remission and relapse. Results The whole‐transcriptome gene expression data for 108 samples obtained from LVV patients (n = 27) and HCs (n = 12) were compared. The pathway analysis and WGCNA revealed that molecular pathway related to interleukin (IL)‐1 was significantly upregulated in LVV patients compared with HCs, which correlated with the positron emission tomography vascular activity score, a disease‐extent score based on the distribution of affected arteries. Further analysis revealed that the expression levels of genes in the IL‐1 signalling pathway remained high after conventional treatment and were associated with disease relapse. Conclusion Upregulation of the IL‐1 signalling pathway was a characteristic of LVV patients and was associated with the extent of disease and a poor prognosis.
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Affiliation(s)
- Kotaro Matsumoto
- Division of Rheumatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Katsuya Suzuki
- Division of Rheumatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Keiko Yoshimoto
- Division of Rheumatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | - Sho Ishigaki
- Division of Rheumatology Department of Internal Medicine Keio University School of Medicine Tokyo Japan
| | | | - Mayu Magi
- Chugai Pharmaceutical Co. Ltd Kanagawa 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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10
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Gérard AL, Simon-Tillaux N, Yordanov Y, Cacoub P, Tubach F, Saadoun D, Dechartres A. Efficacy and safety of steroid-sparing treatments in giant cell arteritis according to the glucocorticoids tapering regimen: A systematic review and meta-analysis. Eur J Intern Med 2021; 88:96-103. [PMID: 33879385 DOI: 10.1016/j.ejim.2021.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of adjuvant therapies in newly diagnosed or relapsing giant cell arteritis (GCA) in terms of relapse rate at week 52 (primary outcome) and to assess the impact of GC tapering regimen on adjuvant effectiveness. METHODS For this systematic review and meta-analysis, we searched PubMed, EMBASE, CENTRAL, trial registries, from inception to November 2020. We included all randomized controlled trials (RCTs) and controlled prospective studies evaluating adjuvant treatments in GCA, without date or language restriction. Two reviewers independently selected studies, extracted data and assessed risk of bias. Quality of evidence was summarised with GRADE. RESULTS Of the 680 records identified, 16 studies were included (1,068 participants) evaluating various adjuvant therapies compared to GC only. No study compared adjuvants with each other. Risk of bias was high in 5/7 trials evaluating our primary outcome. Risk of relapse at week 52 was reduced for only the anti-IL6 and IL6-receptor drug class versus the control (RR=0.45, 95%CI 0.30-0.66, I2=38%), particularly tocilizumab (RR=0.38, 95%CI 0.23-0.63, I2=42%) with a moderate quality of evidence. We found no significant interaction according to GC tapering regimen. Our meta-analysis did not show a significant benefit for methotrexate. Except for dapsone, ciclosporine and hydroxychloroquine, other adjuvants did not seem to show increased risk of adverse events. CONCLUSIONS Tocilizumab seems to reduce the relapse rate in GCA at week 52 but the quality of evidence was moderate. No other molecule has shown efficacy. No significant interaction on relapse rate by GC tapering regimen was found. STUDY REGISTRATION PROSPERO CRD42020172011.
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Affiliation(s)
- Anne-Laure Gérard
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Noémie Simon-Tillaux
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Youri Yordanov
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Patrice Cacoub
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - David Saadoun
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France.
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France.
