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Sheth MS, Hale DE, Mcarthur JC, Zamvil SS, Goldman MD, Riley C, Chitnis T. A 79-Year-Old Woman With Worsening Headaches and Pachymeningeal Enhancement: A Case Report From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200308. [PMID: 39190855 PMCID: PMC11357841 DOI: 10.1212/nxi.0000000000200308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/19/2024] [Indexed: 08/29/2024]
Abstract
A 79-year-old woman presented with subacutely worsening headaches and right arm weakness. MRI showed diffuse pachymeningeal enhancement. Serologic workup revealed elevated erythrocyte sedimentation rate and C-reactive protein. CSF demonstrated elevated opening pressure, a lymphocytic pleocytosis, and elevated protein. We discuss our differential diagnosis and distinguish between 2 overlapping clinical entities.
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Affiliation(s)
- Manali S Sheth
- From the Harvard Medical School (M.S.S., T.C.); Department of Neurology (M.S.S., T.C.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (D.E.H., J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California at San Francisco; Department of Neurology (M.D.G.), Virginia Commonwealth University, Richmond; and Department of Neurology (C.R.), Columbia University, New York
| | - David E Hale
- From the Harvard Medical School (M.S.S., T.C.); Department of Neurology (M.S.S., T.C.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (D.E.H., J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California at San Francisco; Department of Neurology (M.D.G.), Virginia Commonwealth University, Richmond; and Department of Neurology (C.R.), Columbia University, New York
| | - Justin C Mcarthur
- From the Harvard Medical School (M.S.S., T.C.); Department of Neurology (M.S.S., T.C.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (D.E.H., J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California at San Francisco; Department of Neurology (M.D.G.), Virginia Commonwealth University, Richmond; and Department of Neurology (C.R.), Columbia University, New York
| | - Scott S Zamvil
- From the Harvard Medical School (M.S.S., T.C.); Department of Neurology (M.S.S., T.C.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (D.E.H., J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California at San Francisco; Department of Neurology (M.D.G.), Virginia Commonwealth University, Richmond; and Department of Neurology (C.R.), Columbia University, New York
| | - Myla D Goldman
- From the Harvard Medical School (M.S.S., T.C.); Department of Neurology (M.S.S., T.C.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (D.E.H., J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California at San Francisco; Department of Neurology (M.D.G.), Virginia Commonwealth University, Richmond; and Department of Neurology (C.R.), Columbia University, New York
| | - Claire Riley
- From the Harvard Medical School (M.S.S., T.C.); Department of Neurology (M.S.S., T.C.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (D.E.H., J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California at San Francisco; Department of Neurology (M.D.G.), Virginia Commonwealth University, Richmond; and Department of Neurology (C.R.), Columbia University, New York
| | - Tanuja Chitnis
- From the Harvard Medical School (M.S.S., T.C.); Department of Neurology (M.S.S., T.C.), Brigham and Women's Hospital, Boston, MA; Department of Neurology (D.E.H., J.C.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California at San Francisco; Department of Neurology (M.D.G.), Virginia Commonwealth University, Richmond; and Department of Neurology (C.R.), Columbia University, New York
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2
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Uzun GS, Gököz Ö, Oğüt B, Heper A, Güreşçi S, Kardaş RC, Öztürk MA, Uslu E, Ateş A, Armağan B, Omma A, Kılıc L, Karadag O. The impact of histopathological criteria for definite vasculitis in giant cell arteritis: retrospective analysis of temporal artery biopsies. Rheumatol Int 2024:10.1007/s00296-024-05708-z. [PMID: 39245763 DOI: 10.1007/s00296-024-05708-z] [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: 06/02/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
