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Stamatis P, Mohammad MA, Gisslander K, Merkel PA, Englund M, Turesson C, Erlinge D, Mohammad AJ. Myocardial infarction in a population-based cohort of patients with biopsy-confirmed giant cell arteritis in southern Sweden. RMD Open 2024; 10:e003960. [PMID: 38599652 PMCID: PMC11015192 DOI: 10.1136/rmdopen-2023-003960] [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: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To determine the incidence rate (IR) of myocardial infarction (MI), relative risk of MI, and impact of incident MI on mortality in individuals with biopsy-confirmed giant cell arteritis (GCA). METHODS MIs in individuals diagnosed with GCA 1998-2016 in Skåne, Sweden were identified by searching the SWEDEHEART register, a record of all patients receiving care for MI in a coronary care unit (CCU). The regional diagnosis database, with subsequent case review, identified GCA patients receiving care for MI outside of a CCU. A cohort of 10 reference subjects for each GCA case, matched for age, sex and area of residence, was used to calculate the incidence rate ratio (IRR) of MI in GCA to that in the general population. RESULTS The GCA cohort comprised 1134 individuals. During 7958 person-years of follow-up, 102 were diagnosed with incident MI, yielding an IR of 12.8 per 1000 person-years (95% CI 10.3 to 15.3). The IR was highest in the 30 days following GCA diagnosis and declined thereafter. The IRR of MI in GCA to that of the background population was 1.29 (95% CI 1.05 to 1.59). Mortality was higher in GCA patients who experienced incident MI than in those without MI (HR 2.8; 95% CI 2.2 to 3.6). CONCLUSIONS The highest incidence of MI occurs within the 30 days following diagnosis of GCA. Individuals with GCA have a moderately increased risk of MI compared with a reference population. Incident MI has a major impact on mortality in GCA.
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Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Sunderby Hospital, Luleå, Sweden
| | | | - Karl Gisslander
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund Universtiy, Malmö, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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2
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Sato Y, Tada M, Goronzy JJ, Weyand CM. Immune checkpoints in autoimmune vasculitis. Best Pract Res Clin Rheumatol 2024:101943. [PMID: 38599937 DOI: 10.1016/j.berh.2024.101943] [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: 02/01/2024] [Revised: 03/10/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
Giant cell arteritis (GCA) is a prototypic autoimmune disease with a highly selective tissue tropism for medium and large arteries. Extravascular GCA manifests with intense systemic inflammation and polymyalgia rheumatica; vascular GCA results in vessel wall damage and stenosis, causing tissue ischemia. Typical granulomatous infiltrates in affected arteries are composed of CD4+ T cells and hyperactivated macrophages, signifying the involvement of the innate and adaptive immune system. Lesional CD4+ T cells undergo antigen-dependent clonal expansion, but antigen-nonspecific pathways ultimately control the intensity and duration of pathogenic immunity. Patient-derived CD4+ T cells receive strong co-stimulatory signals through the NOTCH1 receptor and the CD28/CD80-CD86 pathway. In parallel, co-inhibitory signals, designed to dampen overshooting T cell immunity, are defective, leaving CD4+ T cells unopposed and capable of supporting long-lasting and inappropriate immune responses. Based on recent data, two inhibitory checkpoints are defective in GCA: the Programmed death-1 (PD-1)/Programmed cell death ligand 1 (PD-L1) checkpoint and the CD96/CD155 checkpoint, giving rise to the "lost inhibition concept". Subcellular and molecular analysis has demonstrated trapping of the checkpoint ligands in the endoplasmic reticulum, creating PD-L1low CD155low antigen-presenting cells. Uninhibited CD4+ T cells expand, release copious amounts of the cytokine Interleukin (IL)-9, and differentiate into long-lived effector memory cells. These data place GCA and cancer on opposite ends of the co-inhibition spectrum, with cancer patients developing immune paralysis due to excessive inhibitory checkpoints and GCA patients developing autoimmunity due to nonfunctional inhibitory checkpoints.
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Affiliation(s)
- Yuki Sato
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Maria Tada
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Jorg J Goronzy
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA; Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA; Department of Medicine, School of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Cornelia M Weyand
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA; Department of Cardiology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA; Department of Immunology, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA; Department of Medicine, School of Medicine, Stanford University, Stanford, CA, 94305, USA.
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3
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Wadström K, Jacobsson LTH, Mohammad AJ, Warrington KJ, Matteson EL, Turesson C. Apolipoproteins and the risk of giant cell arteritis-a nested case-control study. Arthritis Res Ther 2024; 26:37. [PMID: 38281009 PMCID: PMC10821258 DOI: 10.1186/s13075-024-03273-1] [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: 09/19/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The etiology of giant cell arteritis (GCA) and its predictors are incompletely understood. Previous studies have indicated reduced risk of future development of GCA in individuals with obesity and/or diabetes mellitus. There is limited information on blood lipids before the onset of GCA. The objective of the study was to investigate the relation between apolipoprotein levels and future diagnosis of GCA in a nested case-control analysis. METHODS Individuals who developed GCA after inclusion in a population-based health survey (the Malmö Diet Cancer Study; N = 30,447) were identified by linking the health survey database to the local patient administrative register and the national patient register. A structured review of medical records was performed. Four controls for every validated case, matched for sex, year of birth, and year of screening, were selected from the database. Anthropometric measures, self-reported physical activity, based on a comprehensive, validated questionnaire, and non-fasting blood samples had been obtained at health survey screening. Concentrations of apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) in stored serum were measured using an immunonephelometric assay. Potential predictors of GCA were examined in conditional logistic regression models. RESULTS There were 100 cases with a confirmed clinical diagnosis of GCA (81% female; mean age at diagnosis 73.6 years). The median time from screening to diagnosis was 12 years (range 0.3-19.1). The cases had significantly higher ApoA-I at baseline screening compared to controls (mean 168.7 vs 160.9 mg/dL, odds ratio [OR] 1.57 per standard deviation (SD); 95% confidence interval [CI] 1.18-2.10) (SD 25.5 mg/dL). ApoB levels were similar between cases and controls (mean 109.3 vs 110.4 mg/dL, OR 0.99 per SD; 95% CI 0.74-1.32) (SD 27.1 mg/dL). The ApoB/ApoA1 ratio tended to be lower in cases than in controls, but the difference did not reach significance. The association between ApoA-I and GCA development remained significant in analysis adjusted for body mass index and physical activity (OR 1.48 per SD; 95% CI 1.09-1.99). CONCLUSION Subsequent development of GCA was associated with significantly higher levels of ApoA-I. These findings suggest that a metabolic profile associated with lower risk of cardiovascular disease may predispose to GCA.
