1
|
Ness T, Nölle B. Giant Cell Arteritis. Klin Monbl Augenheilkd 2024; 241:644-652. [PMID: 38593832 DOI: 10.1055/a-2252-3371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Giant cell arteritis (GCA) is the most common primary vasculitis and is associated with potential bilateral blindness. Neither clinical nor laboratory evidence is simple and unequivocal for this disease, which usually requires rapid and reliable diagnosis and therapy. The ophthalmologist should consider GCA with the following ocular symptoms: visual loss or visual field defects, transient visual disturbances (amaurosis fugax), diplopia, eye pain, or new onset head or jaw claudication. An immediate ophthalmological examination with slit lamp, ophthalmoscopy, and visual field, as well as color duplex ultrasound of the temporal artery should be performed. If there is sufficient clinical suspicion of GCA, corticosteroid therapy should be initiated immediately, with prompt referral to a rheumatologist/internist and, if necessary, temporal artery biopsy should be arranged. Numerous developments in modern imaging with colour duplex ultrasonography, MRI, and PET-CT have the potential to compete with the classical, well-established biopsy of a temporal artery. Early determination of ESR and CRP may support RZA diagnosis. Therapeutically, steroid-sparing immunosuppression with IL-6 blockade or methotrexate can be considered. These developments have led to a revision of both the classification criteria and the diagnostic and therapeutic recommendations of the American College of Rheumatologists and the European League against Rheumatism, which are summarised here for ophthalmology.
Collapse
Affiliation(s)
- Thomas Ness
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Bernhard Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| |
Collapse
|
2
|
Beyer TR, van Oterendorp C. [Nonarteritic anterior ischemic optic neuropathy (nAION)]. DIE OPHTHALMOLOGIE 2023; 120:1159-1169. [PMID: 37851117 DOI: 10.1007/s00347-023-01938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/19/2023]
Abstract
Nonarteritic anterior ischemic optic neuropathy (nAION) is the second most common degenerative disease of the optic nerve. The pathogenesis remains elusive. A transient ischemia in the short posterior ciliary arteries not triggered by thromboembolic events is suspected. The typical history of a sudden onset of scotoma without associated pain in conjunction with (sectorial) optic disc swelling, an afferent pupillary defect and a visual field defect are of decisive diagnostic importance. The most urgent diagnostic measure is the exclusion of arteritic AION. There are no proven treatment approaches. Frequently used but without clear study results, is the treatment with steroids and secondary prophylaxis with acetylsalicylic acid (ASA). Recurrence in the ipsilateral or contralateral eye is possible.
Collapse
Affiliation(s)
- Tabea Rebecca Beyer
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Christian van Oterendorp
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| |
Collapse
|
3
|
Katayama K, Ishizuka K, Tawara J, Kaji Y, Komuta M, Hayashi Y, Gomi H, Akahane M, Ohira Y. Temporal Arteritis Caused by Tertiary Syphilis. Intern Med 2023; 62:1095-1097. [PMID: 36047113 PMCID: PMC10125830 DOI: 10.2169/internalmedicine.9779-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man arrived at our hospital with bilateral shoulder pain persisting for several months and headache for 1 month. Giant cell arteritis with polymyalgia rheumatica was suspected. However, considering his medical history of testing positive for syphilis, we submitted a sample for a syphilis serology test, which yielded positive results. The Treponema pallidum hemagglutination assay of cerebrospinal fluid was positive, and a temporal artery biopsy revealed vasculitis, confirming the diagnosis of tertiary syphilis. He was successfully treated for two weeks with penicillin G infusions. Symptoms reminiscent of giant cell arteritis and polymyalgia rheumatica may reveal syphilis, which is called the "great imitator."
Collapse
Affiliation(s)
- Kohta Katayama
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Junsuke Tawara
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Yuki Kaji
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Mina Komuta
- Department of Pathology, International University of Health and Welfare, Japan
| | - Yuichiro Hayashi
- Department of Pathology, International University of Health and Welfare, Japan
| | - Harumi Gomi
- Office of Medical Education and Center for Infectious Diseases, International University of Health and Welfare, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| |
Collapse
|
4
|
Villeneuve E, Lacroix JM, Brisebois S. Optimizing the use of temporal artery biopsy: a retrospective study. J Otolaryngol Head Neck Surg 2023; 52:4. [PMID: 36703222 PMCID: PMC9878764 DOI: 10.1186/s40463-022-00605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Giant cell arteritis is an inflammatory disease of the large- and medium-sized vessels. It is the most common primary vasculitis, with lifetime incidences of 0.5% and 1% in men and women, respectively. Its diagnosis is based upon clinical criteria, which may include temporal artery biopsy. Expected positivity rates of temporal artery biopsies and patient selection remain controversial topics in the literature. METHODS A cross-sectional retrospective study of 127 patients referred for temporal artery biopsy with a diagnosis of suspected giant cell arteritis between January 2014 and December 2018 was performed. The primary outcome was the positivity rate. The relationships between positivity rates, symptoms, clinical suspicion, biopsy delay, biopsy length and corticosteroid treatment were also studied. RESULTS A positivity rate of 23.7% (16.6-32.6%) was shown, along with a significant association between jaw claudication and specimen positivity (odds ratio 8.1, p < 0.05). Moreover, there were significant associations between a high initial clinical suspicion of disease and specimen positivity (p < 0.05), as well as a high initial clinical suspicion of disease and pursuit of corticosteroid treatment following biopsy results, regardless of positivity (p < 0.05). The duration of corticosteroid treatment prior to biopsy was not associated with a change in positivity rate. CONCLUSIONS The positivity rate of temporal artery biopsy was 23.7%. Treatment of patients with negative temporal artery biopsy was associated with maintenance of corticosteroid treatment when the initial clinical suspicion of arteritis was high. Therefore, temporal artery biopsy may not be necessary for patients with a high initial clinical suspicion of giant cell arteritis.