Histopathological findings associated with definite vasculitis in temporal artery biopsy (TAB) defined in 2022 ACR/EULAR classification criteria for Giant Cell Arteritis (GCA) was published in 2022. We aimed to evaluate the TAB of our GCA patients for histopathological findings associated with definite vasculitis. Patients who were diagnosed with GCA by clinicians and underwent TAB between January 2012 and May 2022 were included. Hospital electronic records and patients' files were reviewed retrospectively. A total of 90 patients' pathology reports were evaluated by a pathologist and a rheumatologist. In cases where microscopic findings were not specified in the pathology reports, histopathologic specimens were re-evaluated (n = 36). A standard checklist was used for histopathological findings of definite vasculitis. Patients were divided into two groups; (i) definite vasculitis-GCA and (ii) non-definite-GCA group, and the clinical and demographic characteristics for all patients were compared. The mean age of patients was 69.8 (± 8.5) years and 52.2% were female. In the first evaluation, 66 (73.3%) patients had a diagnosis of vasculitis according to pathology reports. In the re-evaluation of biopsy specimens, at least one definite finding of vasculitis was observed in TAB of 10/24 (41.6%) patients whose microscopic findings were not specified in the pathology reports. The ROC analysis showed that biopsy length had diagnostic value in predicting the diagnosis of definite vasculitis (AUC: 0.778, 95% CI: 0.65-0.89, p < 0.001). In those with a biopsy length of ≥ 1 cm, sensitivity was 76.5%, specificity was 64.3%, and PPV value was 92. In multivariate analysis, the most significant factor associated with definite vasculitis was biopsy length (OR: 1.18 (1.06-1.31), p = 0.002). Microscopic findings were reported in over 70% of patients. Reinterpretation of results according to a standard check-list improved the impact of TAB in the diagnosis of GCA. A biopsy length ≥ 1 cm was found to contribute towards a definitive histopathological vasculitis diagnosis.
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Affiliation(s)
- Güllü Sandal Uzun
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Özay Gököz
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Betül Oğüt
- Faculty of Medicine, Department of Pathology, Gazi University, Ankara, Turkey
| | - Aylin Heper
- Pathology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Servet Güreşçi
- Department of Pathology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Rıza Can Kardaş
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Emine Uslu
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aşkın Ateş
- Department of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Berkan Armağan
- Clinic of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Omma
- Clinic of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Levent Kılıc
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey.
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3
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Chen S, Nie R, Wang C, Luan H, Ma X, Gui Y, Zeng X, Yuan H. A two sample mendelian randomization analysis investigates causal effects between gut microbiome and immune related Vasculitis. Sci Rep 2024; 14:18810. [PMID: 39138194 PMCID: PMC11322650 DOI: 10.1038/s41598-024-68205-0] [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: 01/18/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024] Open
Abstract
Observational data suggest a link between gut microbiota and immune-related vasculitis, but causality remains unclear. A bidirectional mendelian randomization study was conducted using public genome-wide data. The inverse-variance-weighted (IVW) method identified associations and addressed heterogeneity.Families Clostridiaceae 1 and Actinomycetaceae correlated positively with granulomatosis with polyangiitis risk, while classes Lentisphaeria and Melainabacteria, and families Lachnospiraceae and Streptococcaceae showed negative associations. Behçet's disease was positively associated with the risk of family Streptococcaceae abundance. And other several gut microbiota constituents were identified as potential risk factors for immune-related vasculitis. Furthermore, combining positive association results from the IVW analysis revealed numerous shared gut microbiota constituents associated with immune-related vasculitis. MR analysis demonstrated a causal association between the gut microbiota and immune-related vasculitis, offering valuable insights for subsequent mechanistic and clinical investigations into microbiota-mediated immune-related vasculitis.
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Affiliation(s)
- Si Chen
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China
| | - Rui Nie
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China
| | - Chao Wang
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China
| | - Haixia Luan
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China
| | - Xu Ma
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China
| | - Yuan Gui
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China
| | - Xiaoli Zeng
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China.
| | - Hui Yuan
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China.
