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Chehem Daoud Chehem F, de Mornac D, Feuillet F, Liozon E, Samson M, Bonnotte B, de Boysson H, Guffroy A, Balquet MH, Ledoult E, Lavigne C, Trefond L, Smets P, Bodard Q, Fenot M, Richez C, Duffau P, Guillaud C, Espitia O, Agard C. Giant cell arteritis associated with scalp, tongue or lip necrosis: A French multicenter case control study. Semin Arthritis Rheum 2024; 64:152348. [PMID: 38091870 DOI: 10.1016/j.semarthrit.2023.152348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/03/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Scalp, tongue and/or lip necrosis are rare complications of GCA. OBJECTIVES To describe characteristics and outcome of patients with giant cell arteritis (GCA) -related scalp, tongue and/or lip necrosis. METHODS A retrospective nationwide multicenter study included 20 GCA patients with scalp, tongue, and/or lip necrosis diagnosed between 1998 and 2021 and 80 GCA control patients matched for age, sex and management period. Logistic regression analyses were conducted to identify baseline characteristics associated with scalp, tongue and/or lip necrosis. RESULTS Compared to controls, patients with scalp, tongue and/or lip necrosis showed significantly more cranial manifestations (headache, p=0.045; scalp tenderness, p=0.006; jaw claudication, p=0.02). No differences were observed between both groups regarding the occurrence of visual symptoms or large vessel involvement. At diagnosis, GCA patients with necrosis more likely received IV methylprednisolone infusions and higher doses of oral prednisone. There were no differences regarding vascular complications during follow up. Compared to controls, survival was decreased in GCA patients with necrosis (p=0.003). In a multivariable logistic regression model, scalp tenderness [odds ratio (OR) 4.81(95 % CI: 1.57, 14.79), p = 0.006] and cognitive disorder [OR 6.42 (95 % CI: 1.01, 40.60), p=0.048] were identified as factors associated to scalp, tongue, and/or lip necrosis. CONCLUSION Our results suggest that scalp, tongue, and/or lip necrosis is associated to higher mortality in GCA patients. Scalp tenderness and cognitive disorder were significant factors associated to this very rare complication of GCA.
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Affiliation(s)
| | - Donatienne de Mornac
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France
| | - Fanny Feuillet
- Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Eric Liozon
- Internal Medicine Department, Limoges University Hospital, Limoges, France
| | - Maxime Samson
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Bernard Bonnotte
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Hubert de Boysson
- Internal Medicine Department, Caen University Hospital, Caen, France
| | - Aurélien Guffroy
- Internal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Emmanuel Ledoult
- Internal Medicine Department, Lille University Hospital, Lille, France
| | - Christian Lavigne
- Internal Medicine Department, Angers University Hospital, Angers, France
| | - Ludovic Trefond
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Perrine Smets
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Quentin Bodard
- Internal medicine and Infectious Diseases Department, Departmental Hospital Centre, Angoulême, France
| | - Marion Fenot
- Dermatology Department, Departmental Hospital Centre, La Roche Sur Yon, France
| | - Christophe Richez
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, and CHU of Bordeaux, Department of Rheumatology, F-33000 Bordeaux, France
| | - Pierre Duffau
- University Bordeaux, CHU Bordeaux, Department of internal medicine, Bordeaux, France
| | - Constance Guillaud
- Internal Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Olivier Espitia
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France; L'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, F-44000 Nantes, France
| | - Christian Agard
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France.
