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Piccirillo A, Perri F, Vittori A, Ionna F, Sabbatino F, Ottaiano A, Cascella M. Evaluating Nutritional Risk Factors for Delirium in Intensive-Care-Unit Patients: Present Insights and Prospects for Future Research. Clin Pract 2023; 13:1577-1592. [PMID: 38131687 PMCID: PMC10742123 DOI: 10.3390/clinpract13060138] [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: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Malnutrition, hypercatabolism, and metabolic changes are well-established risk factors for delirium in critically ill patients. Although the exact mechanisms are not fully understood, there is mounting evidence suggesting that malnutrition can cause a variety of changes that contribute to delirium, such as electrolyte imbalances, immune dysfunction, and alterations in drug metabolism. Therefore, a comprehensive metabolic and malnutrition assessment, along with appropriate nutritional support, may help to prevent or ameliorate malnutrition, reduce hypercatabolism, and improve overall physiological function, ultimately lowering the risk of delirium. For this aim, bioelectrical impedance analysis can represent a valuable strategy. Further research into the underlying mechanisms and nutritional risk factors for delirium is crucial to developing more effective prevention strategies. Understanding these processes will allow clinicians to personalize treatment plans for individual patients, leading to improved outcomes and quality of life in the intensive-care-unit survivors.
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Affiliation(s)
- Arianna Piccirillo
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Franco Ionna
- Otolaryngology and Maxillo-Facial Surgery Unit, Istituto Nazionale Tumori—IRCCS Fondazione G. Pascale, 80131 Naples, Italy
| | | | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, 80131 Naples, Italy;
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Medicine, Surgery, and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081 Baronissi, Italy
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2
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Misra DP, Ahmed S, Goyal M, Sharma A, Agarwal V. Venous Thromboembolism in the Inflammatory Rheumatic Diseases. Rheum Dis Clin North Am 2023; 49:97-127. [PMID: 36424029 DOI: 10.1016/j.rdc.2022.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a cardiovascular event whose risk is increased in most inflammatory rheumatic diseases (IRDs). Mechanisms that increase VTE risk include antiphospholipid antibodies (APLs), particularly anticardiolipin antibodies, anti-beta2glycoprotein I antibodies and lupus anticoagulant present together, and inflammation-mediated endothelial injury. Patients with IRDs should receive long-term anticoagulation drugs when the risk of VTE recurrence is high. In the light of recent warnings from regulatory agencies regarding heightened VTE risk with Janus kinase inhibitors, these drugs should be initiated only after a careful assessment of VTE risk in those with IRDs.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, C block, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow 226014, India.
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar 751024, India. https://twitter.com/sakir_rheum
| | - Mohit Goyal
- Department of Rheumatology and Clinical Immunology, CARE Pain and Arthritis Centre, Udaipur 313002, Rajasthan, India. https://twitter.com/drmohitgoyal
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India. https://twitter.com/Amansharmapgi
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, C block, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow 226014, India. https://twitter.com/vikasagrIMMUNO
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Hino C, Edigin E, Aihie O, Odion J, Eseaton P, Okpujie V, Onobraigho P, Omoike E, Manadan A, Hojjati M. Longitudinal Trends of Hospitalizations for Giant Cell Arteritis: A 21-Year Longitudinal National Population-Based Study. Cureus 2023; 15:e35038. [PMID: 36942165 PMCID: PMC10023869 DOI: 10.7759/cureus.35038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Background Long-term longitudinal studies on giant cell arteritis (GCA) hospitalizations are limited. Here we aim to fill gaps in knowledge by analyzing longitudinal trends of GCA hospitalizations over the last two decades in the United States (U.S.). Materials and methods We performed a 21-year longitudinal trend analysis of GCA hospitalizations using data obtained from the National Inpatient Sample (NIS) database between 1998 and 2018. Using the NIS database, we searched for hospitalizations for patients aged ≥ 50 years with a principal diagnosis of GCA using ICD billing codes. The principal diagnosis was the main reason for hospitalization. We used all hospitalizations in patients without GCA aged ≥50 years as the control population. Multivariable logistic and linear regression analysis was utilized to calculate the adjusted p-trend for outcomes of interest. Results The incidence of GCA hospitalization remained stable at about one per 100,000 U.S. persons throughout the study period. There was no statistically significant change in the inpatient mortality for the GCA group during the study period (adjusted p-trend=0.111). In comparison, inpatient mortality reduced from 4.4% to 3.1% from 1998 to 2018 (adjusted p-trend <0.0001) in the control group. The proportion of whites reduced, while the proportion of racial minorities increased over time in both the GCA and control groups. Conclusion The non-GCA control population saw significant reductions in mortality over time, but unfortunately, the GCA group did not see such improvements. More research into additional treatment modalities for inpatient GCA management may help improve mortality.