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Affiliation(s)
- Karin Wadström
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, 205 02, Sweden
- Center for Rheumatology, Academic Specialist Center, Stockholm, Region Stockholm, Sweden
| | - Lennart T H Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, 205 02, Sweden
- Department of Rheumatology & Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aladdin J Mohammad
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, 205 02, Sweden.
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
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4
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Elfishawi M, Rakholiya J, Gunderson TM, Achenbach SJ, Crowson CS, Matteson EL, Turesson C, Wadström K, Weyand C, Koster MJ, Warrington KJ. Lower Frequency of Comorbidities Prior to Onset of Giant Cell Arteritis: A Population-Based Study. J Rheumatol 2023; 50:526-531. [PMID: 36521923 PMCID: PMC10066824 DOI: 10.3899/jrheum.220610] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the frequency of comorbidities and metabolic risk factors at and prior to giant cell arteritis (GCA) diagnosis. METHODS This is a retrospective case control study of patients with incident GCA between January 1, 2000, and December 31, 2019, in Olmsted County, Minnesota. Two age- and sex-matched controls were identified, and each assigned an index date corresponding to an incidence date of GCA. Medical records were manually abstracted for comorbidities and laboratory data at incidence date, 5 years, and 10 years prior to incidence date. Twenty-five chronic conditions using International Classification of Diseases, 9th revision, diagnosis codes were also studied at incidence date and 5 years prior to incidence date. RESULTS One hundred and twenty-nine patients with GCA (74% female) and 253 controls were identified. At incidence date, the prevalence of diabetes mellitus (DM) was lower among patients with GCA (5% vs 17%; P = 0.001). At 5 years prior to incidence date, patients were less likely to have DM (2% vs 13%; P < 0.001) and hypertension (27% vs 45%; P = 0.002) and had a lower mean number (SD) of comorbidities (0.7 [1.0] vs 1.3 [1.4]; P < 0.001) compared to controls. Moreover, patients had significantly lower median fasting blood glucose (FBG; 96 mg/dL vs 104 mg/dL; P < 0.001) and BMI (25.8 vs 27.7; P = 0.02) compared to controls. Multivariable logistic regression analysis revealed negative associations for FBG with GCA at 5 and 10 years prior to diagnosis/index date. CONCLUSION DM prevalence and median FBG and BMI were lower in patients with GCA up to 5 years prior to diagnosis, suggesting that metabolic factors influence the risk of GCA.
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Affiliation(s)
- Mohanad Elfishawi
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA;
| | - Jigisha Rakholiya
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina M Gunderson
- T.M. Gunderson, MS, S.J. Achenbach, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara J Achenbach
- T.M. Gunderson, MS, S.J. Achenbach, MS, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- C.S Crowson, PhD, E.L. Matteson, MD, MPH, Division of Rheumatology, Department of Internal Medicine, and Department of Quantitative Health Sciences. Mayo Clinic, Rochester, Minnesota, USA
| | - Eric L Matteson
- C.S Crowson, PhD, E.L. Matteson, MD, MPH, Division of Rheumatology, Department of Internal Medicine, and Department of Quantitative Health Sciences. Mayo Clinic, Rochester, Minnesota, USA
| | - Carl Turesson
- C. Turesson, MD, PhD, Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Karin Wadström
- K. Wadström, MD, PhD, Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, and Center for Rheumatology, Academic Specialist Center, Region Stockholm, Stockholm, Sweden
| | - Cornelia Weyand
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J Koster
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth J Warrington
- M. Elfishawi, MBBCh, MS, J. Rakholiya, MBBS, C. Weyand, MD, PhD, M.J. Koster, MD, K.J. Warrington, MD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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5
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Abstract
Giant cell arteritis is an autoimmune disease of medium and large arteries, characterized by granulomatous inflammation of the three-layered vessel wall that results in vaso-occlusion, wall dissection, and aneurysm formation. The immunopathogenesis of giant cell arteritis is an accumulative process in which a prolonged asymptomatic period is followed by uncontrolled innate immunity, a breakdown in self-tolerance, the transition of autoimmunity from the periphery into the vessel wall and, eventually, the progressive evolution of vessel wall inflammation. Each of the steps in pathogenesis corresponds to specific immuno-phenotypes that provide mechanistic insights into how the immune system attacks and damages blood vessels. Clinically evident disease begins with inappropriate activation of myeloid cells triggering the release of hepatic acute phase proteins and inducing extravascular manifestations, such as muscle pains and stiffness diagnosed as polymyalgia rheumatica. Loss of self-tolerance in the adaptive immune system is linked to aberrant signaling in the NOTCH pathway, leading to expansion of NOTCH1+CD4+ T cells and the functional decline of NOTCH4+ T regulatory cells (Checkpoint 1). A defect in the endothelial cell barrier of adventitial vasa vasorum networks marks Checkpoint 2; the invasion of monocytes, macrophages and T cells into the arterial wall. Due to the failure of the immuno-inhibitory PD-1 (programmed cell death protein 1)/PD-L1 (programmed cell death ligand 1) pathway, wall-infiltrating immune cells arrive in a permissive tissues microenvironment, where multiple T cell effector lineages thrive, shift toward high glycolytic activity, and support the development of tissue-damaging macrophages, including multinucleated giant cells (Checkpoint 3). Eventually, the vascular lesions are occupied by self-renewing T cells that provide autonomy to the disease process and limit the therapeutic effectiveness of currently used immunosuppressants. The multi-step process deviating protective to pathogenic immunity offers an array of interception points that provide opportunities for the prevention and therapeutic management of this devastating autoimmune disease.