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Ndosi M, Almeida C, Dawson J, Dures E, Greenwood R, Bromhead A, Guly C, Stern S, Hill C, Mackie S, Robson JC. Validation of a patient-reported outcome measure for giant cell arteritis. Rheumatology (Oxford) 2024; 63:181-189. [PMID: 37144946 PMCID: PMC10765151 DOI: 10.1093/rheumatology/kead201] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES GCA is systemic vasculitis manifesting as cranial, ocular or large vessel vasculitis. A prior qualitative study developed 40 candidate items to assess the impact of GCA on health-related quality of life (HRQoL). This study aimed to determine final scale structure and measurement properties of the GCA patient reported outcome (GCA-PRO) measure. METHODS Cross-sectional study included UK patients with clinician-confirmed GCA. They completed 40 candidate items for the GCA-PRO at times 1 and 2 (3 days apart), EQ-5D-5L, ICECAP-A, CAT-PROM5 and self-report of disease activity. Rasch and exploratory factor analyses informed item reduction and established structural validity, reliability and unidimensionality of the final GCA-PRO. Evidence of validity was also established with hypothesis testing (GCA-PRO vs other PRO scores, and between participants with 'active disease' vs those 'in remission') and test-retest reliability. RESULTS The study population consisted of 428 patients: mean (s.d.) age 74.2 (7.2), 285 (67%) female; 327 (76%) cranial GCA, 114 (26.6%) large vessel vasculitis and 142 (33.2%) ocular involvement. Rasch analysis eliminated 10 candidate GCA items and informed restructuring of response categories into four-point Likert scales. Factor analysis confirmed four domains: acute symptoms (eight items), activities of daily living (seven items), psychological (seven items) and participation (eight items). The overall scale had adequate Rasch model fit (χ2 = 25.219, degrees of freedom = 24, P = 0.394). Convergent validity with EQ5D-5L, ICECAP-A and Cat-PROM5 was confirmed through hypothesis testing. Internal consistency and test-retest reliability were excellent. CONCLUSION The final GCA-PRO is a 30-item, four-domain scale with robust evidence of validity and reliability in measuring HRQoL in people with GCA.
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Affiliation(s)
- Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Celia Almeida
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jill Dawson
- Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK
| | - Emma Dures
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rosemary Greenwood
- NIHR Research Design Service South West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Alison Bromhead
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Catherine Guly
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Steve Stern
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Catherine Hill
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joanna C Robson
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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3
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Kirby C, Flood R, Mullan R, Murphy G, Kane D. Evolution of ultrasound in giant cell arteritis. Front Med (Lausanne) 2022; 9:981659. [PMID: 36262280 PMCID: PMC9574015 DOI: 10.3389/fmed.2022.981659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Ultrasound (US) is being increasingly used to diagnose Giant Cell Arteritis (GCA). The traditional diagnostic Gold Standard has been temporal artery biopsy (TAB), but this is expensive, invasive, has a false-negative rate as high as 60% and has little impact on clinical decision-making. A non-compressible halo with a thickened intima-media complex (IMC) is the sonographic hallmark of GCA. The superficial temporal arteries (STA) and axillary arteries (AA) are the most consistently inflamed arteries sonographically and imaging protocols for evaluating suspected GCA should include at least these two arterial territories. Studies evaluating temporal artery ultrasound (TAUS) have varied considerably in size and methodology with results showing wide discrepancies in sensitivity (9–100%), specificity (66–100%), positive predictive value (36–100%) and negative predictive value (33–100%). Bilateral halos increase sensitivity as does the incorporation of pre-test probability, while prior corticosteroid use decreases sensitivity. Quantifying sonographic vasculitis using Halo Counts and Halo Scores can predict disease extent/severity, risk of specific complications and likelihood of treatment response. Regression of the Halo sign has been observed from as little as 2 days to as late as 7 months after initiation of immunosuppressive treatment and occurs at different rates in STAs than AAs. US is more sensitive than TAB and has comparable sensitivity to MRI and PET/CT. It is time-efficient, cost-effective and allows for the implementation of fast-track GCA clinics which substantially mitigate the risk of irreversible blindness. Algorithms incorporating combinations of imaging modalities can achieve a 100% sensitivity and specificity for a diagnosis of GCA. US should be a standard first line investigation in routine clinical care of patients with suspected GCA with TAB reserved only for those having had a normal US in the context of a high pre-test probability.
