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Mehta PK, Levit RD, Wood MJ, Aggarwal N, O'Donoghue ML, Lim SS, Lindley K, Gaignard S, Quesada O, Vatsa N, Leon A, Volgman AS, Malas W, Pepine CJ. Chronic rheumatologic disorders and cardiovascular disease risk in women. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100267. [PMID: 38511090 PMCID: PMC10945906 DOI: 10.1016/j.ahjo.2023.100267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 03/22/2024]
Abstract
Cardiovascular disease (CVD) is a major health threat to women worldwide. In addition to traditional CVD risk factors, autoimmune conditions are increasingly being recognized as contributors to adverse CVD consequences in women. Chronic systemic autoimmune and inflammatory disorders can trigger premature and accelerated atherosclerosis, microvascular dysfunction, and thrombosis. The presence of comorbid conditions, duration of the autoimmune condition, disease severity, and treatment of underlying inflammation are all factors that impact CVD risk and progression. Early identification and screening of CVD risk factors in those with underlying autoimmune conditions may attenuate CVD in this population. Treatment with non-steroidal anti-inflammatory drugs, corticosteroids, disease modifying agents and biologics may influence CVD risk factors and overall risk. Multi-disciplinary and team-based care, clinical trials, and collaborative team-science studies focusing on systemic autoimmune conditions will be beneficial to advance care for women.
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Affiliation(s)
- Puja K. Mehta
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca D. Levit
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Malissa J. Wood
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Niti Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Michelle L. O'Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - S. Sam Lim
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Kate Lindley
- Cardiovascular Division, Washington University in St. Louis, USA
| | - Scott Gaignard
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA, USA
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
| | - Nishant Vatsa
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA, USA
| | - Ana Leon
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Waddah Malas
- Loyola University Internal Medicine Residency Program, Chicago, IL, USA
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - American College of Cardiology Cardiovascular Disease in Women Committee
- Emory Women's Heart Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
- Division of Rheumatology, Department of Medicine, Emory University, Atlanta, GA, USA
- Cardiovascular Division, Washington University in St. Louis, USA
- J. Willis Hurst Internal Medicine Residency Program, Emory University, Atlanta, GA, USA
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, USA
- Emory University School of Medicine, Atlanta, GA, USA
- Section Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
- Loyola University Internal Medicine Residency Program, Chicago, IL, USA
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
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Fine L, Kurpiel S, Carter A. A woman with temporal pain. Proc AMIA Symp 2022; 35:712-713. [DOI: 10.1080/08998280.2022.2084685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Lauren Fine
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas
| | - Scott Kurpiel
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas
| | - Ashley Carter
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas
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Das S, Khurana T, Tiwary R. Various etiologies and presentations of giant cell arteritis: A series of case reports. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_116_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kobayashi Y, Sato S, Takamatsu R, Ishii W. Long Vertebral Arteritis and Cerebellar Infarction caused by Suspected Giant Cell Arteritis. Neurol India 2021; 69:1114-1115. [PMID: 34507475 DOI: 10.4103/0028-3886.325359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Yuya Kobayashi
- Department of Neurology, Nagano Red Cross Hospital, Wakasato, Nagano, Japan
| | - Shunichi Sato
- Department of Neurology, Nagano Red Cross Hospital, Wakasato, Nagano, Japan
| | - Ryota Takamatsu
- Department of Neurology, Nagano Red Cross Hospital, Wakasato, Nagano, Japan
| | - Wataru Ishii
- Department of Neurology, Nagano Red Cross Hospital, Wakasato, Nagano, Japan
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Shibata A, Kondo T, Kurasawa T, Chino K, Okada Y, Amano K. A case of polyangiitis overlap syndrome of giant cell arteritis and granulomatosis with polyangiitis successfully treated with rituximab. Mod Rheumatol Case Rep 2020; 5:317-321. [PMID: 33250006 DOI: 10.1080/24725625.2020.1780003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a case of polyangiitis overlap syndrome of giant cell arteritis (GCA) and granulomatosis with polyangiitis (GPA) and conduct a literature review of polyangiitis overlap syndrome. The patient was 73-year-old male who developed cranial-type GCA and GPA simultaneously and was successfully treated with rituximab. Rituximab might be effective for not only GPA but also GCA.