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Affiliation(s)
- Cornelia M. Weyand
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Immunology, Mayo Clinic College of Medicine and Science
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94306
| | - Jörg J. Goronzy
- Department of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA
- Department of Immunology, Mayo Clinic College of Medicine and Science
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94306
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6
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Esen I, Arends S, Dalsgaard Nielsen B, Therkildsen P, Hansen I, van 't Ende A, Heeringa P, Boots A, Hauge E, Brouwer E, van Sleen Y. Metabolic features and glucocorticoid-induced comorbidities in patients with giant cell arteritis and polymyalgia rheumatica in a Dutch and Danish cohort. RMD Open 2023; 9:rmdopen-2022-002640. [PMID: 36631159 PMCID: PMC9835962 DOI: 10.1136/rmdopen-2022-002640] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are age-associated inflammatory diseases that frequently overlap. Both diseases require long-term treatment with glucocorticoids (GCs), often associated with comorbidities. Previous population-based cohort studies reported that an unhealthier metabolic profile might prevent the development of GCA. Here, we report metabolic features before start of treatment and during treatment in patients with GCA and PMR. METHODS In the Dutch GCA/PMR/SENEX (GPS) cohort, we analysed metabolic features and prevalence of comorbidities (type 2 diabetes, hypercholesterolaemia, hypertension, obesity and cataract) in treatment-naïve patients with GCA (n=50) and PMR (n=42), and compared those with the population-based Lifelines cohort (n=91). To compare our findings in the GPS cohort, we included data from patients with GCA (n=52) and PMR (n=25) from the Aarhus cohort. Laboratory measurements, comorbidities and GC use were recorded for up to 5 years in the GPS cohort. RESULTS Glycated haemoglobin levels tended to be higher in treatment-naïve patients with GCA, whereas high-density lipoprotein, low-density lipoprotein and cholesterol levels were lower compared with the Lifelines population. Data from the Aarhus cohort were aligned with the findings obtained in the GPS cohort. Presence of comorbidities at baseline did not predict long-term GC requirement. The incidence of diabetes, obesity and cataract among patients with GCA increased upon initiation of GC treatment. CONCLUSION Data from the GCA and PMR cohorts imply a metabolic dysregulation in treatment-naïve patients with GCA, but not in patients with PMR. Treatment with GCs led to the rise of comorbidities and an unhealthier metabolic profile, stressing the need for prednisone-sparing targeted treatment in these vulnerable patients.
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Affiliation(s)
- Idil Esen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Berit Dalsgaard Nielsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip Therkildsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Ib Hansen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna van 't Ende
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Heeringa
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - Annemieke Boots
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen Hauge
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yannick van Sleen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
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7
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Haaversen AB, Brekke LK, Bakland G, Rødevand E, Myklebust G, Diamantopoulos AP. Norwegian society of rheumatology recommendations on diagnosis and treatment of patients with giant cell arteritis. Front Med (Lausanne) 2023; 9:1082604. [PMID: 36687436 PMCID: PMC9853546 DOI: 10.3389/fmed.2022.1082604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To provide clinical guidance to Norwegian Rheumatologists and other clinicians involved in diagnosing and treating patients with giant cell arteritis (GCA). Methods The available evidence in the field was reviewed, and the GCA working group wrote draft guidelines. These guidelines were discussed and revised according to standard procedures within the Norwegian Society of Rheumatology. The European Alliance of Associations for Rheumatology (EULAR) recommendations for imaging and treatment in large vessel vasculitis and the British Society for Rheumatology (BSR) guidelines for diagnostics and treatment in GCA informed the development of the current guidelines. Results A total of 13 recommendations were developed. Ultrasound is recommended as the primary diagnostic test. In patients with suspected GCA, treatment with high doses of Prednisolone (40-60 mg) should be initiated immediately. For patients with refractory disease or relapse, Methotrexate (MTX) should be used as the first-line adjunctive therapy, followed by tocilizumab (TCZ). Conclusion Norwegian recommendations for diagnostics and treatment to improve management and outcome in patients with GCA were developed.
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Affiliation(s)
| | - Lene Kristin Brekke
- Department of Rheumatology, Hospital for Rheumatic Diseases, Haugesund, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Erik Rødevand
- Department of Rheumatology, St. Olav’s University Hospital, Trondheim, Norway
| | - Geirmund Myklebust
- Department of Research, Hospital of Southern Norway, Kristiansand, Norway
| | - Andreas P. Diamantopoulos
- Department of Infectious Diseases, Division of Internal Medicine, Akershus University Hospital, Lørenskog, Norway,*Correspondence: Andreas P. Diamantopoulos,
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8
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Buttgereit F, Palmowski A, Esen I, Brouwer E. Tocilizumab in Giant Cell Arteritis: Better Understanding the Benefits. Arthritis Rheumatol 2022; 75:489-492. [PMID: 36468520 DOI: 10.1002/art.42414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Frank Buttgereit
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Andriko Palmowski
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany, Section for Biostatistics and Evidence-Based Research, The Parker Institute, University of Copenhagen, Copenhagen, Denmark, and Division of Rheumatology, University of California San Francisco
| | - Idil Esen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Abstract
Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease affecting people older than 50 years and is 2-3 times more common in women. The most common symptoms are pain and morning stiffness in the shoulder and pelvic girdle and the onset may be acute or develop over a few days to weeks. General symptoms such as fatigue, fever and weight loss may occur, likely driven by systemic IL-6 signalling. The pathology includes synovial and periarticular inflammation and muscular vasculopathy. A new observation is that PMR may appear as a side effect of cancer treatment with checkpoint inhibitors. The diagnosis of PMR relies mainly on symptoms and signs combined with laboratory markers of inflammation. Imaging modalities including ultrasound, magnetic resonance imaging and positron emission tomography with computed tomography are promising new tools in the investigation of suspected PMR. However, they are still limited by availability, high cost and unclear performance in the diagnostic workup. Glucocorticoid (GC) therapy is effective in PMR, with most patients responding promptly to 15-25 mg prednisolone per day. There are challenges in the management of patients with PMR as relapses do occur and patients with PMR may need to stay on GC for extended periods. This is associated with high rates of GC-related comorbidities, such as diabetes and osteoporosis, and there are limited data on the use of disease-modifying antirheumatic drugs and biologics as GC sparing agents. Finally, PMR is associated with giant cell arteritis that may complicate the disease course and require more intense and prolonged treatment.