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4
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Juncker AS, Appenzeller S, de Souza JM. Central Nervous System Involvement in Systemic Autoimmune Rheumatic Diseases-Diagnosis and Treatment. Pharmaceuticals (Basel) 2024; 17:1044. [PMID: 39204149 PMCID: PMC11357437 DOI: 10.3390/ph17081044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/19/2024] [Accepted: 08/02/2024] [Indexed: 09/03/2024] Open
Abstract
Central nervous system (CNS) involvement in autoimmune rheumatic diseases represents a significant challenge for clinicians across all specialties. While most reviews on the subject focus on neurological manifestations within a specific rheumatic disease, few descriptions shift from neurological clinical syndromes to achieve rheumatological diagnoses. This narrative review aims to synthesize current knowledge on the diagnosis and management of CNS manifestations occurring in the most prevalent rheumatic conditions in adults. We searched the MEDLINE database using the terms "central nervous system", "rheumatic diseases", "systemic lupus erythematosus", "rheumatoid arthritis", "Sjögren syndrome", and "vasculitis". The search strategy included review articles from 2019 to 2024, published in English, Spanish, or Portuguese. We explored the pathophysiological mechanisms linking autoimmunity to CNS pathology, emphasizing the role of syndromic reasoning, autoantibody profiles, and imaging modalities as tools for diagnosis and determination of inflammatory activity. The review also discusses differential diagnoses through a stepwise approach to neurological syndromes, summarized in diagnostic flowcharts, and presents updated treatment options. Although our approach is primarily semiology-based, the complexity of the subject invites future endeavors involving new technologies, such as functional MRI, MR spectroscopy, and nuclear medicine.
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Affiliation(s)
- Aline Santana Juncker
- Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-881, Brazil;
- Post-Graduate Program in Medical Sciences, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13000-000, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-887, Brazil;
| | - Jean Marcos de Souza
- Department of Internal Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-881, Brazil;
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5
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Minamioka H, Tsukihashi Y, Yano T, Sano C, Ohta R. Giant Cell Arteritis With Sepsis-Like Symptoms in an Elderly Man: A Case Report. Cureus 2024; 16:e61074. [PMID: 38915961 PMCID: PMC11196118 DOI: 10.7759/cureus.61074] [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: 05/25/2024] [Indexed: 06/26/2024] Open
Abstract
This case report details the diagnostic challenge and management of an 88-year-old man who presented to a rural Japanese community hospital with sepsis-like symptoms, initially suspected of acute bacterial cholangitis based on his physical and laboratory findings. Despite the antibiotic treatment of tazobactam and piperacillin, the patient's symptoms persisted, leading to further investigations that revealed no signs of infection but notable aortic arch wall thickening on contrast-enhanced computed tomography scans. These findings, combined with the patient's clinical presentation and lack of antibiotic response, redirected the diagnosis toward giant cell arteritis (GCA). The administration of prednisolone of 60 mg daily significantly alleviated symptoms and prevented potential severe complications such as blindness and irreversible neurological damage. This case underscores the importance of considering GCA in elderly patients presenting with systemic inflammatory symptoms and the necessity of timely intervention. It also highlights the challenges in managing high-dose steroid therapy in elderly patients and suggests the potential benefits of integrating immunosuppressants to reduce steroid dependency. This report emphasizes the need for heightened awareness and a comprehensive diagnostic approach in atypical presentations of GCA, particularly in geriatric populations within resource-limited healthcare settings.
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Affiliation(s)
- Hisae Minamioka
- Family Medicine, Shimane University Medical School, Izumo, JPN
| | - Yuto Tsukihashi
- Family Medicine, Shimane University Medical School, Izumo, JPN
| | - Tasuku Yano
- Family Medicine, Shimane University Medical School, Izumo, JPN
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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6
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Ness T, Nölle B. Giant Cell Arteritis. Klin Monbl Augenheilkd 2024; 241:644-652. [PMID: 38593832 DOI: 10.1055/a-2252-3371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Giant cell arteritis (GCA) is the most common primary vasculitis and is associated with potential bilateral blindness. Neither clinical nor laboratory evidence is simple and unequivocal for this disease, which usually requires rapid and reliable diagnosis and therapy. The ophthalmologist should consider GCA with the following ocular symptoms: visual loss or visual field defects, transient visual disturbances (amaurosis fugax), diplopia, eye pain, or new onset head or jaw claudication. An immediate ophthalmological examination with slit lamp, ophthalmoscopy, and visual field, as well as color duplex ultrasound of the temporal artery should be performed. If there is sufficient clinical suspicion of GCA, corticosteroid therapy should be initiated immediately, with prompt referral to a rheumatologist/internist and, if necessary, temporal artery biopsy should be arranged. Numerous developments in modern imaging with colour duplex ultrasonography, MRI, and PET-CT have the potential to compete with the classical, well-established biopsy of a temporal artery. Early determination of ESR and CRP may support RZA diagnosis. Therapeutically, steroid-sparing immunosuppression with IL-6 blockade or methotrexate can be considered. These developments have led to a revision of both the classification criteria and the diagnostic and therapeutic recommendations of the American College of Rheumatologists and the European League against Rheumatism, which are summarised here for ophthalmology.