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Affiliation(s)
- Colm Kirby
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland,Department of Rheumatology, Cork University Hospital and University College Cork, Cork, Ireland,*Correspondence: Colm Kirby
| | - Rachael Flood
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
| | - Ronan Mullan
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
| | - Grainne Murphy
- Department of Rheumatology, Cork University Hospital and University College Cork, Cork, Ireland
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital and Trinity College Dublin, Dublin, Ireland
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Gonzalez Chiappe S, Lechtman S, Maldini CS, Mekinian A, Papo T, Sené T, Mahr AD. Incidence of giant cell arteritis in six districts of Paris, France (2015-2017). Rheumatol Int 2022; 42:1721-1728. [PMID: 35819504 DOI: 10.1007/s00296-022-05167-4] [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: 02/10/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
This prospective population-based study estimated the incidence of giant cell arteritis (GCA) in northeastern Paris. GCA cases diagnosed between 2015 and 2017 were obtained from local hospital and community-based physicians and the national health insurance system database. Criteria for inclusion were living in the study area at that time and fulfilling the 1990 American College of Rheumatology classification criteria and/or its expanded version. Cranial and large-vessel GCA cases were defined by the presence or absence of cranial signs and/or symptoms, respectively. Annual incidence was calculated by dividing the number of incident cases by the size of the study population ≥ 50 years old. Completeness of case ascertainment was assessed by a three-source capture-recapture analysis. Among the 62 included cases, 42 (68%) were women, mean (± SD) age 77.3 ± 9.1 years. The annual incidence of GCA in northeastern Paris and completeness of case ascertainment were estimated at 7.6 (95% CI 5.9-9.8) per 100,000 inhabitants ≥ 50 years old and 66% (95% CI 52-92%), respectively. Incidence increased with age, peaked at age 80-89 years, and was almost twice as high in women versus men. Large-vessel GCA cases, mean (± SD) age 68.6 ± 11.5 years, accounted for 8% of all GCA cases. In this study, GCA epidemiology was mainly driven by cases with cranial GCA signs or symptoms and incidence results were consistent with recent European and past French studies.
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Affiliation(s)
- Solange Gonzalez Chiappe
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France. .,Rheumatology Department, Saint Gallen Kantonsspital, Saint Gallen, Switzerland.
| | - Sarah Lechtman
- Internal Medicine, AP-HP, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - Carla Soledad Maldini
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France
| | - Arsène Mekinian
- Internal Medicine and Inflammation-Immunopathology-Biotherapy Department (DMU i3), AP-HP, Saint Antoine Hospital, Sorbonne Université, Paris, France.,French-Armenian Clinical Research Center, National Institute of Health, 0051, Yerevan, Armenia
| | - Thomas Papo
- Internal Medicine, AP-HP, Bichat Hospital, Paris Diderot University, Paris, France
| | - Thomas Sené
- Internal Medicine, Croix Saint-Simon Hospital, University Paris 6, Paris, France
| | - Alfred Daniel Mahr
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France.,ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, UMR 1153 Inserm, Paris, France.,Rheumatology Department, Saint Gallen Kantonsspital, Saint Gallen, Switzerland
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5
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Guittet L, de Boysson H, Cerasuolo D, Morello R, Sultan A, Deshayes S, Aouba A. Whole-Country and Regional Incidences of Giant Cell Arteritis in French Continental and Overseas Territories: A 7-Year Nationwide Database Analysis. ACR Open Rheumatol 2022; 4:753-759. [PMID: 35695768 PMCID: PMC9469485 DOI: 10.1002/acr2.11472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 11/11/2022] Open
Abstract
Objective The incidence rate of giant cell arteritis (GCA) is poorly studied in France. Therefore, we conducted a national hospital database study to assess the overall and regional incidence rates of GCA in France, including overseas territories. Methods Through the national hospitalization database of all patients hospitalized in France, new incidental GCA was identified using International Classification of Diseases, 10th Revision medical codes (M31.5 = GCA; M31.6 = GCA and polymyalgia rheumatica [PMR]) during 2013‐2019. The regional incidences were analyzed by graphical methods and Poisson regression. Results A total of 16,540 new GCA with or without PMR diagnoses were identified in all French hospitals over 7 years. The female/male ratio was 1.8. The crude annual incidence rate of GCA with or without PMR was 9.64 (9.50‐9.79) per 100,000 persons aged 50 years or older in continental France and 2.91 (2.35‐3.47) in overseas areas. The GCA with or without PMR incidence rate regularly increased with age in both sexes but with a later peak in men (85 vs 80 years in women). The crude incidence rate was 11.43 (11.21‐11.65) in women and 7.50 (7.31‐7.70) in men. An east–western gradient was noted with an increasing standardized incident rate (SIR) from east to west (P < 10−3) using a departmental stratification of incident rates. Of note, all SIRs in continental regions were higher than those in overseas areas. Conclusion This French nationwide study provides new and dynamic insights regarding GCA with or without PMR incident rates at the country and regional levels. Important rate differences were observed between continental France and the overseas areas.