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Affiliation(s)
- Akiko Shibata
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tsuneo Kondo
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takahiko Kurasawa
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kentaro Chino
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yusuke Okada
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Kutty RK, Maekawa M, Kawase T, Fujii N, Kato Y. Temporal arteritis with focal pachymeningitis: a deceptive association. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:143-150. [PMID: 32273643 PMCID: PMC7103863 DOI: 10.18999/nagjms.82.1.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
Temporal arteritis is an immunological disorder mostly affecting the elderly population. This frequently occurs in association with other rheumatological diseases of the elderly. The symptoms of Temporal arteritis overlap with other symptoms of commonly occurring diseases in that population. Focal pachymeningitis in association with temporal arteritis is a rare finding and a literature review revealed less than ten cases of similar associations being published. In such instances, this finding can be mistaken for aseptic meningitis and treated erroneously. We present our case, discuss the management and summarize a review of literature about focal pachymeningitis along with temporal arteritis which was managed successfully with steroids and Toclizumab.
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Affiliation(s)
- Raja K Kutty
- Department of Neurosurgery, Government Medical College, Trivandrum, India
| | - Michitaka Maekawa
- Department of Nephrology, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Naoko Fujii
- Department of Radiology, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Bantane Hospital, Fujita Health University, Nagoya, Japan
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Periadventitial tissue examination in temporal artery biopsies for suspected giant cell arteritis: a case series and literature review. Can J Ophthalmol 2019; 54:615-620. [DOI: 10.1016/j.jcjo.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/16/2022]
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Dardick JM, Esenwa CC, Zampolin RL, Ustun B, Ayesha B, Kirchoff-Torres KF, Liberman AL. Acute Lateral Medullary Infarct due to Giant Cell Arteritis: A Case Study. Stroke 2019; 50:e290-e293. [PMID: 31495325 DOI: 10.1161/strokeaha.119.026566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Joseph M Dardick
- From the Albert Einstein College of Medicine, Bronx, NY (J.M.D.)
| | - Charles C Esenwa
- Saul R. Korey Department of Neurology (C.C.E., K.F.K.-T., A.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Richard L Zampolin
- Department of Radiology (R.L.Z.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Berrin Ustun
- Department of Pathology (B.U.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Bibi Ayesha
- Division of Rheumatology, Department of Medicine (B.A.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Kathryn F Kirchoff-Torres
- Saul R. Korey Department of Neurology (C.C.E., K.F.K.-T., A.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ava L Liberman
- Saul R. Korey Department of Neurology (C.C.E., K.F.K.-T., A.L.L.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Miyake Y, Morimoto Y, Taniguchi M, Yamanaka C, Ueno G, Ejima S, Yutani C. Giant cell arteritis without cranial manifestations caused mesenteric involvement: a case report. Surg Case Rep 2019; 5:119. [PMID: 31342194 PMCID: PMC6656821 DOI: 10.1186/s40792-019-0678-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/19/2019] [Indexed: 12/03/2022] Open
Abstract
Background Giant cell arteritis (GCA) is a granulomatous vasculitis and targets large vessels with predominance for the aortic arch and the cranial branches. GCA with cranial symptoms shows headache, jaw claudication, and ophthalmologic symptoms and thus was previously called temporal arteritis. Recently, cases of GCA without cranial manifestations and extracranial GCA have been reported. Case presentation A 76-year-old woman was referred to our hospital complaining of sudden abdominal pain and high fever. Her present history of illness did not show any cranial symptoms such as headache, visual disturbance, or stroke. CT images showed severe thickening of the small intestinal mesentery and massive ascites. She was diagnosed to have acute abdomen probably with gastrointestinal perforation and underwent the emergent laparotomy. Excisions of a 60-cm length of the jejunum including the thickening mesenteric lesion were carried out. Marked hypertrophy of the vascular intima and mild stenosis of the arterial lumen were displayed with infiltration of lymphocytes, neutrophils, and eosinophils. Scattered multinucleated giant cells on the endothelium, in the intima, media, and adventitia were demonstrated. Elastica van Gieson stain showed focal loss and fragmentation of the internal elastic lamina. Histopathological examinations showed typical GCA. Her postoperative process was uneventful without any symptoms, and she was followed as an out-patient prescribed with daily doses of 40 mg of prednisolone. Conclusions We hereby report a rare case of mesenteric involvement in GCA without cranial manifestations and elucidate the histopathological features of extracranial GCA in arteries as well as veins and jejunum.