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Affiliation(s)
- Thomas Ness
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Bernhard Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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7
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Ohta R, Nishikura N, Suyama S, Sano C. Differentiation Between Disseminated Carcinomatosis of the Bone Marrow From Urothelial Cancer and Intravascular Large B-cell Lymphoma: A Case Report. Cureus 2024; 16:e57221. [PMID: 38686250 PMCID: PMC11056314 DOI: 10.7759/cureus.57221] [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: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
This case report describes a rare case of intravascular large B-cell lymphoma (IVLBCL), initially presenting with nonspecific symptoms of fever and fatigue, and tentatively diagnosed as disseminated carcinomatosis of the bone marrow originating from urothelial cancer in an 80-year-old woman. The patient's journey began with symptoms treated as common ailments and progressed through multiple differential diagnoses, including giant cell arteritis, TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly) syndrome, and disseminated carcinomatosis of the bone marrow originating from urothelial cancer due to the presence of systemic inflammation, anasarca, and elevated soluble interleukin 2 receptor levels, indicative of an intense immunological response. Despite initial treatments, her condition deteriorated, leading to further investigations that ultimately revealed the presence of malignant cells in the urine and bone marrow, confirming the diagnosis of IVLBCL. This case underscores the diagnostic challenges faced when elderly patients present with systemic inflammation and the critical need for thorough investigation beyond initial impressions. It highlights the importance of considering differentiation between disseminated carcinomatosis of the bone marrow and IVLBCL in the differential diagnosis of persistent inflammation, especially in cases where common causes have been excluded and the primary malignancy is not immediately apparent.
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Affiliation(s)
| | | | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Bilton EJ, Coath F, Patil A, Jones C, O'Sullivan E, Hingorani M, Mukhtyar C, Mollan SP. The first giant cell arteritis hospital quality standards (GHOST). Eye (Lond) 2024; 38:1-3. [PMID: 37344604 PMCID: PMC10764942 DOI: 10.1038/s41433-023-02604-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Edward J Bilton
- Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- INSIGHT Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Fiona Coath
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich Hospital, Colney Lane, Colney, Norwich, NR4 7UY, UK
| | - Ajay Patil
- Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Colin Jones
- Ophthalmology Department, Norfolk and Norwich Hospital, Colney Lane, Colney, Norwich, NR4 7UY, UK
| | | | | | - Chetan Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich Hospital, Colney Lane, Colney, Norwich, NR4 7UY, UK
| | - Susan P Mollan
- Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.
- INSIGHT Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.
- Transitional Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
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9
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Keehn CC, Yazdian A, Hunt PJ, Davila-Siliezar P, Laylani NA, Lee AG. Monoclonal antibodies in neuro-ophthalmology. Saudi J Ophthalmol 2024; 38:13-24. [PMID: 38628411 PMCID: PMC11017005 DOI: 10.4103/sjopt.sjopt_256_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 04/19/2024] Open
Abstract
Neuro-ophthalmologic diseases include a broad range of disorders affecting the afferent and efferent visual pathways. Recently, monoclonal antibody (mAb) therapies have emerged as a promising targeted approach in the management of several of these complex conditions. Here, we describe the mechanism-specific applications and advancements in neuro-ophthalmologic mAb therapies. The application of mAbs in neuro-ophthalmologic diseases highlights our increasing understanding of disease-specific mechanisms in autoimmune conditions such as neuromyelitis optica, thyroid eye disease, and myasthenia gravis. Due to the specificity of mAb therapies, applications in neuro-ophthalmologic diseases have yielded exceptional clinical outcomes, including both reduced rate of relapse and progression to disability, visual function preservation, and quality of life improvement. These advancements have not only expanded the range of treatable neuro-ophthalmologic diseases but also reduced adverse events and increased the response rate to treatment. Further research into neuro-ophthalmologic disease mechanisms will provide accurate and specific targeting of important disease mediators through applications of future mAbs. As our understanding of these diseases and the relevant therapeutic targets evolve, we will continue to build on our understanding of how mAbs interfere with disease pathogenesis, and how these changes improve clinical outcomes and quality of life for patients.
