1
|
Pugh D, Karabayas M, Basu N, Cid MC, Goel R, Goodyear CS, Grayson PC, McAdoo SP, Mason JC, Owen C, Weyand CM, Youngstein T, Dhaun N. Large-vessel vasculitis. Nat Rev Dis Primers 2022; 7:93. [PMID: 34992251 PMCID: PMC9115766 DOI: 10.1038/s41572-021-00327-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 02/08/2023]
Abstract
Large-vessel vasculitis (LVV) manifests as inflammation of the aorta and its major branches and is the most common primary vasculitis in adults. LVV comprises two distinct conditions, giant cell arteritis and Takayasu arteritis, although the phenotypic spectrum of primary LVV is complex. Non-specific symptoms often predominate and so patients with LVV present to a range of health-care providers and settings. Rapid diagnosis, specialist referral and early treatment are key to good patient outcomes. Unfortunately, disease relapse remains common and chronic vascular complications are a source of considerable morbidity. Although accurate monitoring of disease activity is challenging, progress in vascular imaging techniques and the measurement of laboratory biomarkers may facilitate better matching of treatment intensity with disease activity. Further, advances in our understanding of disease pathophysiology have paved the way for novel biologic treatments that target important mediators of disease in both giant cell arteritis and Takayasu arteritis. This work has highlighted the substantial heterogeneity present within LVV and the importance of an individualized therapeutic approach. Future work will focus on understanding the mechanisms of persisting vascular inflammation, which will inform the development of increasingly sophisticated imaging technologies. Together, these will enable better disease prognostication, limit treatment-associated adverse effects, and facilitate targeted development and use of novel therapies.
Collapse
Affiliation(s)
- Dan Pugh
- British Hearth Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Maira Karabayas
- Centre for Arthritis & Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Maria C Cid
- Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ruchika Goel
- Department of Clinical Immunology & Rheumatology, Christian Medical College, Vellore, India
| | - Carl S Goodyear
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Peter C Grayson
- National Institute of Arthritis & Musculoskeletal & Skin Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Stephen P McAdoo
- Department of Immunology & Inflammation, Imperial College London, London, UK
| | - Justin C Mason
- National Heart & Lung Institute, Imperial College London, London, UK
| | | | - Cornelia M Weyand
- Centre for Translational Medicine, Stanford University, Stanford, California, USA
| | - Taryn Youngstein
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Neeraj Dhaun
- British Hearth Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
2
|
Marinelli KC, Ahlman MA, Quinn KA, Malayeri AA, Evers R, Grayson PC. Stenosis and Pseudostenosis of the Upper Extremity Arteries in Large-Vessel Vasculitis. ACR Open Rheumatol 2019; 1:156-163. [PMID: 31750423 PMCID: PMC6858046 DOI: 10.1002/acr2.1018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective Pseudostenosis is a magnetic resonance angiography (MRA) artifact that mimics arterial stenosis. The study objective was to compare imaging and clinical aspects of stenosis and pseudostenosis in a cohort of large‐vessel vasculitis (LVV), including giant‐cell arteritis (GCA) and Takayasu's arteritis (TAK). Methods Patients with LVV and comparator conditions (healthy or vasculopathies) underwent MRA of the aortic arch vessels. The subclavian and axillary arteries were systematically assessed for presence of stenosis and pseudostenosis by two independent readers. Serial and delayed imaging and clinical assessments were used to confirm suspected pseudostenoses. Multivariable regression analyses were used to identify associations between angiographic pathology and clinical findings. Results One hundred eighty‐four MRA scans were analyzed from patients with GCA (n = 36), TAK (n = 47), and comparators (n = 25). Pseudostenoses were frequently observed (48 of 184 scans, 26%) in the distal subclavian artery only on the side of injection and were shorter in length compared with true stenoses (25 mm vs 78 mm, P < 0.01). There was no difference in prevalence of pseudostenosis by diagnosis (GCA = 33%, TAK = 23%, comparator = 20%, P = 0.44), disease activity status (P = 0.31), or treatment status (P = 1.00). Percent and length of true stenosis were independently associated with pulse and blood pressure abnormalities in the upper extremity. Adjusting for length and stenosis degree, absence of collateral arteries was associated with arm claudication (odds ratio = 2.37, P = 0.03). Conclusion Although a pseudostenosis could be falsely interpreted as an arterial stenosis, radiographic and associated clinical features can help distinguish true disease from arterial susceptibility artifacts. In addition, the peripheral vascular examination can help to confirm a suspected true stenosis, as specific aspects of angiographic pathology are associated with vascular examination abnormalities in LVV.