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Affiliation(s)
- Christopher Hino
- Department of Internal Medicine, Loma Linda University School of Medicine, Loma Linda, USA
| | - Ehizogie Edigin
- Department of Internal Medicine, Loma Linda University School of Medicine, Loma Linda, USA
| | - Osaigbokan Aihie
- School of Medicine, University of Missouri School of Medicine, Columbia, USA
| | - Jesse Odion
- Department of Internal Medicine, University of Benin College of Medicine, Benin City, NGA
| | - Precious Eseaton
- Department of Internal Medicine, University of Benin College of Medicine, Benin City, NGA
| | - Victory Okpujie
- Department of Internal Medicine, University of Benin College of Medicine, Benin City, NGA
| | - Precious Onobraigho
- Department of Internal Medicine, University of Benin College of Medicine, Benin City, NGA
| | - Eugene Omoike
- Department of Internal Medicine, University of Benin College of Medicine, Benin City, NGA
| | - Augustine Manadan
- Department of Rheumatology, Rush University Medical Center, Chicago, USA
| | - Mehrnaz Hojjati
- Department of Internal Medicine, Loma Linda University School of Medicine, Loma Linda, USA
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4
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Michailidou D, Zhang T, Kuderer NM, Lyman GH, Diamantopoulos AP, Stamatis P, Ng B. Predictive models for thromboembolic events in giant cell arteritis: A US veterans health administration population-based study. Front Immunol 2022; 13:997347. [DOI: 10.3389/fimmu.2022.997347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Giant cell arteritis (GCA) that affects older patients is an independent risk factor for thromboembolic events. The objective of this study was to identify predictive factors for thromboembolic events in patients with GCA and develop quantitative predictive tools (prognostic nomograms) for pulmonary embolism (PE) and deep venous thrombosis (DVT). A total of 13,029 patients with a GCA diagnosis were included in this retrospective study. We investigated potential predictors of PE and DVT using univariable and multivariable Cox regression models. Nomograms were then constructed based on the results of our Cox models. We also assessed the accuracy and predictive ability of our models by using calibration curves and cross-validation concordance index. Age, inpatient status at the time of initial diagnosis of GCA, number of admissions before diagnosis of GCA, and Charlson comorbidity index were each found to be independent predictive factors of thromboembolic events. Prognostic nomograms were then prepared based on these predictors with promising prognostic ability. The probability of developing thromboembolic events over an observation period of 5 years was estimated by with time-to-event analysis using the method of Kaplan and Meier, after stratifying patients based on predicted risk. The concordance index of the time-to-event analysis for both PE and DVT was > 0.61, indicating a good predictive performance. The proposed nomograms, based on specific predictive factors, can accurately estimate the probability of developing PE or DVT among patients with GCA.