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Affiliation(s)
- Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Ankita Sharma
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund-Malmö, Sweden
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, Lund-Malmö, Sweden.,Rheumatology, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
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10
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Wadström K, Jacobsson L, Mohammad AJ, Warrington KJ, Matteson EL, Turesson C. Comment on: Negative associations for fasting blood glucose, cholesterol and triglyceride levels with the development of giant cell arteritis: reply. Rheumatology (Oxford) 2021; 60:e262-e263. [PMID: 33576780 PMCID: PMC8249078 DOI: 10.1093/rheumatology/keab143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karin Wadström
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö
| | - Lennart Jacobsson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö.,Department of Rheumatology & Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenberg, Gothenburg
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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11
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Stamatis P, Turkiewicz A, Englund M, Turesson C, Mohammad AJ. Epidemiology of biopsy-confirmed giant cell arteritis in southern Sweden - an update on incidence and first prevalence estimate. Rheumatology (Oxford) 2021; 61:146-153. [PMID: 33742665 PMCID: PMC8742826 DOI: 10.1093/rheumatology/keab269] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To characterize the epidemiology of temporal artery biopsy-positive (TAB+) GCA, including trends in incidence, seasonal variation and prevalence in Skåne, the southernmost region of Sweden. Methods All histopathology reports of TABs from 1997 through 2019 were reviewed to identify patients diagnosed with TAB+ GCA. Incidence rates based on the 23-year period and the point-prevalence at 31 December 2014 were determined. An alternative prevalence calculation included only TAB+ GCA patients living in the study area and receiving immunosuppressant therapy on the point-prevalence date. Results One thousand three hundred and sixty patients were diagnosed with TAB+ GCA (71% female). The average annual incidence 1997–2019 was 13.3 (95% CI: 12.6, 14.0) per 100 000 inhabitants aged ≥50 years and was higher in females (17.8; 95% CI: 16.7, 18.9) than in males (8.2; 95% CI: 7.4, 9.0). The age- and sex-standardized incidence declined from 17.3 in 1997 to 8.7 in 2019, with incidence ratio (IR) of 0.98 per year (95% CI: 0.98, 0.99). A seasonal variation was observed with higher incidence during spring than winter [IR = 1.19 (95% CI: 1.03, 1.39)]. The overall point-prevalence of TAB+ GCA was 127.1/100 000 (95% CI: 117, 137.3) and was 75.5 (95% CI: 67.7, 83.3) when including only patients receiving immunosuppressants. Conclusion Over the past 2 decades, the incidence of biopsy-confirmed GCA has decreased by ∼2% per year. Still, a high prevalence of GCA on current treatment was observed. More cases are diagnosed during spring and summer than in the winter.
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Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden.,Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Thessaly, Greece
| | - Aleksandra Turkiewicz
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Sweden
| | - Martin Englund
- Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund University, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Sweden.,Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
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12
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Wadström K, Jacobsson L, Mohammad AJ, Warrington KJ, Matteson EL, Turesson C. Negative associations for fasting blood glucose, cholesterol and triglyceride levels with the development of giant cell arteritis. Rheumatology (Oxford) 2021; 59:3229-3236. [PMID: 32240313 PMCID: PMC7590417 DOI: 10.1093/rheumatology/keaa080] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives To investigate metabolic features that may predispose to GCA in a nested case–control study. Methods Individuals who developed GCA after inclusion in a population-based health survey (the Malmö Preventive Medicine Project; N = 33 346) were identified and validated through a structured review of medical records. Four controls for every validated case were selected from the database. Results A total of 76 cases with a confirmed incident diagnosis of GCA (61% female, 65% biopsy positive, mean age at diagnosis 70 years) were identified. The median time from screening to diagnosis was 20.7 years (range 3.0–32.1). Cases had significantly lower fasting blood glucose (FBG) at baseline screening compared with controls [mean 4.7 vs 5.1 mmol/l (S.d. overall 1.5), odds ratio (OR) 0.35 per mmol/l (95% CI 0.17, 0.71)] and the association remained significant when adjusted for smoking [OR 0.33 per mmol/l (95% CI 0.16, 0.68)]. Current smokers had a reduced risk of GCA [OR 0.35 (95% CI 0.18, 0.70)]. Both cholesterol [mean 5.6 vs 6.0 mmol/l (S.d. overall 1.0)] and triglyceride levels [median 1.0 vs 1.2 mmol/l (S.d. overall 0.8)] were lower among the cases at baseline screening, with significant negative associations with subsequent GCA in crude and smoking-adjusted models [OR 0.62 per mmol/l (95% CI 0.43, 0.90) for cholesterol; 0.46 per mmol/l (95% CI 0.27, 0.81) for triglycerides]. Conclusion Development of GCA was associated with lower FBG and lower cholesterol and triglyceride levels at baseline, all adjusted for current smoking, suggesting that metabolic features predispose to GCA.
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Affiliation(s)
- Karin Wadström
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Sweden
| | - Lennart Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology & Inflammation Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Sweden
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13
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Yuan S, Larsson SC. An atlas on risk factors for type 2 diabetes: a wide-angled Mendelian randomisation study. Diabetologia 2020; 63:2359-2371. [PMID: 32895727 PMCID: PMC7527357 DOI: 10.1007/s00125-020-05253-x] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 02/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to use Mendelian randomisation (MR) to identify the causal risk factors for type 2 diabetes. METHODS We first conducted a review of meta-analyses and review articles to pinpoint possible risk factors for type 2 diabetes. Around 170 possible risk factors were identified of which 97 risk factors with available genetic instrumental variables were included in MR analyses. To reveal more risk factors that were not included in our MR analyses, we conducted a review of published MR studies of type 2 diabetes. For our MR analyses, we used summary-level data from the DIAbetes Genetics Replication And Meta-analysis consortium (74,124 type 2 diabetes cases and 824,006 controls of European ancestry). Potential causal associations were replicated using the FinnGen consortium (11,006 type 2 diabetes cases and 82,655 controls of European ancestry). The inverse-variance weighted method was used as the main analysis. Multivariable MR analysis was used to assess whether the observed associations with type 2 diabetes were mediated by BMI. We used the Benjamini-Hochberg method that controls false discovery rate for multiple testing. RESULTS We found evidence of causal associations between 34 exposures (19 risk factors and 15 protective factors) and type 2 diabetes. Insomnia was identified as a novel risk factor (OR 1.17 [95% CI 1.11, 1.23]). The other 18 risk factors were depression, systolic BP, smoking initiation, lifetime smoking, coffee (caffeine) consumption, plasma isoleucine, valine and leucine, liver alanine aminotransferase, childhood and adulthood BMI, body fat percentage, visceral fat mass, resting heart rate, and four plasma fatty acids. The 15 exposures associated with a decreased risk of type 2 diabetes were plasma alanine, HDL- and total cholesterol, age at menarche, testosterone levels, sex hormone binding globulin levels (adjusted for BMI), birthweight, adulthood height, lean body mass (for women), four plasma fatty acids, circulating 25-hydroxyvitamin D and education years. Eight associations remained after adjustment for adulthood BMI. We additionally identified 21 suggestive risk factors (p < 0.05), such as alcohol consumption, breakfast skipping, daytime napping, short sleep, urinary sodium, and certain amino acids and inflammatory factors. CONCLUSIONS/INTERPRETATION The present study verified several previously reported risk factors and identified novel potential risk factors for type 2 diabetes. Prevention strategies for type 2 diabetes should be considered from multiple perspectives on obesity, mental health, sleep quality, education level, birthweight and smoking.