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11
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Tomelleri A, Campochiaro C, Sartorelli S, Farina N, Baldissera E, Dagna L. Presenting features and outcomes of cranial-limited and large-vessel giant cell arteritis: a retrospective cohort study. Scand J Rheumatol 2021; 51:59-66. [PMID: 33913792 DOI: 10.1080/03009742.2021.1889025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: To compare the presenting features and outcomes of patients with cranial-limited (C-) and large-vessel (LV-) giant cell arteritis (GCA).Methods: Data from our GCA cohort were collected retrospectively. Patients who underwent total-body large-vessel imaging within 10 days after commencing steroid therapy were included. Patients with LV involvement were classified as LV-GCA. Presenting features, treatments, and outcomes of LV-GCA and C-GCA patients were compared.Results: 161 patients were included (LV-GCA, n = 100). At baseline, LV-GCA patients were younger than those with C-GCA (73.2 ± 8.9 vs 76 ± 8.8 years, p = 0.018) and had a longer delay to diagnosis (3.5 ± 4.6 vs 2.3 ± 4.9 months, p = 0.001). C-GCA patients had a higher incidence of headache (p = 0.006) and ischaemic optic neuropathy (p < 0.001), whereas LV-GCA patients had more systemic symptoms (fever, p = 0.002; fatigue, p < 0.001; weight loss, p < 0.001; night sweats, p = 0.015) and dry cough (p = 0.031). Corrected cumulative prednisone dose, relapse-free survival, relapse-rate, and incidence of ascending aortic aneurysms were not significantly different between the two subgroups. A steroid-sparing agent was added in 73% of LV- and 55.7% of C-GCA patients (p = 0.027), but was introduced more frequently at baseline in LV-GCA patients (52% vs 23.5%, p = 0.006). LV-GCA patients initially treated with glucocorticoid monotherapy relapsed sooner (relapse-free survival, HR = 0.56, 95% CI 0.41-0.78, p < 0.001) and had a higher relapse rate (relapses per 10 person-years, 6.73 ± 11.50 vs 3.82 ± 10.83, p = 0.011).Conclusion: LV-GCA patients were younger at diagnosis and suffered a longer diagnostic delay. The outcomes of the two subgroups were similar. An earlier introduction of steroid-sparing agents in LV-GCA patients might have played a positive role.
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Affiliation(s)
- A Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - C Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - S Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - N Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - E Baldissera
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - L Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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de Boysson H, Espitia O, Samson M, Tieulié N, Bachmeyer C, Moulinet T, Dumont A, Deshayes S, Bonnotte B, Agard C, Aouba A. Giant cell arteritis-related aortic dissection: A multicenter retrospective study. Semin Arthritis Rheum 2021; 51:430-435. [PMID: 33690049 DOI: 10.1016/j.semarthrit.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To describe characteristics and outcomes of patients with giant cell arteritis (GCA)-related aortic dissection. PATIENTS AND METHODS We retrospectively included, through a nationwide GCA network, all patients who had an aortic dissection either revealing GCA or occurring during follow-up. RESULTS A total of 46 patients were included in this study. Aortic dissection was inaugural and led to GCA diagnosis in 21 patients, whereas it occurred during follow-up in the 25 others, at a median of 53 [1-265] months after GCA diagnosis. Large-vessel vasculitis (LVV) was diagnosed through imaging before or at the time of aortic dissection in 31 (67%) patients. In patients who developed an aortic dissection during follow-up, the aortic event occurred 22 [1-143] months post GCA diagnosis in the patients with previous aortitis, whereas it occurred after 72 [19-265] months in patients without previously diagnosed aortitis (p = 0.005). Aortic surgery was performed in 27 (59%) patients and 23 of them survived. A total of 15 (32%) patients died following the aortic dissection, including 11 who were not operated on. In a multivariate analysis, aortic surgery was the single predictor of survival (HR: 4.3; 95% CI: 1.47- 15.7; p = 0.007). CONCLUSION Patients with prior LVV are more prone to develop early aortic dissection and require close monitoring of aortic morphology. One third of patients died from the aortic dissection. Surgery remains the best predictive factor for survival.
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Affiliation(s)
- Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France.
| | - Olivier Espitia
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Maxime Samson
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Nathalie Tieulié
- Department of Internal Medicine, Nice University Hospital, Nice, France
| | | | - Thomas Moulinet
- Department of Internal Medicine, Nancy University Hospital, Nancy, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Dijon University Hospital, Dijon, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Avenue de la Côte de Nacre, Caen 14000, France; Normandy University, Caen, Unicaen, France
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Abstract
Systemic vasculitides are multisystem blood vessel disorders, which are defined by the size of the vessel predominantly affected, namely small, medium, or large vessels. The term "large vessel" relates to the aorta and its major branches; "medium vessel" refers to the main visceral arteries and veins and their initial branches. The most common causes of large-vessel vasculitis are giant cell arteritis and Takayasu arteritis, and those of medium-vessel arteritis are polyarteritis nodosa and Kawasaki disease. However, there is some overlap, and arteries of any size can potentially be involved in any of the 3 main categories of dominant vessel involvement. In addition to multisystem vasculitides, other forms of vasculitis have been defined, including single-organ vasculitis (eg, isolated aortitis). Prompt identification of vasculitides is important because they are associated with an increased risk of mortality. Left undiagnosed or mismanaged, these conditions may result in serious adverse outcomes that might otherwise have been avoided or minimized. The ethnic and regional differences in the incidence, prevalence, and clinical characteristics of patients with vasculitis should be recognized. Because the clinical presentation of vasculitis is highly variable, the cardiovascular clinician must have a high index of suspicion to establish a reliable and prompt diagnosis. This article reviews the pathophysiology, epidemiology, diagnostic strategies, and management of vasculitis.