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Rodriguez-Pla A, Rossello-Urgell J. Trend and Geographic Disparities in the Mortality Rates of Primary Systemic Vasculitis in the United States from 1999 to 2019: A Population-Based Study. J Clin Med 2021; 10:1759. [PMID: 33919526 PMCID: PMC8074184 DOI: 10.3390/jcm10081759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
The current data on rates and geographic distribution of vasculitis mortality are limited. We aimed to estimate the mortality rates of primary systemic vasculitis and its geographic distribution using recent population data in the United States. The mortality rates of vasculitis from 1999 to 2019 were obtained from the Center for Disease Control (CDC) Wonder Multiple Cause of Death (MCD). The age-adjusted rates per million for vasculitis as MCD and as an underlying cause of death (UCD) were calculated by state using demographics. A joinpoint regression analysis was applied to evaluate trends over time. The age-adjusted mortality rate of vasculitis as MCD was 4.077 (95% CI: 4.029-4.125) and as a UCD was 1.888 per million (95% CI: 1.855-1.921). Since 1999, mortality rates have progressively decreased. The age-adjusted mortality rate was higher in females than in males. The highest mortality rate for vasculitis as MCD was in White patients (4.371; 95% CI: 4.317-4.424). The northern states and areas with lower populations had higher mortality rates. We found a trend of progressive decreases in the mortality rates of vasculitis, as well as gender, racial, and geographic disparities. Further analyses are warranted to better understand the factors associated with these disparities in order to implement targeted public health interventions to decrease them.
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Affiliation(s)
| | - Jose Rossello-Urgell
- Statistics and Epidemiology Consultant, ARJR Media LLC, Scottsdale, AZ 85259, USA;
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Nashi R, Misra D. Special Considerations in Geriatric Populations. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:731-737. [DOI: 10.1002/acr.24342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/22/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Rand Nashi
- Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts
| | - Devyani Misra
- Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts
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Milchert M, Brzosko M. Familial aggregation of longevity in giant cell arteritis and polymyalgia rheumatica. Rheumatol Int 2020; 40:2071-2075. [PMID: 32683496 PMCID: PMC7591435 DOI: 10.1007/s00296-020-04649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022]
Abstract
The long-term mortality in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) is unexpectedly decreased or at least not increased regardless of several mortality risk factors that these diseases share with other chronic immune-mediated rheumatic diseases. The genetic and immunological profile of PMR/GCA patients is unique, therefore, the hypothesis that this profile provides some survival advantage to PMR/GCA patients should be considered. The longevity is a phenomenon that was demonstrated to be familial. The familial aggregation of longevity can be studied by analysis of life expectancy in family members. Here we test the hypothesis of the aggregation of an increased longevity in the families of PMR/GCA patients. We compared the age of death of 358 parents of 179 PMR and GCA patients with corresponding data retrieved from 506 parents of 253 randomly collected age and sex-matched controls. The number of nonagenarian (≥ 90-year -old) mothers of PMR/GCA patients was significantly higher (OR = 2.34, 95%CI 1.11–11.95, p < 0.0005) vs controls. Both nonagenarian parents were found in 6 patients (3.35%) and none in the control cohort (OR = 8.77, 95%CI 2.26–405.10, p = 0.003). Our data suggest the familial aggregation of nonagenarians in PMR/GCA patients.
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Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland.
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland
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Garcia-Cazares R, Merlos-Benitez M, Marquez-Romero JM. Role of the physical examination in the determination of etiology of ischemic stroke. Neurol India 2020; 68:282-287. [PMID: 32415006 DOI: 10.4103/0028-3886.284386] [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: 11/04/2022]
Abstract
The actual investigation of the body of a patient by the clinician in search for the signs of the disease beginning with the primary vital signs and continues with the careful and attentive observation of the patient. This article reviews the key findings in the physical examination of patients with ischemic stroke that have the potential to indicate the etiology of the infarct and to help to choose the use of ancillary tests. Through a systematic search of articles published in English related to the physical examination of patients with stroke, we identified key findings in the vital signs and classic components of the physical exam (appearance of the patient, auscultation, and eye examination) that have shown clinical significance when determining ischemic stroke etiology. We further suggest that the prompt identification of such findings can translate into better use of diagnostic tools and selection of ancillary confirmatory tests, thus, reducing the time to etiology based treatment and secondary prevention of ischemic stroke. in this manuscript, we aim to show that even though nowadays the clinical skills tend to be overlooked due to the overreliance on technology, the physical exam continues to be a valuable tool in the clinician armamentarium when facing the challenge of a patient with ischemic stroke.