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Affiliation(s)
- Caroline C. Keehn
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Arman Yazdian
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Patrick J. Hunt
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
| | - Noor A. Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
| | - Andrew G. Lee
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
- Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, USA
- Department of Ophthalmology, Texas A and M College of Medicine, Bryan, Texas, USA
- Department of Ophthalmology, University of Buffalo, Buffalo, NY, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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10
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Brittain JM, Hansen MS, Carlsen JF, Brandt AH, Terslev L, Jensen MR, Lindberg U, Larsson HBW, Heegaard S, Døhn UM, Klefter ON, Wiencke AK, Subhi Y, Hamann S, Haddock B. Multimodality Imaging in Cranial Giant Cell Arteritis: First Experience with High-Resolution T1-Weighted 3D Black Blood without Contrast Enhancement Magnetic Resonance Imaging. Diagnostics (Basel) 2023; 14:81. [PMID: 38201390 PMCID: PMC10802188 DOI: 10.3390/diagnostics14010081] [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: 09/27/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
In order to support or refute the clinical suspicion of cranial giant cell arteritis (GCA), a supplemental imaging modality is often required. High-resolution black blood Magnetic Resonance Imaging (BB MRI) techniques with contrast enhancement can visualize artery wall inflammation in GCA. We compared findings on BB MRI without contrast enhancement with findings on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/low-dose computed tomography (2-[18F]FDG PET/CT) in ten patients suspected of having GCA and in five control subjects who had a 2-[18F]FDG PET/CT performed as a routine control for malignant melanoma. BB MRI was consistent with 2-[18F]FDG PET/CT in 10 out of 10 cases in the group with suspected GCA. In four out of five cases in the control group, the BB MRI was consistent with 2-[18F]FDG PET/CT. In this small population, BB MRI without contrast enhancement shows promising performance in the diagnosis of GCA, and might be an applicable imaging modality in patients.
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Affiliation(s)
- Jane Maestri Brittain
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, DK-2100 Copenhagen, Denmark;
| | - Michael Stormly Hansen
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (M.S.H.); (S.H.); (O.N.K.); (A.K.W.); (Y.S.); (S.H.)
| | - Jonathan Frederik Carlsen
- Department of Radiology, Rigshospitalet, DK-2100 Copenhagen, Denmark; (J.F.C.); (A.H.B.)
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark;
| | - Andreas Hjelm Brandt
- Department of Radiology, Rigshospitalet, DK-2100 Copenhagen, Denmark; (J.F.C.); (A.H.B.)
| | - Lene Terslev
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark;
- Department of Rheumatology and Spine Diseases, Rigshospitalet, DK-2600 Glostrup, Denmark;
| | - Mads Radmer Jensen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark;
| | - Ulrich Lindberg
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, DK-2600 Glostrup, Denmark; (U.L.); (H.B.W.L.)
| | - Henrik Bo Wiberg Larsson
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, DK-2600 Glostrup, Denmark; (U.L.); (H.B.W.L.)
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (M.S.H.); (S.H.); (O.N.K.); (A.K.W.); (Y.S.); (S.H.)
- Eye Pathology Section, Department of Pathology, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Uffe Møller Døhn
- Department of Rheumatology and Spine Diseases, Rigshospitalet, DK-2600 Glostrup, Denmark;
| | - Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (M.S.H.); (S.H.); (O.N.K.); (A.K.W.); (Y.S.); (S.H.)
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark;
| | - Anne Katrine Wiencke
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (M.S.H.); (S.H.); (O.N.K.); (A.K.W.); (Y.S.); (S.H.)
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark;
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (M.S.H.); (S.H.); (O.N.K.); (A.K.W.); (Y.S.); (S.H.)
- Department of Clinical Research, University of Southern Denmark, DK-5000 Odense, Denmark
- Department of Ophthalmology, Zealand University Hospital, DK-4000 Roskilde, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (M.S.H.); (S.H.); (O.N.K.); (A.K.W.); (Y.S.); (S.H.)