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Affiliation(s)
- Lydia Guittet
- Caen Universisty Hospital, Caen, France.,University of Caen, Caen, France
| | - Hubert de Boysson
- Caen Universisty Hospital, Caen, France.,University of Caen, Caen, France
| | | | | | | | - Samuel Deshayes
- Caen Universisty Hospital, Caen, France.,University of Caen, Caen, France
| | - Achille Aouba
- Caen Universisty Hospital, Caen, France.,University of Caen, Caen, France
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De Boysson H, Guittet L, Cerasuolo D, Morello R, Sultan A, Deshayes S, Aouba A. Incidences nationale et régionales de l’artérite à cellules géantes en France métropolitaine et d’Outre-mer. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Conway R, Brouwer E, van der Geest KSM, Mackie SL, Mehta P, Putman M, Robinson P, Sattui S. Dr. Conway et al reply. J Rheumatol 2022; 49:120-121. [PMID: 34974424 DOI: 10.3899/jrheum.2100913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, UK;
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, and Department of Rheumatology, University College London Hospital (UCLH) NHS Trust, London, UK
| | | | - Philip Robinson
- University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Sebastian Sattui
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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8
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Mahr A, Hachulla E, de Boysson H, Guerroui N, Héron E, Vinzio S, Broner J, Lapébie FX, Michaud M, Sailler L, Zenone T, Djerad M, Jouvray M, Shipley E, Tieulie N, Armengol G, Bouldoires B, Viallard JF, Idier I, Paccalin M, Devauchelle-Pensec V. Presentation and Real-World Management of Giant Cell Arteritis (Artemis Study). Front Med (Lausanne) 2021; 8:732934. [PMID: 34859001 PMCID: PMC8631900 DOI: 10.3389/fmed.2021.732934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Few studies of daily practice for patients with giant cell arteritis (GCA) are available. This French study aimed to describe the characteristics and management of GCA in a real-life setting. Methods: Cross-sectional, non-interventional, multicenter study of patients ≥50 years old who consulted hospital-based specialists for GCA and were under treatment. Patient characteristics and journey, diagnostic methods and treatments were collected. Descriptive analyses were performed. Results: In total, 306 patients (67% females, mean age 74 ± 8 years old) were recruited by 69 physicians (internists: 85%, rheumatologists: 15%); 13% of patients had newly diagnosed GCA (diagnosis-to-visit interval <6 weeks). Overall median disease duration was 13 months (interquartile range 5–26). Most patients were referred by general practitioners (56%), then ophthalmologists (10%) and neurologists (7%). Most common comorbidities were hypertension (46%), psychiatric disorders (10%), dyslipidemia (12%), diabetes (9%), and osteoporosis (6%). Initial GCA presentations included cranial symptoms (89%), constitutional symptoms (74%), polymyalgia rheumatica (48%), and/or other extra-cranial manifestations (35%). Overall, 85, 31, 26, and 30% of patients underwent temporal artery biopsy, high-resolution temporal artery Doppler ultrasonography, 18FDG-PET, and aortic angio-CT, respectively. All patients received glucocorticoids, which were ongoing for 89%; 29% also received adjunct medication(s) (methotrexate: 19%, tocilizumab: 15%). A total of 40% had relapse(s); the median time to the first relapse was 10 months. Also, 37% had comorbidity(ies) related to or aggravated by glucocorticoids therapy. Conclusion: This large observational study provides insight into current medical practices for GCA. More than one third of patients had comorbidities related to glucocorticoid therapy for a median disease duration of 13 months. Methotrexate and tocilizumab were the most common adjunct medications.