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Ketz F, Monti A, Velentza A, Breining A, Léger A, Pautas É. [Strokes and Giant cell arteritis: imaging characteristics]. SOINS. GÉRONTOLOGIE 2019; 24:17-19. [PMID: 31307684 DOI: 10.1016/j.sger.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Giant cell arteritis (GCA) is associated with an increased risk of cardio- or cerebro-vascular death. The stroke rate in patients with GCA varies between 2.7 and 7.4%. The etiological diagnosis may be challenging between atherosclerotic stroke and stroke related to GCA. Case of an old woman who had ischemic stroke and concomitant diagnosis of GCA and brain imaging characteristics.
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Affiliation(s)
- Flora Ketz
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France; UFR de médecine, université Paris-6, université Paris-Sorbonne, 91-105, boulevard de l'Hôpital, 75013 Paris, France.
| | - Alexandra Monti
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Athanasia Velentza
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Alice Breining
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France
| | - Anne Léger
- Unité de soins intensifs neurovasculaires, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Éric Pautas
- Gériatrie aiguë polyvalente, GH Pitié-Salpêtrière - Charles-Foix (AP-HP), site Charles-Foix, 7, avenue de la République, 94200 Ivry-sur-Seine, France; UFR de médecine, université Paris-6, université Paris-Sorbonne, 91-105, boulevard de l'Hôpital, 75013 Paris, France
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Brault C, Riis AH, Mor A, Duhaut P, Thomsen RW. Does low risk of infections as a marker of effective immunity predict increased risk of subsequent giant cell arteritis or polymyalgia rheumatica? A Danish population-based case-control study. Clin Epidemiol 2018; 10:1533-1543. [PMID: 30425584 PMCID: PMC6201992 DOI: 10.2147/clep.s158293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective It has been suggested that a hyper-effective immune system (“hyper-immunity”) is central to the pathogenesis of giant cell arteritis and polymyalgia rheumatica (GCA/PMR). We examined if a low risk of infections, as a marker of hyper-immunity, can predict increased subsequent risk of GCA/PMR. Patients and methods We conducted a population-based case–control study including all patients aged ≥50 years with incident GCA/PMR diagnosed between 1997 and 2012 in Northern Denmark. For each case, we selected 10 population controls matched on gender, age, place of residence, and time spent in the region. Complete history of hospital-treated infections and community-based anti-infective prescriptions was assessed in population-based registries. We used conditional logistic regression to compute OR of GCA/PMR associated with infections while adjusting for comorbidities, immunosuppressive treatment, and other potential confounders. Results We included 7,225 GCA/PMR cases and 72,250 controls. When excluding all infections occurring within the last year before GCA/PMR diagnosis, there was no decreased risk for GCA/PMR in people with a history of hospital-treated infection (adjusted OR=1.04, 95% CI: 0.98–1.10) or community anti-infective treatment (adjusted OR=1.07, 95% CI: 0.99–1.16). Within the last year preceding the GCA/PMR index date, patients with hospital-treated infections (adjusted OR=1.59, 95% CI: 1.44–1.75) or community anti-infective treatment (adjusted OR=1.63, 95% CI: 1.48–1.79) had a greatly increased risk of a GCA/PMR diagnosis. Conclusion These results do not support the hypothesis of “hyper-immunity” leading to GCA/PMR. Instead, incident GCA/PMR is preceded by a slightly increased risk of infection, which may be related to protopathic bias or support theories that infections may be directly involved in the pathogenesis of GCA/PMR.
