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Evangelatos G, Grivas A, Pappa M, Kouna K, Iliopoulos A, Fragoulis GE. Cranial giant cell arteritis mimickers: A masquerade to unveil. Autoimmun Rev 2022; 21:103083. [PMID: 35341973 DOI: 10.1016/j.autrev.2022.103083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis that affects cranial and extra-cranial arteries. Extra-cranial GCA presents mainly with non-specific symptoms and the differential diagnosis is very broad, while the cranial form has more typical clinical picture and physicians have a lower threshold for diagnosis and treatment. Although temporal artery biopsy (TAB) has an established role, ultrasound (US) is being increasingly used as the first-line imaging modality in suspected GCA. Vasculitides (especially ANCA-associated), hematological disorders (mainly amyloidosis), neoplasms, infections, atherosclerosis and local disorders can affect the temporal arteries or might mimic the symptoms of cranial GCA and produce US and TAB findings that resemble those of temporal vasculitis. Given that prompt diagnosis is essential and proper treatment varies significantly among these diseases, in this review we aimed to collectively present disorders that can masquerade cranial GCA.
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Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexandros Grivas
- Clinical Immunology-Rheumatology Unit, Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kouna
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Misra DP, Thomas KN, Gasparyan AY, Zimba O. Mechanisms of thrombosis in ANCA-associated vasculitis. Clin Rheumatol 2021; 40:4807-4815. [PMID: 34109491 PMCID: PMC8189705 DOI: 10.1007/s10067-021-05790-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/07/2021] [Accepted: 05/22/2021] [Indexed: 12/19/2022]
Abstract
Patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have a two- to threefold greater risk of developing venous as well as arterial thrombotic events. Although such thrombotic events are more commonly seen during phases of active AAV, they are also recognized to occur during AAV in remission. Endothelial injury is a key pathogenic event in AAV. Endothelial injury can be caused by neutrophil activation and release of thrombogenic tissue factor into the circulation. Neutrophil activation further results in the formation of neutrophil extracellular traps (NETs). NETs contribute to thrombosis by expressing tissue factor. NETs have also been detected in cutaneous thrombi from patients with AAV induced by hydralazine. Activated neutrophils in AAV patients release thrombogenic microparticles loaded with tissue factor which further enhances clotting of blood. Antiphospholipid antibodies (APLs) have been detected in up to a third of AAV and might also be induced by drugs such as cocaine adulterated with levamisole and propylthiouracil, which are known to trigger AAV. Such APLs further drive the thrombosis in AAV. Once thrombogenesis occurs, the homeostatic mechanisms resulting in clot dissolution are further impaired in AAV due to anti-plasminogen antibodies. The ongoing pandemic of coronavirus disease 2019 (COVID-19) is associated with endothelial injury and NETosis, mechanisms which are in common with AAV. Reports of new-onset AAV following COVID-19 have been described in the literature, and there could be shared mechanisms driving these processes that require further evaluation.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
| | - Koshy Nithin Thomas
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK
| | - Olena Zimba
- Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Zhou Z, Ye J, Teng J, Liu H, Cheng X, Sun Y, Su Y, Chi H, Wang F, Yang C, Jin W. Clinical characteristics of infective endocarditis in patients with antineutrophil cytoplasmic antibody or antiphospholipid antibody: a retrospective study in Shanghai. BMJ Open 2020; 10:e031512. [PMID: 32051300 PMCID: PMC7044959 DOI: 10.1136/bmjopen-2019-031512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aimed to characterise rheumatic manifestations and autoantibodies in 432 patients diagnosed with infective endocarditis (IE) in Shanghai. DESIGN, SETTING AND PARTICIPANTS A retrospective study was conducted in Ruijin Hospital from 1997 to 2017. The clinical and laboratory characteristics of a total of 432 patients were analysed. In addition, the differences between patients with positive and negative antineutrophil cytoplasmic antibodies (ANCA) and antiphospholipid (aPL) antibodies as well as the survival rates of these patients were compared. RESULTS A total of 432 patients, including 278 male patients and 154 female patients, were included. The mean age of the patients was 46±16 years. A total of 346 patients (80%) had cardiac surgery, and 55 patients (13%) died in the hospital. Among the IE patients, 104 were tested for either ANCA or aPL and were analysed in different groups. Twenty-one (24%) positive ANCA patients were proteinase 3-ANCA positive. Compared with the ANCA-negative group, patients with positive ANCA had higher IgM (p=0.048), lower haemoglobin (p=0.001) and a higher likelihood of arthritis (p=0.003). Twenty-one (40%) aPL-positive patients had a higher erythrocyte sedimentation rate than was found in the aPL-negative group (p=0.003). In addition, the survival rate of the ANCA-positive IE patients was lower (p=0.032) than that of the ANCA-negative group, while there was no difference between patients with or without aPL antibodies (p=0.728). CONCLUSION This study supports the claim that rheumatic manifestations and autoantibodies are frequently present in patients with IE and might lead to early misdiagnosis. Physicians should pay more attention to the measurement of autoantibodies in these patients.
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Affiliation(s)
- Zhuochao Zhou
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junna Ye
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Teng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Honglei Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Sun
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huihui Chi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Wang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Jin
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Broncano J, Vargas D, Bhalla S, Cummings KW, Raptis CA, Luna A. CT and MR Imaging of Cardiothoracic Vasculitis. Radiographics 2018; 38:997-1021. [PMID: 29883266 DOI: 10.1148/rg.2018170136] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The term vasculitis includes a variable group of entities in which the common characteristic is inflammation of the walls of blood vessels occurring at some time during the course of the disease. The vasculitides can be divided into primary and secondary vasculitides, depending on the etiology and according to the size of the vessel affected. Both primary vasculitis and secondary vasculitis are associated with cardiac morbidity that is often subclinical. Cardiac involvement is associated with prognostic implications and higher rates of related mortality. Vasculitis of cardiac structures and the assessment of disease extent are important for appropriate management and selection of treatment. Although echocardiography, radionuclide imaging, and catheter-directed coronary angiography remain the cornerstones of cardiac imaging, cardiac computed tomography and magnetic resonance imaging can offer a 360° assessment of cardiac anatomy, function, and complications secondary to vasculitis. Postoperative complications, which are more frequent in patients with active disease, can also be depicted with those imaging modalities. A multidisciplinary approach is important to yield an appropriate estimate of the disease activity and extent and, therefore, to enable better treatment selection and monitoring. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Kristopher W Cummings
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Constantine A Raptis
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Ressalta Health Time Group, Hospital Cruz Roja, Avenida Paseo de la Victoria s/n, Córdoba 14004, Spain (J.B.); Department of Radiology, University of Colorado, Denver, Colo (D.V.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B., C.A.R.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.); and MRI Section, Health Time, Jaén, Spain, and Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio (A.L.)
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López-Mato P, Zamora-Martínez C, Carbajal S, Estevez M, Rodriguez-Pinto I, Cervera R, Prieto-González S, Espinosa G. All that glitters is not lupus. Lupus 2017; 27:1047-1048. [PMID: 29153011 DOI: 10.1177/0961203317742713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- P López-Mato
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
| | - C Zamora-Martínez
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
| | - S Carbajal
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
| | - M Estevez
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
| | - I Rodriguez-Pinto
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
| | - R Cervera
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
| | - S Prieto-González
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
| | - G Espinosa
- Department of Autoimmune Diseases, 16493 Hospital Clinic, Barcelona , Spain
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