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Affiliation(s)
- Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden.
- Department of Surgical Sciences, Uppsala University, Dag Hammarskjölds Väg 14B, 75185, Uppsala, Sweden.
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Incidence and prevalence of giant cell arteritis and polymyalgia rheumatica: A systematic literature review. Semin Arthritis Rheum 2020; 50:1040-1048. [DOI: 10.1016/j.semarthrit.2020.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022]
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15
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Watanabe R, Berry GJ, Liang DH, Goronzy JJ, Weyand CM. Cellular Signaling Pathways in Medium and Large Vessel Vasculitis. Front Immunol 2020; 11:587089. [PMID: 33072134 PMCID: PMC7544845 DOI: 10.3389/fimmu.2020.587089] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022] Open
Abstract
Autoimmune and autoinflammatory diseases of the medium and large arteries, including the aorta, cause life-threatening complications due to vessel wall destruction but also by wall remodeling, such as the formation of wall-penetrating microvessels and lumen-stenosing neointima. The two most frequent large vessel vasculitides, giant cell arteritis (GCA) and Takayasu arteritis (TAK), are HLA-associated diseases, strongly suggestive for a critical role of T cells and antigen recognition in disease pathogenesis. Recent studies have revealed a growing spectrum of effector functions through which T cells participate in the immunopathology of GCA and TAK; causing the disease-specific patterning of pathology and clinical outcome. Core pathogenic features of disease-relevant T cells rely on the interaction with endothelial cells, dendritic cells and macrophages and lead to vessel wall invasion, formation of tissue-damaging granulomatous infiltrates and induction of the name-giving multinucleated giant cells. Besides antigen, pathogenic T cells encounter danger signals in their immediate microenvironment that they translate into disease-relevant effector functions. Decisive signaling pathways, such as the AKT pathway, the NOTCH pathway, and the JAK/STAT pathway modify antigen-induced T cell activation and emerge as promising therapeutic targets to halt disease progression and, eventually, reset the immune system to reestablish the immune privilege of the arterial wall.
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Affiliation(s)
- Ryu Watanabe
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - David H Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Jörg J Goronzy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Cornelia M Weyand
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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16
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Yates M, Luben R, Hayat S, Mackie SL, Watts RA, Khaw KT, Wareham NJ, MacGregor AJ. Cardiovascular risk factors associated with polymyalgia rheumatica and giant cell arteritis in a prospective cohort: EPIC-Norfolk Study. Rheumatology (Oxford) 2020; 59:319-323. [PMID: 31325308 DOI: 10.1093/rheumatology/kez289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/13/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES PMR and GCA are associated with increased risk of vascular disease. However, it remains unclear whether this relationship is causal or reflects a common underlying propensity. The aim of this study was to identify whether known cardiovascular risk factors increase the risk of PMR and GCA. METHODS Clinical records were examined using key word searches to identify cases of PMR and GCA, applying current classification criteria in a population-based cohort. Associations between cardiovascular risk factors and incident PMR and GCA were analysed using Cox proportional hazards. RESULTS In 315 022 person years of follow-up, there were 395 incident diagnoses of PMR and 118 incident diagnoses of GCA that met the clinical definition. Raised diastolic blood pressure (>90 mmHg) at baseline/recruitment was associated with subsequent incident PMR [hazard ratio=1.35 (95% CI 1.01, 1.80) P=0.045], and ever-smoking was associated with incident GCA [hazard ratio=2.01 (95% CI 1.26, 3.20) P=0.003]. Estimates were similar when the analysis was restricted to individuals whose diagnoses satisfied the current classification criteria sets. CONCLUSION PMR and GCA shares common risk factors with vascular disease onset, suggesting a common underlying propensity. This may indicate a potential for disease prevention strategies through modifying cardiovascular risk.
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Affiliation(s)
- Max Yates
- Centre for Epidemiology Versus Arthritis, Norwich Medical School, University of East Anglia, Norwich
| | - Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge
| | - Shabina Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge
| | - Sarah L Mackie
- Department of Rheumatology, Chapel Allerton Hospital, Leeds
| | - Richard A Watts
- Centre for Epidemiology Versus Arthritis, Norwich Medical School, University of East Anglia, Norwich
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge
| | - Nick J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Alex J MacGregor
- Centre for Epidemiology Versus Arthritis, Norwich Medical School, University of East Anglia, Norwich
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Matsumoto K, Kaneko Y, Takeuchi T. Body mass index associates with disease relapse in patients with giant cell arteritis. Int J Rheum Dis 2019; 22:1782-1786. [PMID: 31245915 DOI: 10.1111/1756-185x.13642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify risk factors associated with disease relapse in giant cell arteritis (GCA). METHODS We reviewed data from 30 consecutive, newly diagnosed patients with GCA. The patients were divided according to relapse or non-relapse status, and their baseline characteristics were compared. RESULTS Among the 30 patients, 8 relapsed at a median of 28 weeks from GCA diagnosis. Patients with relapse were male-dominant (male: 88% vs female: 41%, P = 0.02) and showed a higher body mass index (BMI, 23 kg/m2 vs 19 kg/m2 , P < 0.01) than non-relapse patients. Patients with BMI ≥ 21 kg/m2 showed a significantly higher relapse rate than those with BMI < 21 kg/m2 during the 100-week follow-up (46% vs 0%, log-rank test, P < 0.01). CONCLUSION Higher BMI may be associated with relapse in patients with GCA.