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Affiliation(s)
- Clément Brault
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, .,Department of Internal Medicine and RECIF, Amiens-Picardie University Hospital, Amiens, France,
| | - Anders H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Anil Mor
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
| | - Pierre Duhaut
- Department of Internal Medicine and RECIF, Amiens-Picardie University Hospital, Amiens, France,
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark,
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Giant-cell arteritis-related mortality in France: A multiple-cause-of-death analysis. Autoimmun Rev 2018; 17:1219-1224. [PMID: 30316993 DOI: 10.1016/j.autrev.2018.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Giant-cell arteritis (GCA) is a large vessel vasculitis. Data regarding mortality are controversial. We describe the mortality data of the French death certificates for the period of 2005 to 2014. METHODS Using multiple-cause-of-death (MCOD) analysis, we calculated age-adjusted mortality rates for GCA, examined differences in mortality rates according to age and gender and analyzed the underlying causes of death (UCD). RESULTS We analyzed 4628 death certificates listing a diagnosis of GCA as UCD or non-underlying cause of death (NUCD). The mean age of death was 86 (±6.8) years. The overall age-standardized mortality rate among GCA patients was 7.2 per million population. Throughout the study period, the mean age of death was significantly increased (r = 0.17, p < .0001) in both genders. There was no significant difference with age repartition of death in the general population (p = .26). When GCA was listed as the UCD, most frequent associated diseases were cardiovascular (79%) and infectious diseases (35%). When GCA was reported as the NUCD, the listed UCD was a cardiovascular event in 40% of cases, neoplasm in 13%, neurodegenerative disorder in 11% and infectious disease in 10%. When GCA was the UCD or NUCD, an age-adjusted observed/expected ratio > 1 in GCA-associated mortality compared with the general population mortality was observed for tuberculosis, pneumonia and cardiovascular diseases. CONCLUSION In this analysis of French death certificates mentioning GCA, we observed a stable standardized mortality rate between 2005 and 2014. The most frequent associated diseases were cardiovascular diseases and infections.
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12
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Brekke LK, Diamantopoulos AP, Fevang BT, Aβmus J, Esperø E, Gjesdal CG. Incidence of giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study. Arthritis Res Ther 2017; 19:278. [PMID: 29246164 PMCID: PMC5732381 DOI: 10.1186/s13075-017-1479-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022] Open
Abstract
Background Giant cell arteritis (GCA) is the most common systemic vasculitis in persons older than 50 years. The highest incidence rates of the disease have been reported in Scandinavian countries. Our objective was to determine the epidemiology of GCA in an expected high-incidence region during a 41-year period. Methods This is a hospital-based, retrospective, cohort study. Patients diagnosed with GCA in Bergen health area during 1972–2012 were identified through computerized hospital records (n = 1341). Clinical information was extracted from patients’ medical journals, which were reviewed by a standardized method. We excluded patients if data were unavailable (n = 253), if the reviewing rheumatologist found GCA to be an implausible diagnosis (n = 207) or if the American College of Rheumatology (ACR) 1990 classification criteria for GCA were not fulfilled (n = 89). Descriptive methods were used to characterize the sample. Incidence was analyzed by graphical methods and Poisson regression. Results A total of 792 patients were included. The average annual cumulative incidence of GCA was 16.7 (95% CI 15.5-18.0) per 100,000 of the population ≥ 50 years old. The corresponding incidence for biopsy-verified GCA was 11.2 (95% CI 10.2–12.3). The annual cumulative incidence increased with time in the period 1972–1992 (relative risk (RR) 1.1, p < 0.001) but not in 1993–2012 (RR 1.0, p = 0.543). The incidence was higher in women compared to men (average annual incidence 37.7 (95% CI 35.8–39.6) vs. 14.3 (95% CI 13.2–15.5), p < 0.001) with women having a twofold to threefold higher incidence rate throughout the study period. Average annual incidence increased with age until the 7th decade of life in both sexes throughout the study period (2.8 (95% CI 2.3–3.3) for age <60, 15.5 (95% CI 14.4–16.8) for age 60–69, 34.5 (95% CI 32.8–36.4) for age 70–79 and 26.8 (95% CI 25.3-28.4) for age ≥80 years, p < 0.001 for all age adjustments). Conclusions Our study confirms an incidence of GCA comparable to previous reports on Scandinavian populations. Our results show increasing incidence from 1972 through 1992, after which the incidence has levelled out. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1479-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L K Brekke
- Hospital for Rheumatic Diseases, Haugesund, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway. .,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway. .,Hospital for Rheumatic Diseases (HSR AS), PB 2175, 5504, Haugesund, Norway.