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Affiliation(s)
- Alfred Mahr
- Department of Internal Medicine, University Hospital Paris (AP-HP, Saint Louis), Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Nassim Guerroui
- Department of Rheumatology, European Hospital of Marseille, Marseille, France
| | - Emmanuel Héron
- Department of Internal Medicine, Hospital Quinze-Vingts, Internal Medicine, Paris, France
| | - Stéphane Vinzio
- Department of Internal Medicine, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Jonathan Broner
- Department of Internal Medicine, University Hospital Centre Nimes, Nimes, France
| | | | - Martin Michaud
- Department of Internal Medicine, Hopital Joseph Ducuing Toulouse, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, University Hospital of Toulouse, Toulouse, France
| | - Thierry Zenone
- Department of Internal Medicine, General Hospital of Valence, Valence, France
| | - Mohamed Djerad
- Department of Internal Medicine, General Hospital of Nevers, Nevers, France
| | - Mathieu Jouvray
- Department of Internal Medicine, General Hospital of Arras, Arras, France
| | - Emilie Shipley
- Department of Rheumatology, General Hospital of Dax, Dax, France
| | - Nathalie Tieulie
- Department of Rheumatology, University Hospital of Nice, Nice, France
| | - Guillaume Armengol
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Bastien Bouldoires
- Department of Internal Medicine, Civil Hospital of Colmar, Colmar, France
| | | | - Isabelle Idier
- Medical Affairs, Chugai Pharma France, Paris La Défense, Paris, France
| | - Marc Paccalin
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
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Gérard AL, Simon-Tillaux N, Yordanov Y, Cacoub P, Tubach F, Saadoun D, Dechartres A. Efficacy and safety of steroid-sparing treatments in giant cell arteritis according to the glucocorticoids tapering regimen: A systematic review and meta-analysis. Eur J Intern Med 2021; 88:96-103. [PMID: 33879385 DOI: 10.1016/j.ejim.2021.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of adjuvant therapies in newly diagnosed or relapsing giant cell arteritis (GCA) in terms of relapse rate at week 52 (primary outcome) and to assess the impact of GC tapering regimen on adjuvant effectiveness. METHODS For this systematic review and meta-analysis, we searched PubMed, EMBASE, CENTRAL, trial registries, from inception to November 2020. We included all randomized controlled trials (RCTs) and controlled prospective studies evaluating adjuvant treatments in GCA, without date or language restriction. Two reviewers independently selected studies, extracted data and assessed risk of bias. Quality of evidence was summarised with GRADE. RESULTS Of the 680 records identified, 16 studies were included (1,068 participants) evaluating various adjuvant therapies compared to GC only. No study compared adjuvants with each other. Risk of bias was high in 5/7 trials evaluating our primary outcome. Risk of relapse at week 52 was reduced for only the anti-IL6 and IL6-receptor drug class versus the control (RR=0.45, 95%CI 0.30-0.66, I2=38%), particularly tocilizumab (RR=0.38, 95%CI 0.23-0.63, I2=42%) with a moderate quality of evidence. We found no significant interaction according to GC tapering regimen. Our meta-analysis did not show a significant benefit for methotrexate. Except for dapsone, ciclosporine and hydroxychloroquine, other adjuvants did not seem to show increased risk of adverse events. CONCLUSIONS Tocilizumab seems to reduce the relapse rate in GCA at week 52 but the quality of evidence was moderate. No other molecule has shown efficacy. No significant interaction on relapse rate by GC tapering regimen was found. STUDY REGISTRATION PROSPERO CRD42020172011.
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Affiliation(s)
- Anne-Laure Gérard
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Noémie Simon-Tillaux
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Youri Yordanov
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP, Hôpital Saint-Antoine, Service d'Accueil des Urgences, Paris, France
| | - Patrice Cacoub
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France
| | - Florence Tubach
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - David Saadoun
- Sorbonne Université, INSERM U959, Immunopathology, Immunotherapies of autoimmunes and inflammatory diseases, RHU I2B, Labex Transimunom, AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France, Centre national de référence Maladies Autoimmunes systémiques rares, Centre national de référence Maladies Auto-inflammatoires et Amylose, France.
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France.