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Affiliation(s)
- Kotaro Matsumoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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18
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Stamatis P, Turesson C, Willim M, Nilsson JÅ, Englund M, Mohammad AJ. Malignancies in Giant Cell Arteritis: A Population-based Cohort Study. J Rheumatol 2019; 47:400-406. [PMID: 31154410 DOI: 10.3899/jrheum.190236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the risk of cancer in patients with biopsy-proven giant cell arteritis (GCA) from a defined population in southern Sweden. METHODS The study cohort consisted of 830 patients (mean age at GCA diagnosis was 75.3 yrs, 74% women) diagnosed with biopsy-proven GCA between 1997 and 2010. Temporal artery biopsy results were retrieved from a regional database and reviewed to ascertain GCA diagnosis. The cohort was linked to the Swedish Cancer Registry. The patients were followed from GCA diagnosis until death or December 31, 2013. Incident malignancies registered after GCA diagnosis were studied. Based on data on the first malignancy in each organ system, age- and sex-standardized incidence ratios (SIR) with 95% CI were calculated compared to the background population. RESULTS One hundred seven patients (13%) were diagnosed with a total of 118 new malignancies after the onset of GCA. The overall risk for cancer after the GCA diagnosis was not increased (SIR 0.98, 95% CI 0.81-1.17). However, there was an increased risk for myeloid leukemia (2.31, 95% CI 1.06-4.39) and a reduced risk for breast cancer (0.33, 95% CI 0.12-0.72) and upper gastrointestinal tract cancer (0.16, 95% 0.004-0.91). Rates of other site-specific cancers were not different from expected. CONCLUSION In this Swedish population-based cohort of GCA, the overall risk for cancer was not increased compared to the background population. However, there was an increased risk for leukemia and a decreased risk for breast and upper gastrointestinal tract cancer.
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Affiliation(s)
- Pavlos Stamatis
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK. .,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge.
| | - Carl Turesson
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Minna Willim
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Jan-Åke Nilsson
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Martin Englund
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
| | - Aladdin J Mohammad
- From Lund University, Department of Clinical Sciences Lund, Section of Rheumatology, and Orthopaedics and Clinical Epidemiology Unit, Lund; Lund University, Department of Clinical Sciences Malmö, Section of Rheumatology, Malmö, Sweden; Department of Medicine, University of Cambridge, Cambridge, UK.,P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences Lund, Rheumatology, Lund University; C. Turesson, MD, PhD, Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences Malmö, Rheumatology, Lund University; M. Willim, IT Coordinator, Department of Clinical Sciences Lund, Rheumatology, Lund University; J.Å. Nilsson, PhD, Statistician, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Lund, Clinical Epidemiology Unit; A.J. Mohammad, MD, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Clinical Epidemiology Unit, Lund University, and Department of Medicine, University of Cambridge
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Watanabe R, Hilhorst M, Zhang H, Zeisbrich M, Berry GJ, Wallis BB, Harrison DG, Giacomini JC, Goronzy JJ, Weyand CM. Glucose metabolism controls disease-specific signatures of macrophage effector functions. JCI Insight 2018; 3:123047. [PMID: 30333306 PMCID: PMC6237479 DOI: 10.1172/jci.insight.123047] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/11/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In inflammatory blood vessel diseases, macrophages represent a key component of the vascular infiltrates and are responsible for tissue injury and wall remodeling. METHODS To examine whether inflammatory macrophages in the vessel wall display a single distinctive effector program, we compared functional profiles in patients with either coronary artery disease (CAD) or giant cell arteritis (GCA). RESULTS Unexpectedly, monocyte-derived macrophages from the 2 patient cohorts displayed disease-specific signatures and differed fundamentally in metabolic fitness. Macrophages from CAD patients were high producers for T cell chemoattractants (CXCL9, CXCL10), the cytokines IL-1β and IL-6, and the immunoinhibitory ligand PD-L1. In contrast, macrophages from GCA patients upregulated production of T cell chemoattractants (CXCL9, CXCL10) but not IL-1β and IL-6, and were distinctly low for PD-L1 expression. Notably, disease-specific effector profiles were already identifiable in circulating monocytes. The chemokinehicytokinehiPD-L1hi signature in CAD macrophages was sustained by excess uptake and breakdown of glucose, placing metabolic control upstream of inflammatory function. CONCLUSIONS We conclude that monocytes and macrophages contribute to vascular inflammation in a disease-specific and discernible pattern, have choices to commit to different functional trajectories, are dependent on glucose availability in their immediate microenvironment, and possess memory in their lineage commitment. FUNDING Supported by the NIH (R01 AR042527, R01 HL117913, R01 AI108906, P01 HL129941, R01 AI108891, R01 AG045779 U19 AI057266, R01 AI129191), I01 BX001669, and the Cahill Discovery Fund.
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Affiliation(s)
- Ryu Watanabe
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Marc Hilhorst
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
- Department of Internal Medicine, Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Hui Zhang
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Markus Zeisbrich
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Gerald J. Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Barbara B. Wallis
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - David G. Harrison
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John C. Giacomini
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California USA
| | - Jörg J. Goronzy
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Cornelia M. Weyand
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
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Smoking as a risk factor for giant cell arteritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:529-537. [PMID: 30093239 DOI: 10.1016/j.semarthrit.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To investigate the association between smoking and giant cell arteritis (GCA). METHODS A systematic review was performed and meta-analysis conducted on observational studies that reported absolute numbers and/or statistical comparisons with 95% confidence intervals comparing smoking history and presence of GCA, among patients with GCA and non-GCA controls. Studies were reviewed in accordance with PRISMA guidelines. Point estimates and standard errors were extracted from individual studies and were combined by the generic inverse variance method of DerSimonian and Laird. A random-effects meta-analysis was performed. Statistical heterogeneity was assessed using the Cochran's Q test which was complemented with the I2 statistic. RESULTS The initial search yielded 3312 articles. Of these, thirteen studies (8 prospective and, 5 retrospective case-control studies) with unique cohorts were identified and included in the primary analysis (ever vs. never smoking history). Patients in the GCA cohort were more likely to have a history of smoking with an odds ratio of 1.19 (95% CI, 1.01-1.39). Considerable heterogeneity was present (I2 = 85%). Five of these studies included information on current smoking status. One additional study, which only reported current smoking status, was also included. The GCA cohort showed an association with current smoking with an odds ratio of 1.18 (95% CI, 1.01-1.38). CONCLUSION Our study demonstrated a statistically significant increased risk of GCA among both current and ever smokers compared to non-smokers.