Collapse
Affiliation(s)
- Kathleen C Marinelli
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Mark A Ahlman
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Kaitlin A Quinn
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Ashkan A Malayeri
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Robert Evers
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| |
Collapse
|
3
|
Misra DP, Wakhlu A, Agarwal V, Danda D. Recent advances in the management of Takayasu arteritis. Int J Rheum Dis 2019; 22 Suppl 1:60-68. [PMID: 30698358 DOI: 10.1111/1756-185x.13285] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology; Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS); Lucknow India
| | - Anupam Wakhlu
- Department of Rheumatology; King George's Medical University; Lucknow India
| | - Vikas Agarwal
- Department of Clinical Immunology; Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS); Lucknow India
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology; Christian Medical College Hospital; Vellore India
| |
Collapse
|
4
|
Banerjee S, Bagheri M, Sandfort V, Ahlman MA, Malayeri AA, Bluemke DA, Yao J, Grayson PC. Vascular calcification in patients with large-vessel vasculitis compared to patients with hyperlipidemia. Semin Arthritis Rheum 2018; 48:1068-1073. [PMID: 30318124 DOI: 10.1016/j.semarthrit.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/10/2018] [Accepted: 09/07/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Calcification of the coronary arteries, aorta, and branch vessels can occur in both large-vessel vasculitis (LVV) and atherosclerosis. The study objective was to determine the location and amount of vascular calcification in patients with LVV versus hyperlipidemia (HLD) and to identify risk factors associated with vascular calcification in LVV. METHODS Patients with giant cell arteritis (GCA), Takayasu's arteritis (TAK), and HLD underwent non-contrast computed tomography of the aorta and branch vessels. Vascular calcification in 14 specific arterial territories (4 segments of the aorta, 9 branch arteries, and the coronary arteries) was quantified throughout the large arteries by a cumulative Agatston score. Multivariate linear regression analyses were used to identify associations between traditional and disease-specific risk factors and total Agatston score. RESULTS A total of 88 subjects, including GCA (n = 29); TAK (n = 22); and HLD (n = 37), participated. Prevalence of vascular calcification in the aorta and branch vessels significantly differed in the coronary arteries (HLD = 67%, GCA = 35%, TAK = 9%, p < 0.01). Total Agatston scores were higher in GCA (median 3260, range 25-18,138) versus HLD (460, 19-17,215) (p < 0.01) but did not significantly differ between GCA and TAK (1944, 52-47,520) (p = 0.53). In multivariable regression analysis, age, type of vasculitis, and prednisone use was associated with vascular calcification in LVV. CONCLUSION The prevalence of coronary artery calcification is lower in LVV compared to HLD, but the amount of total vascular calcification throughout the large arteries is greater in LVV. Both traditional and disease-specific risk factors are associated with vascular calcification in LVV.
Collapse
Affiliation(s)
- Shubhasree Banerjee
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Building 10, Rm 216G, Bethesda, MD 20892, USA
| | - Mohammadhadi Bagheri
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive Building 10, Bethesda, MD 20892, USA
| | - Veit Sandfort
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive Building 10, Bethesda, MD 20892, USA
| | - Mark A Ahlman
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive Building 10, Bethesda, MD 20892, USA
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive Building 10, Bethesda, MD 20892, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Jianhua Yao
- Radiology and Imaging Sciences, National Institutes of Health, 10 Center Drive Building 10, Bethesda, MD 20892, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Building 10, Rm 216G, Bethesda, MD 20892, USA.
| |
Collapse
|
5
|
Barra L, Yang G, Pagnoux C. Non-glucocorticoid drugs for the treatment of Takayasu's arteritis: A systematic review and meta-analysis. Autoimmun Rev 2018; 17:683-693. [DOI: 10.1016/j.autrev.2018.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 02/05/2023]
|
6
|
Průcha M, Šnajdrová A, Zdráhal P. Isolated Arteritis of Both Lower Limbs. Prague Med Rep 2018; 119:70-75. [PMID: 29665349 DOI: 10.14712/23362936.2018.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Isolated arteritis of the lower limb vessels is an extremely rare condition. The use of modern vascular imaging techniques substantially facilitates and accelerates the diagnostics. In the isolated lower limb arteritis, it is always necessary to exclude Takayasu's and giant-cell arteritis. We present the case of a female patient with an isolated lower extremity arteritis without any other symptoms of systemic vascular damage or systemic autoimmune disease. Immunosuppressive therapy is obligatory in this case. Interdisciplinary co-operation is required for rapid diagnosis and successful therapy. Our patient has consented to the publication of this report.
Collapse
Affiliation(s)
- Miroslav Průcha
- Department of Clinical Biochemistry, Haematology and Immunology, Na Homolce Hospital, Prague, Czech Republic.
| | - Alena Šnajdrová
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Zdráhal
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| |
Collapse
|