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark;
| | - Bryan Haddock
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, DK-2100 Copenhagen, Denmark;
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11
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Alkatan HM, AlMana F, Maktabi AMY. Giant cell temporal arteritis: a clinicopathological study with emphasis on unnecessary biopsy. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1327420. [PMID: 38983072 PMCID: PMC11182246 DOI: 10.3389/fopht.2023.1327420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 07/11/2024]
Abstract
Introduction Temporal artery (TA) biopsy is commonly used for the diagnosis of giant cell arteritis (GCA). However, a positive biopsy is no longer mandatory for diagnosis. This study aims to correlate the histopathological findings of TA biopsies in suspected cases of GCA to the clinical presentation in an ophthalmic tertiary eye care center to draw useful conclusions and advocate the possible implementation of guidelines for TA biopsy. Methods Data was collected from patients' medical records including, demographics, clinical data, and histopathological findings and diagnosis. The 2022 American College of Rheumatology/ European Alliance of Associations for Rheumatology (ACR/EULAR) criteria have been used and partially adopted as a guide to compare the variables between TA biopsy-positive and negative groups as well as the TA biopsy-positive group and the group of patients with TA biopsy showing atherosclerosis. Results Out of the total 35 patients who underwent a TA biopsy during the period of 23 years, 22.9% of patients had histopathological findings consistent with GCA and 42.9% had TA atherosclerotic changes, while the remaining 34.3% had histologically unremarkable TA. The mean age of all patients was 66 ± 10.9 years. Slightly more than half were females (54.3%) and the remaining were males (45.7%). In the group with positive TA biopsies, the mean age was 71 ± 8.4 years with a higher female predominance (female-to-male ratio of 5:3). The mean diagnostic clinical score used in our study was higher (7.5 ± 2.33) in the GCA-positive group when compared to the other groups with statistical significance (mean of 4.85 ± 2.01 in patients with overall GCA-negative biopsies and 5.13 ± 2.10 in the group with atherosclerosis). Other three clinical variables that were found to be statistically significant in the GCA biopsy-positive group were scalp tenderness, jaw claudication, and optic nerve pallor. Discussion The mean age (71 ± 8.4 years) and the female predominance of GCA in our group of patients with positive TA biopsy (62.5%) was like other reports. In our study 22.9% of performed TA biopsies over the period of the study were positive confirming the diagnosis of GCA on histological exam, which was similar to another report and is considered to be relatively low. The incorporation of increased clinically focused assessments and algorithms, with the aid of the ACR/EULAR criteria, may decrease the frequency of TA biopsies that carries unnecessary cost and risk of procedure-related morbidity. We highly recommend applying the age of ≥ 50 years as an initial criterion for diagnosis, followed by the consideration of the statistically significant clinical features: scalp tenderness, jaw claudication, and optic nerve pallor.
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Affiliation(s)
- Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fawziah AlMana
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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12
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Böhm EW, Buonfiglio F, Voigt AM, Bachmann P, Safi T, Pfeiffer N, Gericke A. Oxidative stress in the eye and its role in the pathophysiology of ocular diseases. Redox Biol 2023; 68:102967. [PMID: 38006824 PMCID: PMC10701459 DOI: 10.1016/j.redox.2023.102967] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
Oxidative stress occurs through an imbalance between the generation of reactive oxygen species (ROS) and the antioxidant defense mechanisms of cells. The eye is particularly exposed to oxidative stress because of its permanent exposure to light and due to several structures having high metabolic activities. The anterior part of the eye is highly exposed to ultraviolet (UV) radiation and possesses a complex antioxidant defense system to protect the retina from UV radiation. The posterior part of the eye exhibits high metabolic rates and oxygen consumption leading subsequently to a high production rate of ROS. Furthermore, inflammation, aging, genetic factors, and environmental pollution, are all elements promoting ROS generation and impairing antioxidant defense mechanisms and thereby representing risk factors leading to oxidative stress. An abnormal redox status was shown to be involved in the pathophysiology of various ocular diseases in the anterior and posterior segment of the eye. In this review, we aim to summarize the mechanisms of oxidative stress in ocular diseases to provide an updated understanding on the pathogenesis of common diseases affecting the ocular surface, the lens, the retina, and the optic nerve. Moreover, we discuss potential therapeutic approaches aimed at reducing oxidative stress in this context.