Collapse
Affiliation(s)
- Etienne Villeneuve
- Division of Otolaryngology, Head and Neck Surgery, Université de Sherbrooke, Sherbrooke, Canada.
| | | | - Simon Brisebois
- Division of Otolaryngology, Head and Neck Surgery, Université de Sherbrooke, Sherbrooke, Canada
| |
Collapse
|
5
|
Yoshida S, Matsumoto H, Temmoku J, Shakespear N, Kiko Y, Kikuchi K, Sumichika Y, Saito K, Fujita Y, Matsuoka N, Asano T, Sato S, Suzuki E, Watanabe H, Ohira H, Migita K. Case report: Rapid development of amyloid A amyloidosis in temporal arteritis with SAA1.3 allele; An unusual case of intestinal amyloidosis secondary to temporal arteritis. Front Immunol 2023; 14:1144397. [PMID: 37026007 PMCID: PMC10071027 DOI: 10.3389/fimmu.2023.1144397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
Temporal arteritis (TA) is a large-vessel vasculitis mostly seen in older patients. Amyloid A (AA) amyloidosis secondary to a chronic inflammation induces multiple organ dysfunctions, including a dysfunction of the gastrointestinal tract. Herein, we present a case of TA complicated by AA amyloidosis that was resistant to oral and intravenous steroids. An 80-year-old man with a history of new-onset headache, jaw claudication, and distended temporal arteries was referred to our department. On admission, the patient presented with tenderness and a subcutaneous temporal nodule in both temple arteries. Ultrasonography of the nodule revealed an anechoic perivascular halo surrounding the right temporal artery. Following the diagnosis of TA, high-dose prednisolone therapy was initiated. However, the patient presented with recurrent abdominal pain and refractory diarrhea. Due to the unclear origin of refractory diarrhea, an extensive workup, including biopsy of the duodenal mucosa, was performed. Endoscopy revealed chronic inflammation in the duodenum. Immunohistochemical analysis of duodenal mucosal biopsy samples revealed AA amyloid deposition resulting in the diagnosis of AA amyloidosis. After tocilizumab (TCZ) administration, refractory diarrhea reduced; however, the patient died of intestinal perforation 1 month after the start of TCZ administration. Gastrointestinal involvement was the main clinical manifestation of AA amyloidosis in the present case. This case highlights the importance of bowel biopsy screening for amyloid deposition in patients with unexplained gastrointestinal tract symptoms, even in a recent onset of large-vessel vasculitis. In the present case, the carriage of the SAA1.3 allele likely contributed to the rare association of AA amyloidosis with TA.