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Affiliation(s)
- David Saadoun
- Sorbonne Universités, Assistance Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Department of Internal Medicine and Clinical Immunology, Centre national de Référence des Maladies Auto-Immunes Systémiques Rares, Centre national de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France (D.S., M.V.).,Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de recherche (UMR) S 959, and Recherche Hospitalo-Universitaire en santé (RHU) Interleukin-2 Therapy for autoimmune and inflammatory diseases, Paris, France (D.S., P.C.)
| | - Mathieu Vautier
- Sorbonne Universités, Assistance Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Department of Internal Medicine and Clinical Immunology, Centre national de Référence des Maladies Auto-Immunes Systémiques Rares, Centre national de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France (D.S., M.V.)
| | - Patrice Cacoub
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de recherche (UMR) S 959, and Recherche Hospitalo-Universitaire en santé (RHU) Interleukin-2 Therapy for autoimmune and inflammatory diseases, Paris, France (D.S., P.C.)
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14
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Dammacco F, Cirulli A, Simeone A, Leone P, Pulli R, Angiletta D, Rubini G, Di Palo A, Vacca A, Dammacco R. Takayasu arteritis: a cohort of Italian patients and recent pathogenetic and therapeutic advances. Clin Exp Med 2020; 21:49-62. [PMID: 33026580 PMCID: PMC7867549 DOI: 10.1007/s10238-020-00668-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/28/2020] [Indexed: 04/03/2023]
Abstract
Takayasu arteritis (TAK) is a rare granulomatous vasculitis of unknown etiology that mainly affects the aorta and its major branches. The aim is to describe the clinical features, diagnostic procedures, pathogenesis, and management of TAK in a longitudinal cohort of patients recruited within a single region of southern Italy. The cohort included 43 patients who were diagnosed with TAK and followed up according to a standard protocol, in a collaboration between four university tertiary referral centers and a regional hospital. Clinical and imaging classification criteria were those established by the American College of Rheumatology. Thirty-five patients (81.4%) were female, and the mean age at disease onset was 32.6 (range 16–54) years. Angiographic assessment of the vascular involvement allowed disease classification in five different types. Clinical features ranged from constitutional symptoms in the early inflammatory stage of the disease to cardiovascular ischemic symptoms in the late, chronic stage. Noninvasive imaging techniques were employed to assess the extent and severity of the arterial wall damage and to monitor the clinical course and response to therapy. Medical treatment, based on pathogenetic insights into the roles of humoral and cell-mediated immune mechanisms, included glucocorticoids mostly combined with steroid-sparing immunosuppressive agents and, in patients with relapsing/refractory disease, biologic drugs. Significant clinical and angiographic differences have been detected in TAK patients from different geographic areas. Patients with life-threatening cardiovascular and neurologic manifestations as well as sight-threatening ophthalmologic signs and symptoms should be promptly diagnosed, properly treated, and closely followed up to avoid potentially severe consequences.
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Affiliation(s)
- Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Anna Cirulli
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Annalisa Simeone
- Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Raffaele Pulli
- Department of Emergency and Organ Transplantation, Vascular and Endovascular Surgery Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Domenico Angiletta
- Department of Emergency and Organ Transplantation, Vascular and Endovascular Surgery Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Rubini
- Department of Interdisciplinary Medicine, Nuclear Medicine Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Alessandra Di Palo
- Department of Interdisciplinary Medicine, Nuclear Medicine Unit, Medical School, University of Bari Aldo Moro, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Medical School, Polyclinic, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, Medical School, University of Bari Aldo Moro, Bari, Italy
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Carvajal Alegria G, van Sleen Y, Graver JC, Sandovici M, Devauchelle-Pensec V, Brouwer E, Cornec D. Aortic involvement in giant cell arteritis. Joint Bone Spine 2020; 88:105045. [PMID: 32649986 DOI: 10.1016/j.jbspin.2020.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Guillermo Carvajal Alegria
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France
| | - Yannick van Sleen
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba Carolien Graver
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Sandovici
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Valérie Devauchelle-Pensec
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France
| | - Elisabeth Brouwer
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Divi Cornec
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France.
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