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Affiliation(s)
- Elsa Wilma Böhm
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anna Maria Voigt
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Philipp Bachmann
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Tarek Safi
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
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13
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Bahrami M, Mohammadi H, Mirgaloyebayat H, Mohajeri Z, Fazeli P, Mojahedi A, Afsharirad A, Tavakoli R, Sadeghian A, Nourian SMA. The role of 18F-fluorodeoxyglucose PET/computed tomography in the diagnosis and monitoring of large vessel vasculitides - a review article. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2023; 13:127-135. [PMID: 37736492 PMCID: PMC10509293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/13/2023] [Indexed: 09/23/2023]
Abstract
In the last two decades, advancements in positron emission tomography (PET) technology have increased the diagnostic accuracy of patients with large-vessel vasculitis (LVV). Numerous systematic reviews and meta-analyses have been conducted, and patients suspected of having LVV can be diagnosed earlier with 18F-FDG PET. Two subtypes, giant cell arteritis (GCA) and Takayasu arteritis (TA), will progress when their response to corticosteroids and enhanced immunosuppression is inadequate. In the majority of patients, disease activity cannot be monitored solely through laboratory procedures; consequently, glucose metabolism may be a source of potential biomarkers. In this article, we discuss the current state of 18F-FDG PET/CT imaging standards.
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Affiliation(s)
- Mahshid Bahrami
- Department of Radiology, Isfahan University of Medical SciencesIsfahan, Iran
| | - Hossein Mohammadi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | | | - Zahra Mohajeri
- Faculty of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Pooya Fazeli
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Azad Mojahedi
- Department of Internal Medicine, Stony Brook University HospitalStony Brook, NY 10041, USA
| | - Ali Afsharirad
- Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical SciencesTehran, Iran
| | - Reza Tavakoli
- Department of Radiology, Arak University of Medical SciencesArak, Iran
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14
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Buonfiglio F, Böhm EW, Pfeiffer N, Gericke A. Oxidative Stress: A Suitable Therapeutic Target for Optic Nerve Diseases? Antioxidants (Basel) 2023; 12:1465. [PMID: 37508003 PMCID: PMC10376185 DOI: 10.3390/antiox12071465] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Optic nerve disorders encompass a wide spectrum of conditions characterized by the loss of retinal ganglion cells (RGCs) and subsequent degeneration of the optic nerve. The etiology of these disorders can vary significantly, but emerging research highlights the crucial role of oxidative stress, an imbalance in the redox status characterized by an excess of reactive oxygen species (ROS), in driving cell death through apoptosis, autophagy, and inflammation. This review provides an overview of ROS-related processes underlying four extensively studied optic nerve diseases: glaucoma, Leber's hereditary optic neuropathy (LHON), anterior ischemic optic neuropathy (AION), and optic neuritis (ON). Furthermore, we present preclinical findings on antioxidants, with the objective of evaluating the potential therapeutic benefits of targeting oxidative stress in the treatment of optic neuropathies.
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Affiliation(s)
- Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (E.W.B.); (N.P.)
| | | | | | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (E.W.B.); (N.P.)
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15
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Esin RG, Fatykhova AF, Esin OR. [Vasculitis as a cause of stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:5-11. [PMID: 38148691 DOI: 10.17116/jnevro20231231225] [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: 12/28/2023]
Abstract
The review considers the clinical picture, key aspects of the diagnosis and treatment of vasculitis that are the causes of strokes (giant cell arteritis, polyarteritis nodosa, varicella zoster virus vasculopathy, cerebrovascular pathology caused by herpes simplex virus types 1 and 2, primary CNS angiitis, adenosine deaminase-2 deficiency).
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Affiliation(s)
- R G Esin
- Kazan (Volga region) Federal University, Kazan, Russia
- Kazan State Medical Academy, Kazan, Russia
| | - A F Fatykhova
- Kazan (Volga region) Federal University, Kazan, Russia
| | - O R Esin
- Kazan (Volga region) Federal University, Kazan, Russia
- Clinic of Otorhinolaryngology, Kazan, Russia
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