Collapse
Affiliation(s)
- Shuhei Yoshida
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Haruki Matsumoto
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Norshalena Shakespear
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichiro Kiko
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kentaro Kikuchi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuya Sumichika
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenji Saito
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Eiji Suzuki
- Department of Rheumatology, Ohta-Nishinouchi Hospital, Koriyama, Japan
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
- *Correspondence: Kiyoshi Migita,
| |
Collapse
|
6
|
Temporal Artery Biopsy Debate: Positive TAB Result Prolongs Steroid Use in Giant Cell Arteritis. Plast Reconstr Surg Glob Open 2022; 10:e4652. [PMID: 36438469 PMCID: PMC9681624 DOI: 10.1097/gox.0000000000004652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022]
Abstract
UNLABELLED Temporal artery biopsy (TAB) in diagnosing giant cell arteritis has been criticized due to surgical risks, a high false negative rate, and redundant information when patients already met American College of Rheumatology criteria. The objective of this study was to investigate TAB's impact on steroid treatment duration. METHODS A retrospective chart review garnered patient demographics, symptoms, comorbidities, and steroid treatment duration in patients undergoing TAB at a single center. Steroid treatment was compared between TAB+ and TAB - patients. RESULTS One hundred seven patients undergoing TAB were included. Patients were predominantly women (70.1%) with a median age of 74 years (46 -91). Of 107 TAB results, 74 (69.2%) were negative, 23 (21.5%) were positive, and 10 (9.3%) were found to be indeterminate. In TAB+ patients, the mean erythrocyte sedimentation rate was not significantly different than TAB - patients (60.2 versus 43.7, P = 0.45), nor was the median C-reactive protein (38.8 versus 18.1, P = 0.17). Regarding steroid use, both TAB+ and TAB - patients had a similarly high rate of prebiopsy steroid initiation (82.6% versus 70.3%, P = 0.32). More TAB+ patients remained on steroids at 6 weeks (95.0% versus 57.4%, P = 0.004), 6 months (95% versus 37.7%, P < 0.001), 1 year (65.0% versus 31.1%, P = 0.024), and 18 months (50.0% versus 19.7%, P = 0.045). By 2 years, the difference no longer met significance (35.0% versus 14.8%, P = 0.12). P = 0.12). CONCLUSION TAB positivity does seem to influence maintenance of steroids up to 18 months after biopsy.
Collapse
|
7
|
Giant Cell Arteritis: A Case-Based Narrative Review of the Literature. Curr Pain Headache Rep 2022; 26:725-740. [PMID: 36057073 PMCID: PMC9440460 DOI: 10.1007/s11916-022-01075-1] [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] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Giant cell arteritis (GCA) is a chronic, inflammatory condition, primarily affecting the medium and larger arteries. The purpose of this narrative review is to describe GCA in the context of headache and facial pain, based on a case and the available current literature. Understanding the etiology, pathophysiology, the associated conditions, and the differential diagnoses is important in managing GCA. Recent Findings In a patient presenting with unilateral facial/head pain with disturbances of vision, GCA should be considered in the differential diagnosis. There is an association of GCA with several comorbid conditions, and infections including coronavirus-19 (COVID-19) infection. Management of GCA primarily depends upon the identification of the affected artery and prompt treatment. Permanent visual loss and other serious complications are associated with GCA. Summary GCA is characterized by robust inflammation of large- and medium-sized arteries and marked elevation of systemic mediators of inflammation. An interdisciplinary approach of management involving the pertinent specialties is strongly recommended.
Collapse
|
8
|
Arning C, Hanke-Arning K, Eckert B. The Clinical Features of Dissection of the Cervical Brain-Supplying Arteries. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:581-587. [PMID: 35734920 PMCID: PMC9749844 DOI: 10.3238/arztebl.m2022.0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Dissections of the cervical brain-supplying arteries are a leading cause of ischemic stroke in young adults, with an annual incidence of 2.5-3 / 100 000 for carotid artery dissection and 1-1.5 / 100 000 for vertebral artery dissection. It can be assumed that many cases go unreported. We present the clinical features here to help physicians diagnose this disease entity as rapidly as possible. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS Spontaneous dissection of the internal carotid or vertebral artery is characterized by a hematoma in the vessel wall. It often arises in connection with minor injuries; underlying weakness of the arterial wall (possibly only temporary) may be a predisposing factor. Acute unilateral pain is the main presenting symptom. In internal carotid dissection, the site of the pain is temporal in 46% of cases, and frontal in 19%; in vertebral artery dissection, it is nuchal and occipital in 80%. Pain and local findings, such as Horner syndrome, are generally present from the beginning, while stroke may arise only after a latency of hours to days. If the diagnosis is made early with MRI, CT, or ultrasound, and anticoagulation or antiplatelet drugs can help prevent a stroke, yet none of these methods can detect all cases. Recurrent dissection is rare, except in patients with connective tissue diseases such as Ehlers-Danlos syndrome or fibromuscular dysplasia. Spontaneous dissection of the great vessels of the neck must be differentiated from aortic dissection spreading to the supra-aortic vessels and from traumatic dissection due to blunt or penetrating vascular trauma. CONCLUSION Dissection of the cervical brain-supplying vessels is not always revealed by the imaging methods that are used to detect it. Stroke prevention thus depends on the physician's being aware of the symptoms and signs of this disease entity, so that early diagnosis can be followed by appropriate treatment.