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Épidémiologie et histoire naturelle de l’artérite à cellules géantes (Horton). Rev Med Interne 2017; 38:663-669. [DOI: 10.1016/j.revmed.2017.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/11/2017] [Indexed: 02/02/2023]
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22
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Cefai E, Galea M, Galea R, Borg AA, Mercieca C. Can rheumatologists diagnose and manage Giant Cell Arteritis better than non-rheumatologists? The Maltese Experience. Mediterr J Rheumatol 2017; 28:147-152. [PMID: 32185273 PMCID: PMC7046062 DOI: 10.31138/mjr.28.3.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/28/2017] [Accepted: 09/03/2017] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES: Giant Cell Arteritis (GCA) remains a challenge both in terms of diagnosis and management as patients may present to several different specialists. The objectives were to determine incidence of biopsy-proven GCA in Malta and to compare the management between rheumatologists and non-rheumatologists. METHODS: This was a retrospective observational population study of patients with suspected GCA who underwent a temporal artery biopsy (TAB) between 2012 and 2015. Data collected consisted of demographics, presenting symptoms, TAB histology reports, treatment and outcome. The British Society for Rheumatology (BSR) 2010 guidelines were used as standard of care. RESULTS: 136 patients underwent a TAB for suspected GCA of which 26 were positive. The incidence of biopsy-proven GCA in Malta was 3.82 per 100,000 patient years in the over 50 population. There were 63 patients who were treated as GCA. Only 43.3% of confirmed cases had rheumatology input. TABs requested by rheumatologists were twice more likely to be positive compared to requests by non-rheumatologists (30.5% vs. 14.1%).The majority of patients were started on a Prednisolone dose between 40–60mg. Rheumatologists maintained patients on high doses for at least 1 month in 54% of cases as opposed to 20% under non-rheumatologists. Monitoring was more regular for cases followed up by rheumatologists (40% vs. 21%). CONCLUSIONS: Malta has a low incidence of biopsy proven GCA. Although rheumatologists are more likely to adhere to the recommended guidelines, improvement is needed. Rheumatologists should take the lead to minimise variation and optimise management of GCA.
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Affiliation(s)
- Erika Cefai
- Department of Rheumatology, Mater Dei Hospital, Msida, Malta
| | - Marica Galea
- Department of Rheumatology, Mater Dei Hospital, Msida, Malta
| | - Rebecca Galea
- Department of Rheumatology, Mater Dei Hospital, Msida, Malta
| | - Andrew A Borg
- Department of Rheumatology, Mater Dei Hospital, Msida, Malta
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23
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Olsson P, Turesson C, Mandl T, Jacobsson L, Theander E. Cigarette smoking and the risk of primary Sjögren's syndrome: a nested case control study. Arthritis Res Ther 2017; 19:50. [PMID: 28270185 PMCID: PMC5341180 DOI: 10.1186/s13075-017-1255-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/09/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Smoking is reported to affect the risk of a number of chronic disorders, including rheumatic diseases. Previous cross-sectional studies have shown a lower frequency of smoking in patients with primary Sjögren's syndrome (pSS). The aim of this study was to investigate the impact of smoking and socioeconomic status on the risk of subsequent diagnosis of pSS in a nested case-control study. METHOD Participants in two large population-based health surveys who were later diagnosed with pSS were identified through linkage with the Malmö Sjögren's Syndrome Register. Matched controls were obtained from the health surveys. RESULTS Sixty-three patients with pSS with pre-diagnostic data from the health surveys were identified. Current smoking was associated with a significantly lower risk of later being diagnosed with pSS (odds ratio (OR) 0.3; 95% CI 0.1-0.6). Furthermore, former smoking was associated with an increased risk of subsequent pSS diagnosis (OR 4.0; 95% CI 1.8-8.8) compared to never smoking. Similar results were found in a sub-analysis of patients with reported symptom onset after inclusion in the health surveys. Socioeconomic status and levels of formal education had no significant impact on the risk of later being diagnosed with pSS. CONCLUSION In this nested case-control study, current smoking was associated with a reduced risk of subsequent diagnosis of pSS. In addition, former smoking was associated with an increased risk. Whether this reflects a biological effect of cigarette smoking or other mechanisms should be further investigated in future studies.
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Affiliation(s)
- Peter Olsson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden.
| | - Carl Turesson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
| | - Thomas Mandl
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
| | - Lennart Jacobsson
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology and Inflammation research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elke Theander
- Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden
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24
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Jakobsson K, Jacobsson L, Mohammad AJ, Nilsson JÅ, Warrington K, Matteson EL, Turesson C. The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis. BMC Musculoskelet Disord 2016; 17:363. [PMID: 27558589 PMCID: PMC4997683 DOI: 10.1186/s12891-016-1225-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/18/2016] [Indexed: 02/05/2023] Open
Abstract
Background To investigate the effect of baseline clinical characteristics and glucocorticoid treatment on temporal artery biopsy (TAB) findings in patients with giant cell arteritis (GCA). Methods Individuals who developed GCA after inclusion in two population-based health surveys were identified through linkage to the local and the national patient registers. In addition, other patients diagnosed with GCA at the Departments of Internal Medicine and Rheumatology at an area hospital were included. A structured review of medical records and TAB pathology reports was performed. The presence or absence of giant cells, granuloma, fragmented internal elastic lamina, fibrosis and grade of inflammatory infiltrates were recorded. Results In 183 cases with a confirmed clinical diagnosis of GCA, 139 were biopsied after start of glucocorticoids (median treatment duration 3 days; interquartile range 2–5). Patients with a positive TAB (77 %) had significantly higher C-reactive protein (CRP; p = 0.007) and erythrocyte sedimentation rate (ESR; p = 0.03) at the time of clinical diagnosis. A positive TAB tended to more common in women, but there was no difference in the proportion of patients with polymyalgia rheumatica or visual symptoms. Patients biopsied before or on the same day as initial treatment where more likely than those biopsied 1–3 days after treatment start to have positive biopsy [odds ratio (OR) 2.86; 95 % CI 1.06–7.70] as well as inflammatory infiltrates (OR 3.30; 95 % CI 1.15–9.49). There was no significant difference in the proportions of a fragmented internal lamina (p = 0.86), giant cells (p = 0.10), granuloma (p = 0.19), minor inflammatory infiltrates (p = 0.47), major inflammatory infiltrates (p = 0.09), or overall positive biopsy (p = 0.17) report by treatment duration comparing: ≤ 0 days, 1–3 days, 4–6 days, 7–28 days. Among those biopsied 7–28 days after start of treatment, 80 % of TABs were positive, and histopathology features were not substantially different from those biopsied after shorter glucocorticoid treatment. Conclusion Biopsies were more likely to be positive and have characteristic histopathologic features in patients with high CRP and ESR, and prior to start of corticosteroid treatment TABs taken 1–4 weeks after initiation of glucocorticoid treatment reveal changes consistent with GCA and therefore still yields clinically useful information for the diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1225-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin Jakobsson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden. .,Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden.