| | | | - B-T Fevang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - J Aβmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - E Esperø
- Hospital for Rheumatic Diseases, Haugesund, Norway
| | - C G Gjesdal
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
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13
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Venous thrombosis in patients with giant cell arteritis: Features and outcomes in a cohort study. Joint Bone Spine 2017; 84:323-326. [DOI: 10.1016/j.jbspin.2016.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/27/2016] [Indexed: 11/22/2022]
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14
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Unizony S, Lu N, Tomasson G, Zhang Y, Merkel PA, Stone JH, Antonio Aviña‐Zubieta J, Choi HK. Temporal Trends of Venous Thromboembolism Risk Before and After Diagnosis of Giant Cell Arteritis. Arthritis Rheumatol 2016; 69:176-184. [DOI: 10.1002/art.39847] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/16/2016] [Indexed: 12/28/2022]
Affiliation(s)
| | - Na Lu
- Massachusetts General Hospital, Harvard Medical School, and Boston University School of MedicineBoston
| | - Gunnar Tomasson
- Boston University School of Medicine, Boston, Massachusetts, and University of IcelandReykjavik Iceland
| | - Yuqing Zhang
- Boston University School of MedicineBoston Massachusetts
| | | | - John H. Stone
- Massachusetts General Hospital, Harvard Medical SchoolBoston
| | | | - Hyon K. Choi
- Massachusetts General Hospital, Harvard Medical School, and Boston University School of MedicineBoston
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Mohammad AJ, Englund M, Turesson C, Tomasson G, Merkel PA. Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study. J Rheumatol 2016; 44:84-90. [DOI: 10.3899/jrheum.160249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/11/2022]
Abstract
Objective.To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden.Methods.The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skåne region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skåne Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA:reference population) was also calculated.Results.There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95% CI 2.33–3.37), followed by venous thromboembolic diseases (2.36, 95% CI 1.61–3.40), severe infections (1.85, 95% CI 1.57–2.18), thyroid diseases (1.55, 95% CI 1.25–1.91), cerebrovascular accidents (1.40, 95% CI 1.12–1.74), and diabetes mellitus (1.29, 95% CI 1.05–1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95% CI 1.00–1.44).Conclusion.Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.
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Ungprasert P, Koster MJ, Thongprayoon C, Warrington KJ. Risk of venous thromboembolism among patients with vasculitis: a systematic review and meta-analysis. Clin Rheumatol 2016; 35:2741-2747. [PMID: 27572522 DOI: 10.1007/s10067-016-3394-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/21/2016] [Indexed: 01/11/2023]
Abstract
To investigate the possible association between systemic vasculitis and risk of venous thromboembolism (VTE), two investigators independently searched published studies indexed in MEDLINE, EMBASE, and the Cochrane database from inception to April 2016 using the terms for each type of vasculitis in conjunction with the terms for venous thromboembolism. The inclusion criteria were as follows: (1) observational studies published as original studies to evaluate the association between vasculitis and VTE, (2) odds ratios, relative risk or hazard ratio or standardized incidence ratio with 95 % confidence intervals (CI) were provided, and (3) participants without vasculitis were used as comparators for cohort studies and cross-sectional studies while participants without VTE were used as comparators for case-control studies. RevMan 5.3 software was used for the data analysis. Point estimates and standard errors were extracted from individual studies and were combined by the generic inverse variance method of DerSimonian and Laird. Seven studies investigating the risk of VTE among patients with systemic vasculitis were identified. At least one study was available for three specific forms of vasculitis (polyarteritis nodosa [PAN], granulomatosis with polyangiitis [GPA], and giant cell arteritis [GCA]). An increased risk of VTE was seen in all three vasculitides (GPA, pooled RR 3.94, 95 % CI 1.11-14.01; PAN, pooled RR 3.00, 95 % CI 2.20-4.09; GCA, pooled RR 2.26, 95 % CI 1.38-3.71). This meta-analysis demonstrates that patients with systemic vasculitis may have a significantly increased risk of VTE.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA.
| | - Matthew J Koster
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA
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Abstract
Giant cell arteritis (GCA) is the most common vasculitis of the elderly. The diagnosis can be challenging at times because of the limitation of the American Rheumatology Association (ARA) classification criteria and the significant proportion of biopsy-negative patients with GCA. We discuss the role of advanced imaging techniques, including positron emission tomography (PET) scanning, in establishing diagnosis and improved histopathology techniques to improve the sensitivity of temporal artery biopsy. There have been significant advances in the understanding of the pathogenesis of GCA, particularly the role of cytokine pathways such as the interleukins, IL-6-IL-17 axis, and the IL-12-interferon-γ axis and their implication for new therapies. We highlight that glucocorticoids remain the primary treatment for GCA, but recognize the risk of steroid-induced side effects. A number of pharmacotherapies to enable glucocorticoid dose reduction and prevent relapse have been studied. Early diagnosis and fast-track pathways have improved outcomes by encouraging adherence to evidence-based practice.