Collapse
Affiliation(s)
- Christian Arning
- Praxis Neurologie und Neuro-Ultraschall, Hamburg,*Facharzt für Neurologie und Psychiatrie Moorhof 2d, D-22399 Hamburg, Germany
| | | | - Bernd Eckert
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg
| |
Collapse
|
9
|
Valenzuela-Rodríguez G, Lescano-Alva M, Bryce-Alberti M, Portmann-Baracco A, Prudencio-León W. [Acute cardiovascular complications in a Peruvian population of oncology patients]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:1-7. [PMID: 37583980 PMCID: PMC10424505 DOI: 10.47487/apcyccv.v3i1.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/09/2022] [Indexed: 07/07/2023]
Abstract
Objective To know the most frequent acute cardiovascular complications in a Peruvian population of oncologic patients. Materials and methods Retrospective, descriptive study of oncologic patients treated at Clinica Delgado between January 2014 and December 2019, from which the subgroup with the seven most prevalent cancers at the national level was selected according to information from Globocan 2018. Additionally, we evaluated the epidemiology of patients with cardiovascular complications that conditioned their hospitalization or were detected during this, calculating their cardiovascular risk according to Hermann and SCORE risk scales. Results Forty-four patients had complications; 27 (61.4%) were hospitalized due to acute cardiovascular causes. The mean age of this subgroup was 69.88 years (SD 12.77), and 22 (81.5%) were older than 60 years. Fourteen (51.9%) were male. According to the Hermann scale, 33.3% had intermediate-risk and 14.9% had a high or very high risk. According to the SCORE scale, 62.97% had an intermediate-risk and 7.40% high risk. The most common acute cardiovascular complications were deep vein thrombosis and ischemic stroke (66.65%). One patient (3.7%) reported previous cardiovascular disease. Four patients (14.8%) had a fatal outcome during hospitalization. The median length of hospitalization was five days. Conclusions We present the cases of acute cardiovascular complications in a population of oncologic patients and their vascular risk according to Hermann and SCORE scales. The most common complications were deep vein thrombosis (48.14%), stroke (18.51%), and myocardial infarction (14.81%).
Collapse
Affiliation(s)
- Germán Valenzuela-Rodríguez
- Servicio de Medicina Interna, Clínica Delgado. Lima, Perú.Servicio de Medicina InternaClínica DelgadoLimaPerú
- Universidad San Ignacio de Loyola, Unidad de Revisiones Sistemáticas y Metaanálisis, Guías de Práctica Clínica y Evaluaciones Tecnológicas Sanitarias. Lima, Perú.Universidad San Ignacio de LoyolaUniversidad San Ignacio de LoyolaUnidad de Revisiones Sistemáticas y MetaanálisisGuías de Práctica Clínica y Evaluaciones Tecnológicas SanitariasLimaPeru
| | - Miguel Lescano-Alva
- Servicio de Cardiología Posoperatoria, Instituto Nacional Cardiovascular, Lima, Perú.Servicio de Cardiología PosoperatoriaInstituto Nacional CardiovascularLimaPerú
| | - Mayte Bryce-Alberti
- Universidad Peruana Cayetano Heredia. Lima, Perú.Universidad Peruana Cayetano HerediaUniversidad Peruana Cayetano HerediaLimaPeru
| | - Arianna Portmann-Baracco
- Universidad Peruana Cayetano Heredia. Lima, Perú.Universidad Peruana Cayetano HerediaUniversidad Peruana Cayetano HerediaLimaPeru
| | - Walter Prudencio-León
- Servicio de Epidemiología, Hospital Nacional Edgardo Rebagliati. Lima, Perú.Servicio de EpidemiologíaHospital Nacional Edgardo RebagliatiLimaPerú
| |
Collapse
|
10
|
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.
Collapse
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
| | | |
Collapse
|
11
|
Biscetti L, De Vanna G, Cresta E, Corbelli I, Gaetani L, Cupini L, Calabresi P, Sarchielli P. Headache and immunological/autoimmune disorders: a comprehensive review of available epidemiological evidence with insights on potential underlying mechanisms. J Neuroinflammation 2021; 18:259. [PMID: 34749743 PMCID: PMC8573865 DOI: 10.1186/s12974-021-02229-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 12/31/2022] Open
Abstract
Several lines of evidence support a role of the immune system in headache pathogenesis, with particular regard to migraine. Firstly, alterations in cytokine profile and in lymphocyte subsets have been reported in headache patients. Secondly, several genetic and environmental pathogenic factors seem to be frequently shared by headache and immunological/autoimmune diseases. Accordingly, immunological alterations in primary headaches, in particular in migraine, have been suggested to predispose some patients to the development of immunological and autoimmune diseases. On the other hand, pathogenic mechanisms underlying autoimmune disorders, in some cases, seem to favour the onset of headache. Therefore, an association between headache and immunological/autoimmune disorders has been thoroughly investigated in the last years. The knowledge of this possible association may have relevant implications in the clinical practice when deciding diagnostic and therapeutic approaches. The present review summarizes findings to date regarding the plausible relationship between headache and immunological/autoimmune disorders, starting from a description of immunological alteration of primary headaches, and moving onward to the evidence supporting a potential link between headache and each specific autoimmune/immunological disease.