| | - Lennart Jacobsson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology & Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden
| | - Aladdin J Mohammad
- Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden.,Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | - Jan-Åke Nilsson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden
| | - Kenneth Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Carl Turesson
- Department of Clinical Sciences, Rheumatology, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, S-205 02, Malmö, Sweden
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25
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Perricone C, Versini M, Ben-Ami D, Gertel S, Watad A, Segel MJ, Ceccarelli F, Conti F, Cantarini L, Bogdanos DP, Antonelli A, Amital H, Valesini G, Shoenfeld Y. Smoke and autoimmunity: The fire behind the disease. Autoimmun Rev 2016; 15:354-74. [DOI: 10.1016/j.autrev.2016.01.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/31/2015] [Indexed: 12/14/2022]
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26
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Ungprasert P, Thongprayoon C, Warrington KJ. Lower body mass index is associated with a higher risk of giant cell arteritis: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:232. [PMID: 26539449 DOI: 10.3978/j.issn.2305-5839.2015.09.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To characterize the possible association between body mass index (BMI) and risk of giant cell arteritis (GCA). METHODS We conducted a systematic review of observational studies (case-control or cohort study) that (I) reported BMI of patients with GCA prior to the diagnosis of GCA compared with subjects without GCA and (II) provided relative risk (RR), odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI) from its regression analysis. Meta-analysis of the included studies was then performed to estimate the pooled effect using generic variance method of DerSimonian and Laird. RESULTS Three studies encompassing 141 patients with GCA and 85,736 controls met our eligibility criteria and were included in the data analyses. We demonstrated a statistically significant inverse relationship between BMI and risk of subsequent development of GCA as the risk increased by 8% when BMI was reduced by 1.0 kg/m(2) (pooled OR of 0.92/kg/m(2); 95% CI, 0.88-0.96). CONCLUSIONS Our study demonstrated a statistically significant inverse relationship between BMI and risk of subsequent development GCA. The pathophysiologic link behind this negative correlation is not well-characterized and further investigation is required.
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Affiliation(s)
- Patompong Ungprasert
- 1 Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA ; 2 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ; 3 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Charat Thongprayoon
- 1 Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA ; 2 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ; 3 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Kenneth J Warrington
- 1 Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA ; 2 Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand ; 3 Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Turesson C, Bergström U, Pikwer M, Nilsson JÅ, Jacobsson LT. High serum cholesterol predicts rheumatoid arthritis in women, but not in men: a prospective study. Arthritis Res Ther 2015; 17:284. [PMID: 26458977 PMCID: PMC4603637 DOI: 10.1186/s13075-015-0804-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Environmental exposures, including smoking, hormone-related factors, and metabolic factors, have been implicated in the etiology of rheumatoid arthritis (RA). A previous study has indicated that blood lipid levels may influence the development of RA. The objective of this study was to investigate the impact of serum total cholesterol and triglycerides on the risk of RA in a prospective study. METHODS Among participants in a large population-based health survey (n = 33,346), individuals who subsequently developed RA were identified by linkage to four different registers and a structured review of the medical records. In a nested case-control study, with controls, matched for age, sex, and year of inclusion, from the health survey database, the relation between serum lipids (levels of total cholesterol and triglycerides) and future RA development was examined. RESULTS In total, 290 individuals (151 men and 139 women) whose RA was diagnosed a median of 12 years (range of 1-28) after inclusion in the health survey were compared with 1160 controls. Women with a diagnosis of RA during the follow-up had higher total cholesterol levels at baseline compared with controls: odds ratio (OR) 1.54 per standard deviation; 95 % confidence interval (CI) 1.22-1.94. This association remained statistically significant in multivariate models adjusted for smoking and a history of early menopause and in analyses stratified by rheumatoid factor status and time to RA diagnosis. Total cholesterol had no significant impact on the risk of RA in men (OR 1.03; 95 % CI 0.83-1.26). Triglycerides did not predict RA in men or women. CONCLUSIONS A high total cholesterol was a risk factor for RA in women but not in men. This suggests that sex-specific exposures modify the impact of lipids on the risk of RA. Hormone-related metabolic pathways may contribute to RA development.
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Affiliation(s)
- Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Ulf Bergström
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Mitra Pikwer
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Eskilstuna Hospital, Kungsvägen 34, Eskilstuna, 631 88, Sweden.
| | - Jan-Åke Nilsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology, Skåne University Hospital, Inga-Marie Nilssons gata 32, 205 02, Malmö, Sweden.
| | - Lennart Th Jacobsson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Inga-Marie Nilssons gata 32, Malmö, 205 02, Sweden. .,Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, Gothenburg, 413 46, Sweden.
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28
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Turesson C, Bergström U, Pikwer M, Nilsson JÅ, Jacobsson LTH. A high body mass index is associated with reduced risk of rheumatoid arthritis in men, but not in women. Rheumatology (Oxford) 2015; 55:307-14. [PMID: 26350488 DOI: 10.1093/rheumatology/kev313] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To investigate the impact of overweight and obesity on the risk of RA. METHODS From two large population-based health surveys (30 447 and 33 346 participants), individuals who developed RA after inclusion were identified by linkage to four different registers and a structured review of the medical records. Matched controls were selected from the corresponding health survey database. The impact of overweight or obesity (BMI > 25 kg/m(2)) compared with normal BMI (18.5-25 kg/m(2)) on the risk of RA was examined in conditional logistic regression models, stratified by sex. RESULTS A total of 172 (36 men/136 women) and 290 (151 men/139 women) individuals were diagnosed with RA after inclusion in the two health surveys. The median time from inclusion to RA diagnosis was 5 years and 12 years, respectively. In men, being overweight or obese at inclusion in the health survey was associated with a reduced risk of subsequent development of RA in both cohorts [odds ratio (OR) = 0.33; 95% CI: 0.14, 0.76, and 0.60; 95% CI: 0.39, 0.91]. There was no such association in women (OR = 1.01; 95% CI: 0.65, 1.54, and 1.37; 95% CI: 0.86, 2.18). Estimates were similar in analyses adjusted for potential confounders, including smoking. CONCLUSION A high BMI was associated with a reduced risk of future RA in men, but not in women. Factors related to adipose tissue may contribute to mechanisms that are protective from RA in men.
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Affiliation(s)
- Carl Turesson
- Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Department of Rheumatology, Skåne University Hospital, Malmö,
| | - Ulf Bergström
- Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Department of Rheumatology, Skåne University Hospital, Malmö
| | - Mitra Pikwer
- Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Department of Rheumatology, Eskilstuna Hospital, Eskilstuna and
| | - Jan-Åke Nilsson
- Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Department of Rheumatology, Skåne University Hospital, Malmö
| | - Lennart T H Jacobsson
- Section of Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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