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Affiliation(s)
- Jem Ninan
- Rheumatology Unit, Modbury Hospital, Modbury, South Australia, Australia
| | - Susan Lester
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; Department of Medicine, University of Adelaide, Adelaide, Australia; Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.
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Lo Gullo A, Koster MJ, Crowson CS, Makol A, Ytterberg SR, Saitta A, Salvarani C, Matteson EL, Warrington KJ. Venous Thromboembolism and Cerebrovascular Events in Patients with Giant Cell Arteritis: A Population-Based Retrospective Cohort Study. PLoS One 2016; 11:e0149579. [PMID: 26901431 PMCID: PMC4763510 DOI: 10.1371/journal.pone.0149579] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/01/2016] [Indexed: 01/06/2023] Open
Abstract
Objective To investigate the incidence of venous thromboembolism (VTE) and cerebrovascular events in a community-based incidence cohort of patients with giant cell arteritis (GCA) compared to the general population. Methods A population-based inception cohort of patients with incident GCA between January 1, 1950 and December 31, 2009 in Olmsted County, Minnesota and a cohort of non-GCA subjects from the same population were assembled and followed until December 31, 2013. Confirmed VTE and cerebrovascular events were identified through direct medical record review. Results The study population included 244 patients with GCA with a mean ± SD age at diagnosis of 76.2 ± 8.2 years (79% women) and an average length of follow-up of 10.2 ± 6.8 years. Compared to non-GCA subjects of similar age and sex, patients diagnosed with GCA had a higher incidence (%) of amaurosis fugax (cumulative incidence ± SE: 2.1 ± 0.9 versus 0, respectively; p = 0.014) but similar rates of stroke, transient ischemic attack (TIA), and VTE. Among patients with GCA, neither baseline characteristics nor laboratory parameters at diagnosis reliably predicted risk of VTE or cerebrovascular events. Conclusion In this population-based study, the incidence of VTE, stroke and TIA was similar in patients with GCA compared to non-GCA subjects.
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Affiliation(s)
- Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, University of Messina, Messina ME, Italy
| | - Matthew J. Koster
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
- * E-mail:
| | - Cynthia S. Crowson
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
- Department of Health Sciences Research, Division of Biomedical Statistics, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Ashima Makol
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Steven R. Ytterberg
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Antonino Saitta
- Department of Clinical and Experimental Medicine, University of Messina, Messina ME, Italy
| | - Carlo Salvarani
- Department of Internal Medicine, Rheumatology Unit, Azienda Ospedaliera ASMN, Reggio Emilia, Italy
| | - Eric L. Matteson
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Kenneth J. Warrington
- Department of Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
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The prediction and monitoring of toxicity associated with long-term systemic glucocorticoid therapy. Curr Rheumatol Rep 2016; 17:513. [PMID: 25903665 DOI: 10.1007/s11926-015-0513-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Glucocorticoids are often required for adequate control of inflammation in many serious inflammatory diseases; common indications for long-term treatment include polymyalgia rheumatica, giant cell arteritis, asthma and chronic obstructive pulmonary disease. Long-term glucocorticoid therapy is, however, associated with many adverse effects involving skin, gastro-intestinal, eye, skeletal muscle, bone, adrenal, cardio-metabolic and neuropsychiatric systems. This balance between benefits and risks of glucocorticoids is important for clinical practice and glucocorticoid-related adverse effects can significantly impair health-related quality of life. Understanding the nature and mechanisms of glucocorticoid-related adverse effects may inform how patients are monitored for toxicity and identify those groups, such as older people, that may need closer monitoring. For clinical trials in diseases commonly treated with glucocorticoids, standardised measurement of glucocorticoid-related adverse effects would facilitate future evidence synthesis and meta-analysis.
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