Collapse
Affiliation(s)
- Leonardo Biscetti
- Istituto Nazionale di Riposo e Cura dell'Anziano a carattere scientifico, IRCSS- INRCA, Ancona, Italy
| | - Gioacchino De Vanna
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Cresta
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ilenia Corbelli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Letizia Cupini
- Headache Center, UOC Neurologia-Stroke Unit, Emergency Department, Ospedale S. Eugenio, Rome, Italy
| | - Paolo Calabresi
- Department of Neuroscience, Università Cattolica Sacro Cuore, Rome, Italy
| | - Paola Sarchielli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| |
Collapse
|
12
|
Crain MA, Lakhani DA, Winkler L, Adelanwa A, Kim C. Giant cell arteritis: A case report and review of literature. Radiol Case Rep 2021; 16:3734-3738. [PMID: 34630809 PMCID: PMC8493503 DOI: 10.1016/j.radcr.2021.08.072] [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: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Giant cell arteritis, the most common form of vasculitis in the elderly, is characterized by granulomatous inflammation of arteries, which can lead to serious, life-threatening conditions including aortic aneurysms, ruptures, and dissections as well as blindness. Since GCA can be treated by immunosuppressant therapy, such as corticosteroids, early diagnosis and treatment may reduce the risk of serious disability and morbidity. While temporal artery biopsy is considered the gold standard to diagnosis giant cell arteritis, it is intrusive with inherent risks as well as unreliable due to tissue sampling. Imaging studies, such as computerized tomography, are nonintrusive and have been shown to identify vasculitis including giant cell arteritis. We present a case of a 72-year-old male patient who was diagnosed with giant cell arteritis by temporal artery biopsy during surgery for aortic aneurysm and coronary artery bypass graft. Computerized tomography imaging studies, prior to the surgery and biopsy, were suggestive of vasculitis. This case serves to emphasize the beneficial role of imaging studies to assess vasculitis, including giant cell arteritis, that can be done prior to the progressive development of more serious debilitating and potentially fatal pathology.
Collapse
Affiliation(s)
| | - Dhairya A Lakhani
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506
| | - Lana Winkler
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506
| | - Ayodele Adelanwa
- Department of Pathology, Ruby Memorial Hospital, West Virginia University, Morgantown, WV
| | - Cathy Kim
- Department of Radiology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506
| |
Collapse
|
13
|
Venhoff N, Schmidt WA, Lamprecht P, Tony HP, App C, Sieder C, Legeler C, Jentzsch C, Thiel J. Efficacy and safety of secukinumab in patients with giant cell arteritis: study protocol for a randomized, parallel group, double-blind, placebo-controlled phase II trial. Trials 2021; 22:543. [PMID: 34404463 PMCID: PMC8369438 DOI: 10.1186/s13063-021-05520-1] [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: 06/23/2020] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background One key pathological finding in giant cell arteritis (GCA) is the presence of interferon-gamma and interleukin (IL)-17 producing T helper (Th) 1 and Th17 cells in affected arteries. There is anecdotal evidence of successful induction and maintenance of remission with the monoclonal anti-IL-17A antibody secukinumab. Inhibition of IL-17A could therefore represent a potential new therapeutic option for the treatment of GCA. Methods This is a randomized, parallel-group, double-blind, placebo-controlled, multi-center, phase II study in which patients, treating physicians, and the associated clinical staff as well as the sponsor clinical team are blinded. It is designed to evaluate efficacy and safety of secukinumab compared to placebo in combination with an open-label prednisolone taper regimen. Patients included are naïve to biological therapy and have newly diagnosed or relapsing GCA. Fifty patients are randomly assigned in a 1:1 ratio to receive either 300 mg secukinumab or placebo subcutaneously at baseline, weeks 1, 2 and 3, and every 4 weeks from week 4. Patients in both treatment arms receive a 26-week prednisolone taper regimen. The study consists of a maximum 6-week screening period, a 52-week treatment period (including the 26-week tapering), and an 8-week safety follow-up, with primary and secondary endpoint assessments at week 28. Patients who do not achieve remission by week 12 experience a flare after remission or cannot adhere to the prednisolone tapering will enter the escape arm and receive prednisolone at a dose determined by the investigator’s clinical judgment. The blinded treatment is continued. Two optional imaging sub-studies are included (ultrasound and contrast-media enhanced magnetic resonance angiography [MRA]) to assess vessel wall inflammation and occlusion before and after treatment. The primary endpoint is the proportion of patients in sustained remission until week 28 in the secukinumab group compared to the proportion of patients in the placebo group. A Bayesian approach is applied. Discussion The trial design allows the first placebo-controlled data collection on the efficacy and safety of secukinumab in patients with GCA. Trial registration ClinicalTrials.gov NCT03765788. Registration on 5 December 2018, prospective registration, EudraCT number 2018-002610-12; clinical trial protocol number CAIN457ADE11C.