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Inflammatory Markers are Quickly Improved by Tocilizumab in Early Polymyalgia Rheumatica and Might Predict Early Response to Interleukin-6 Blockade. Rheumatol Ther 2021; 8:751-760. [PMID: 33745124 PMCID: PMC7981388 DOI: 10.1007/s40744-021-00299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/06/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION It is unclear whether polymyalgia rheumatica (PMR) should be considered an inflammatory disease or an autoimmune disease. METHODS Eighteen untreated early PMR patients and 18 sex- and age-matched healthy controls (HCs) were included. PMR patients received tocilizumab from week 0 to week 12 and glucocorticoids from week 12 to week 24. Leukocytes, neutrophils, platelets, hemoglobin, γ-globulins, IgG, IgA, and IgM were compared between the PMR patients and HCs and before and after tocilizumab treatment in the PMR group. RESULTS The mean age was 68 ± 7 and 66 ± 11 years, and the mean serum C-reactive protein level was 82 ± 16 and 5 ± 2 mg/l for PMR patients and HCs, respectively. At inclusion, leukocytes (p < 0.0001), neutrophils (p < 0.0001), and platelets (p < 0.0001) were increased and hemoglobin (p < 0.0001) decreased in the PMR group compared to the HC group. After tocilizumab therapy, leukocytes, neutrophils, and platelets decreased, and hemoglobin increased. At inclusion, all four parameters were significantly associated with the serum IL-6 level, though it was not associated after tocilizumab therapy. Levels of γ-globulin were increased in the PMR patients compared to HCs (p = 0.0087), and PMR patients with γ-globulins levels over 11 g/l at inclusion responded more quickly to tocilizumab therapy. Autoantibody profiles did not differ between the PMR patients and HCs. CONCLUSIONS This study suggests that PMR is more an inflammatory disease than an autoimmune disease. Tocilizumab improves all markers of inflammation. Patients with elevated γ-globulins respond more quickly to tocilizumab.
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Barra L, Pope JE, Pequeno P, Saxena FE, Bell M, Haaland D, Widdifield J. Incidence and prevalence of giant cell arteritis in Ontario, Canada. Rheumatology (Oxford) 2021; 59:3250-3258. [PMID: 32249899 DOI: 10.1093/rheumatology/keaa095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To estimate trends in the incidence and prevalence of GCA over time in Canada. METHODS We performed a population-based study of Ontario health administrative data using validated case definitions for GCA. Among Ontario residents ≥50 years of age we estimated the annual incidence and prevalence rates between 2000 and 2018. We performed sensitivity analyses using alternative validated case definitions to provide comparative estimates. RESULTS Between 2000 and 2018 there was a relatively stable incidence over time with 25 new cases per 100 000 people >50 years of age. Age-standardized incidence rates were significantly higher among females than males [31 cases (95% CI: 29, 34) vs 15 cases (95% CI: 13, 18) per 100 000 in 2000]. Trends in age-standardized incidence rates were stable among females but increased among males over time. Incidence rates were highest among those ≥70 years of age. Standardized prevalence rates increased from 125 (95% CI 121, 129) to 235 (95% CI 231, 239) cases per 100 000 from 2000 to 2018. The age-standardized rates among males rose from 76 (95% CI 72, 81) cases in 2000 to 156 (95% CI 151, 161) cases per 100 000 population in 2018. Between 2000 and 2018, the age-standardized rates among females similarly increased over time, from 167 (95% CI 161, 173) to 304 (95% CI 297, 310) cases per 100 000 population. CONCLUSION The incidence and prevalence of GCA in Ontario is similar to that reported in the USA and northern Europe and considerably higher than that reported for southern Europe and non-European populations.
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Affiliation(s)
- Lillian Barra
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Medicine, St. Joseph's Health Care London, Ontario, Canada
| | - Janet E Pope
- Department of Medicine, Western University, Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Medicine, St. Joseph's Health Care London, Ontario, Canada
| | | | | | - Mary Bell
- Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Derek Haaland
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Northern Ontario School of Medicine, Laurentian University Campus, Sudbury, Ontario, Canada
| | - Jessica Widdifield
- ICES, Toronto, Ontario, Canada.,Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
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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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Carvajal Alegria G, van Sleen Y, Graver JC, Sandovici M, Devauchelle-Pensec V, Brouwer E, Cornec D. Aortic involvement in giant cell arteritis. Joint Bone Spine 2020; 88:105045. [PMID: 32649986 DOI: 10.1016/j.jbspin.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Guillermo Carvajal Alegria
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France
| | - Yannick van Sleen
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba Carolien Graver
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Sandovici
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Valérie Devauchelle-Pensec
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France
| | - Elisabeth Brouwer
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Divi Cornec
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France.
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