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Affiliation(s)
- Yasuhiro Miyake
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Yoshikazu Morimoto
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan.
| | - Masaaki Taniguchi
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Chihiro Yamanaka
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Goro Ueno
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Sakae Ejima
- Department of Pathology, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Chikao Yutani
- Department of Pathology, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
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Mahr A, Belhassen M, Paccalin M, Devauchelle-Pensec V, Nolin M, Gandon S, Idier I, Hachulla E. Characteristics and management of giant cell arteritis in France: a study based on national health insurance claims data. Rheumatology (Oxford) 2019; 59:120-128. [DOI: 10.1093/rheumatology/kez251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objective
Few data are available on the epidemiology and management of GCA in real life. We aimed to address this situation by using health insurance claims data for France.
Methods
This retrospective study used the Echantillon Généraliste de Bénéficiaires (EGB) database, a 1% representative sample of the French national health insurance system. The EGB contains anonymous data on long-term disease status, hospitalizations and reimbursement claims for 752 717 people. Data were collected between 2007 and 2015. The index date was defined as the date of the first occurrence of a GCA code. Demographics, comorbidities, diagnostic tests and therapies were analysed. Annual incidence rates were calculated, and incident and overall GCA cases were studied.
Results
We identified 241 patients with GCA. The annual incidence was 7–10/100 000 people ⩾50 years old. Among the 117 patients with incident GCA, 74.4% were females, with mean age 77.6 years and mean follow-up 2.2 years. After the index date, 51.3% underwent temporal artery biopsy and 29.1% high-resolution Doppler ultrasonography. Among the whole cohort, 84.3% used only glucocorticoids. The most-prescribed glucocorticoid-sparing agent was methotrexate (12.0%).
Conclusion
The incidence of GCA in France is 7–10/100 000 people ⩾ 50 years old. Adjunct agents, mainly methotrexate, are given to only a few patients. The use of temporal artery biopsy in only half of the patients might reflect a shift toward the use of imaging techniques to diagnose GCA.
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Affiliation(s)
- Alfred Mahr
- Internal Medicine, Hospital Saint-Louis, University Paris Diderot, Paris, France
| | | | - Marc Paccalin
- Internal Medicine, University Hospital Poitiers, Poitiers, France
| | | | - Maeva Nolin
- Pelyon EA 7425, University Hospital Lyon, Lyon, France
| | - Sophie Gandon
- Clinical Operations France, Roche S.A.S., Boulogne-Billancourt, France
| | - Isabelle Idier
- Rheumatology Medical, Chugai Pharma France, Paris La Défense, France
| | - Eric Hachulla
- Internal Medicine and Clinical Immunology, CHU Lille, University Lille, LIRIC, INSERM, Lille, France
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Torisu Y, Horai Y, Michitsuji T, Kawahara C, Mori T, Iwanaga N, Izumi Y, Kawakami A. Giant Cell Arteritis with Generalized Granuloma Annulare. Intern Med 2019; 58:1173-1177. [PMID: 30568109 PMCID: PMC6522400 DOI: 10.2169/internalmedicine.1978-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022] Open
Abstract
We report the case of an 80-year-old man with generalized granuloma annulare (GGA) who subsequently developed giant cell arteritis (GCA). Steroid treatment was effective for both diseases in this case. Although cases of concomitant GGA and GCA have rarely been reported, previous studies suggest that common histological characteristics underlie the two diseases. It is therefore necessary to recognize that GGA can be complicated by GCA, particularly when typical symptoms, such as headache and visual disturbance, are present.