Collapse
Affiliation(s)
- Nils Venhoff
- Department Innere Medizin, Klinik für Rheumatologie und Klinische Immunologie, Vaskulitiszentrum Freiburg, Universitätsklinikum Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Klinik für Innere Medizin, Abteilung Rheumatologie und Klinische Immunologie in Berlin-Buch, Lindenberger Weg 19, D-13125, Berlin, Germany
| | - Peter Lamprecht
- Universität zu Lübeck, Klinik für Rheumatologie und klinische Immunologie, Ratzeburger Allee 160, D-23538, Lübeck, Germany
| | - Hans-Peter Tony
- Medizinische Klinik II, Universitätsklinik, Rheumatology/Immunology, Oberduerrbacher Strasse 6, D-97080, Wuerzburg, Germany
| | - Christine App
- Department of Immunology, Hepatology & Dermatology, Novartis Pharma GmbH, Roonstrasse 25, D-90429, Nuremberg, Germany
| | - Christian Sieder
- Department of Immunology, Hepatology & Dermatology, Novartis Pharma GmbH, Roonstrasse 25, D-90429, Nuremberg, Germany
| | - Carolin Legeler
- Department of Immunology, Hepatology & Dermatology, Novartis Pharma GmbH, Roonstrasse 25, D-90429, Nuremberg, Germany.
| | | | - Jens Thiel
- Department Innere Medizin, Klinik für Rheumatologie und Klinische Immunologie, Vaskulitiszentrum Freiburg, Universitätsklinikum Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany
| |
Collapse
|
14
|
Echevarría-Lucas L, Senciales-González JM, Medialdea-Hurtado ME, Rodrigo-Comino J. Impact of Climate Change on Eye Diseases and Associated Economical Costs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137197. [PMID: 34281132 PMCID: PMC8297364 DOI: 10.3390/ijerph18137197] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 01/22/2023]
Abstract
Climate change generates negative impacts on human health. However, little is known about specific impacts on eye diseases, especially in arid and semi-arid areas where increases in air temperatures are expected. Therefore, the main goals of this research are: (i) to highlight the association between common eye diseases and environmental factors; and (ii) to analyze, through the available literature, the health expenditure involved in combating these diseases and the savings from mitigating the environmental factors that aggravate them. Mixed methods were used to assess the cross-variables (environmental factors, eye diseases, health costs). Considering Southern Spain as an example, our results showed that areas with similar climatic conditions could increase eye diseases due to a sustained increase in temperatures and torrential rains, among other factors. We highlight that an increase in eye diseases in Southern Spain is conditioned by the effects of climate change by up to 36.5%; the economic burden of the main eye diseases, extrapolated to the rest of the country, would represent an annual burden of 0.7% of Spain’s Gross Domestic Product. In conclusion, the increase in eye diseases has a strong economic and social impact that could be reduced with proper management of the effects of climate change. We propose a new concept: disease sink, defined as any climate change mitigation action which reduces the incidence or morbidity of disease.
Collapse
Affiliation(s)
- Lucía Echevarría-Lucas
- Ophthalmology Service of Axarquía Hospital, 29700 Vélez-Málaga, Spain; (L.E.-L.); (M.E.M.-H.)
| | | | | | - Jesús Rodrigo-Comino
- Department of Regional Geographical Analysis and Physical Geography, University of Granada, 18010 Granada, Spain
- Department of Physical Geography, University of Trier, 54296 Trier, Germany
- Correspondence:
| |
Collapse
|
15
|
Arévalo Ruales K, Elkes B, Miehle N. [Cough in times of coronavirus]. Z Rheumatol 2021; 80:270-273. [PMID: 33559755 PMCID: PMC7871317 DOI: 10.1007/s00393-021-00961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Abstract
Es wird der stationäre Fall einer 58-jährigen Patientin mit chronischem Reizhusten und erhöhten Entzündungswerten beschrieben. Zuvor erfolgte ambulant ein Ausschluss einer Erkrankung mit der Corona-Virus-Disease 19 (COVID-19) durch eine Thoraxröntgenaufnahme (Rö-Thorax) sowie einen 2‑malig negativen Polymerase-Kettenreaktion(PCR)-Nasen-Rachen-Abstrich. Bei der Aufnahme bestand anamnestisch ein trockener Husten bei klinisch unauffälligem Auskultationsbefund. In den Laboruntersuchungen waren eine Anämie sowie deutlich erhöhte Entzündungswerte (C-reaktives Protein [CRP] 92,4 mg/l, Blutsenkungsgeschwindigkeit [BSG] 102 mm n.W) zu sehen. In der MR-Angiographie (MRA) ließ sich eine Großgefäßvaskulitis (GGV) nachweisen. Bei Diagnosestellung einer Riesenzellarteriitis (RZA) erfolgte eine Einleitung einer Therapie mit oralen Glukokortikoiden (GC) und subkutanem Methotrexat (MTX) mit im Verlauf gutem klinischem und laborchemischem Ansprechen. Ein Reizhusten wird in seltenen Fällen als erstes Zeichen einer RZA in der Literatur beschrieben.
Collapse
Affiliation(s)
- K Arévalo Ruales
- Süddeutsches Rheumazentrum RKH Kliniken Neuenbürg, Marxzeller Str. 46, 75305, Neuenbürg, Deutschland.
| | - B Elkes
- Radiologiezentrum Mühlacker, Mühlacker, Deutschland
| | - N Miehle
- Süddeutsches Rheumazentrum RKH Kliniken Neuenbürg, Marxzeller Str. 46, 75305, Neuenbürg, Deutschland
| |
Collapse
|
16
|
Gul M, Moinuddin S, Alam A, Aftab I, Shah Z, Chaudhry A. Thoracic imaging finding of rheumatic diseases. J Thorac Dis 2020; 12:5110-5118. [PMID: 33145088 PMCID: PMC7578499 DOI: 10.21037/jtd.2020.04.16] [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] [Indexed: 11/06/2022]
Abstract
In the era of Precision Medicine, diagnostic imaging plays a key role in initial diagnosis and treatment response assessment in thoracic manifestation of various rheumatic disorders; resulting in increased dependency on imaging for treatment planning. Chest radiographs serve as a good initial screening tool for assessment of emergent and urgent thoracic conditions, e.g., pneumothorax, pulmonary edema, consolidation and pleural effusions. Cross-sectional imaging techniques, e.g., computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) are most commonly utilized to evaluate more detailed pulmonary and mediastinal manifestations of rheumatic conditions. Magnetic resonance imaging (MRI) and ultrasound are most commonly used in cardiovascular, neural and musculoskeletal structures. This review article aims to highly key common thoracic imaging findings of rheumatic disorders, highlighting imaging test of choice for the particular disorder.
Collapse
Affiliation(s)
- Maryam Gul
- Department of Rheumatology, Southern California Kaiser Permanente, Lancaster, CA, 93534, USA
| | - Sadia Moinuddin
- Department of Internal Medicine, San Antonio Regional Medical Center, Upland, CA 91786, USA
| | - Aisha Alam
- Medical Student, Caribbean Medical University, Willemstad, Curaçao
| | - Iqra Aftab
- Department of Internal Medicine, Maimonides Medical Centre, Brooklyn, NY 11219, USA
| | - Zunairah Shah
- Department of Internal Medicine, Louis A Weiss memorial hospital, Chicago, IL 60640, USA
| | - Ammar Chaudhry
- Department of Radiology, City of Hope National Medical Center, Duarte, CA 91010, USA
| |
Collapse
|
17
|
Ing E, Xu Q(A, Chuo J, Kherani F, Landau K. Practice Preferences: Temporal Artery Biopsy versus Doppler Ultrasound in the Work-Up of Giant Cell Arteritis. Neuroophthalmology 2020; 44:174-181. [PMID: 32395169 PMCID: PMC7202440 DOI: 10.1080/01658107.2019.1656752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 01/23/2023] Open
Abstract
To determine whether temporal artery biopsy (TABx) or Doppler ultrasound (US) of the temporal artery is the preferred confirmatory test for giant cell arteritis, an online survey of ophthalmologists and neurologists in North America, Europe and Israel was conducted in 2019; Canadian rheumatologists were also included. There were 406 survey participants with an estimated survey response rate of 18%. Ninety-four per cent of North American practitioners preferred TABx compared with 74% of their European counterparts. Two per cent of North American practitioners preferred Doppler US versus 24% of European physicians. Regional differences were statistically significant (p < .001).