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Affiliation(s)
- Yuichi Torisu
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Japan
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Japan
| | - Tohru Michitsuji
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Rheumatology, Sasebo City General Hospital, Japan
| | - Chieko Kawahara
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Takahiro Mori
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Posarelli C, Talarico R, Passani A, Mosca M, Nardi M, Figus M. Morphologic ultrasonography of the temporal artery for diagnosis of giant cell arteritis: Brief report. Mod Rheumatol 2018; 29:717-719. [PMID: 30041560 DOI: 10.1080/14397595.2018.1504395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Chiara Posarelli
- a Ophthalmology Unit, Department of Surgical , Medical and Molecular Pathology and of the Critical Area, University of Pisa , Pisa , Italy
| | - Rosaria Talarico
- b Rheumatology Unit, Department of Internal Medicine , University of Pisa , Pisa , Italy
| | - Andrea Passani
- a Ophthalmology Unit, Department of Surgical , Medical and Molecular Pathology and of the Critical Area, University of Pisa , Pisa , Italy
| | - Marta Mosca
- b Rheumatology Unit, Department of Internal Medicine , University of Pisa , Pisa , Italy
| | - Marco Nardi
- a Ophthalmology Unit, Department of Surgical , Medical and Molecular Pathology and of the Critical Area, University of Pisa , Pisa , Italy
| | - Michele Figus
- a Ophthalmology Unit, Department of Surgical , Medical and Molecular Pathology and of the Critical Area, University of Pisa , Pisa , Italy
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A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA). Geriatrics (Basel) 2018; 3:geriatrics3030036. [PMID: 31011074 PMCID: PMC6319224 DOI: 10.3390/geriatrics3030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Giant cell arteritis/temporal arteritis (GCA) is an inflammatory condition that affects large to medium vessels such as the aorta and its primary branches. Patients classically present with fatigue, fever, headache, jaw claudication and in severe cases, may suffer either transient (amaurosis fugax) or permanent visual loss. The reference standard for diagnosis is the temporal artery biopsy (TAB) and the mainstay of treatment is with immunosuppression. Our patient JG, presented with a range of non-specific symptoms that mimicked generalised sepsis, but was ultimately diagnosed with GCA through effective, methodical multi-disciplinary team (MDT) work. Clinical case: JG, an 81 year old gentleman, presented acutely with a 3-4 weeks history of fatigue, lethargy, pyrexia and a marked inflammatory response suggestive of a sepsis but without a clear primary source or clinical features of vasculitis. His inflammatory markers were markedly raised although his erythrocyte sedimentation rate (ESR) was not elevated. He was initially treated for sepsis of unknown origin however, body imaging after admission suggested a possible infection around a previous aortic graft site. This was refuted in subsequent 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET/CT) scanning. Microbiological, parasitic, as well as autoimmune assays were unremarkable. He underwent a TAB which was diagnostic for GCA and as a result, was started on oral corticosteroids with immediate symptom relief. He was discharged and followed up on an outpatient basis. Conclusions: This case highlights how a vasculitis can present with a range of non-specific symptoms that may resemble a fever of unknown origin (FUO)/sepsis that can lead to a delay in making the correct diagnosis. It also highlights the importance of considering a diagnosis of vasculitis in patients who present with a FUO where there is no clear focus of infection. Delays in diagnosis and management of these conditions can potentially lead to significant irreversible morbidity.
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Singh JA, Cleveland JD. The association of gout with incident giant cell arteritis in older adults. Joint Bone Spine 2018; 86:219-224. [PMID: 29885976 DOI: 10.1016/j.jbspin.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess whether gout is associated with a higher or lower risk of a new diagnosis of giant cell arteritis (GCA) in older adults, adjusting for known risk factors of GCA. METHODS We used the 5% Medicare claims to conduct a multivariable Cox regression analyses to assess the association of gout with incident GCA in adults 65 years or older adjusting for age, gender, race (known risk factors for GCA) and Charlson-Romano comorbidity score, the use of medications for cardiovascular diseases (statins, beta-blockers, diuretics, ACE-inhibitors) and gout (allopurinol, febuxostat). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS There were 3004 incident cases (new diagnosis) of GCA with crude incidence rates of GCA of 28.0/100,000 person-years in patients without gout and 63.8/100,000 person-years in patients with gout. Multivariable-adjusted analyses showed that preexisting gout was associated with a higher risk of incident/new GCA diagnosis with a hazard ratio of 2.05 (95% CI: 1.76, 2.40), confirmed in sensitivity analyses that substituted continuous Charlson-Romano comorbidity score with categorized score or individual comorbidities (plus hypertension, hyperlipidemia, and coronary artery disease). Older age, female gender, white race and higher comorbidity index, were also associated with a higher hazard of GCA. Subgroup analyses did not show any significant variation of the association of preexisting gout with incident GCA by age, race or sex. CONCLUSIONS Gout was associated with more than 2-fold higher risk of incident GCA in older adults, independent of known risk factors of GCA. Future studies should explore the underlying mechanisms for this association.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL 35233, USA; Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0022, USA; Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave. South, Birmingham, AL 35294-0022, USA.
| | - John D Cleveland
- Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0022, USA
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Overview of the Diagnosis, Evaluation, and Novel Treatment Strategies for Ophthalmic Emergencies in the Hospitalized Geriatric Patient. Am J Ther 2018. [DOI: 10.1097/mjt.0000000000000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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