Collapse
Affiliation(s)
- Edsel Ing
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada
| | - Qinyuan (Alis) Xu
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jean Chuo
- Department of Ophthalmology & Vision Sciences, University of British Columbia, Vancouver, Canada
| | - Femida Kherani
- Department of Ophthalmology & Vision Sciences, University of British Columbia, Vancouver, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
18
|
Lamas ES, Bononi RLJR, Reis PACDÁ. Giant Cell Arteritis with Aortic Involvement Leading to Cardio Vocal Syndrome (Ortner's Syndrome). Arq Bras Cardiol 2020; 114:16-18. [PMID: 32428102 PMCID: PMC8149116 DOI: 10.36660/abc.20180427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/10/2019] [Indexed: 11/18/2022] Open
|
19
|
Best JH, Kong AM, Smith DM, Abbass I, Michalska M. Healthcare Costs of Potential Glucocorticoid-Associated Adverse Events in Patients with Giant Cell Arteritis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 11:799-807. [PMID: 31920351 PMCID: PMC6934125 DOI: 10.2147/ceor.s228400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To quantify the healthcare expenditures associated with potential oral glucocorticoid (OGC)-related adverse events (AEs) in patients with giant cell arteritis (GCA). Methods Patients with GCA and ≥ 1 OGC prescription fill between 2009 and 2014 were identified from the MarketScan Commercial and Medicare Supplemental claims databases. Patients were stratified into four groups based on cumulative OGC dose (> 0 to ≤ 2607 mg, > 2607 to ≤ 4800 mg, > 4800 to ≤ 7200 mg, and > 7200 mg) during the 1-year follow-up period; incidence of potential AEs and AE-related direct healthcare costs in USD were assessed. Association between the log of cumulative OGC dose and AE-related direct healthcare costs was evaluated, adjusting for baseline characteristics. Results Of 1602 patients with GCA included, 69% were women; the mean age was 73 years. The mean cumulative OGC dose was 5806 mg during the 1-year follow-up; most exposure occurred in the first 6 months. The proportion of patients with potential OGC-related AEs was 36.5% overall and increased as cumulative dose increased (30.7%–45.3% across dose groups). Unadjusted mean AE-related costs for patients with an AE was USD $12,818. In the multivariable model including all patients, increasing OGC dose was associated with increasing AE-related healthcare costs (cost ratio, 1.38 [95% CI, 1.16–1.64] per 1-unit increase in log of cumulative OGC dose [P < 0.001]). Mean (median)-predicted AE costs for the dose groups were USD $4389 ($2749) for > 0 to ≤ 2607 mg, USD $5176 ($3009) for > 2607 to ≤ 4800 mg, USD $5576 ($3633) for > 4800 to ≤ 7200 mg, and USD $6609 ($4447) for > 7200 mg. Conclusion In patients with GCA, OGC-related AEs increased with increasing cumulative OGC dose, resulting in increased healthcare costs. These results highlight the need for efficacious therapies that reduce the exposure to and potential risks associated with OGCs.
Collapse
|
20
|
Zhang Y, Wang D, Yin Y, Fan H, Zhang W, Zeng X. Clinical comparisons of patients with giant cell arteritis with versus without fever at onset. J Int Med Res 2019; 47:5613-5622. [PMID: 31547723 PMCID: PMC6862894 DOI: 10.1177/0300060519875379] [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: 11/16/2022] Open
Abstract
Objective Giant cell arteritis (GCA) is the most common systemic vasculitis in individuals aged ≥50 years. Some patients with GCA who develop fever at onset without typical ischemic manifestations may be misdiagnosed with fever of unknown origin. Methods In the present study, we retrospectively evaluated the clinical records of patients with GCA. Patients with and without fever at onset were compared. Results This study included 91 patients with GCA, 55 of whom had fever at onset. The patients with fever at onset showed a lower frequency of jaw claudication and arthralgia and a higher percentage of constitutional symptoms than patients without fever. Additionally, their laboratory results revealed a lower percentage of positive anti-neutrophil cytoplasmic antibody. Furthermore, a lower proportion of affected intracranial vessels was found in patients with fever at onset. Finally, the proportion of biopsy-positive cases was higher in patients with than without fever at onset. Conclusions In this study, 60.4% of patients with GCA had fever at onset. Patients in this group usually had more severe inflammation with a potentially lower risk of ischemic accidents of the central nervous system than patients without fever at onset.
Collapse
Affiliation(s)
- Yun Zhang
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Dongmei Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yue Yin
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hongwei Fan
- Department of Infectious Disease, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Wen Zhang
- Department of Rheumatology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xuejun Zeng
- Department of General Internal Medicine of Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
21
|
Neß T, Schmidt W. [Eye involvement in large vesssel vasculitis (giant cell arteritis and Takayasu's arteritis)]. Ophthalmologe 2019; 116:899-914. [PMID: 31463637 DOI: 10.1007/s00347-019-00959-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Giant cell arteritis (GCA) and Takayasu's arteritis are both forms of large vessel vasculitis and can be manifested in the eye. While GCA affects patients over the age of 50 years, patients with Takayasu's arteritis are between 15 and 30 years old. The diagnosis is based on a combination of anamnesis, imaging and systemic inflammatory reactions. The diagnosis can be confirmed by biopsy. Typical eye involvement of GCA are anterior ischemic optic neuropathy (AION) and central retinal artery occlusion, while Takayasu's arteritis involves hypertensive retinopathy and Takayasu's retinopathy (capillary dilatation, microaneurysms and arteriovenous anastomoses). The treatment consists of steroids in combination with classical immunosuppressants or biologics.
Collapse
Affiliation(s)
- Thomas Neß
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - Wolfgang Schmidt
- Rheumatologie, Klinische Immunologie und Osteologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| |
Collapse
|
22
|
Lapić I, Piva E, Spolaore F, Tosato F, Pelloso M, Plebani M. Automated measurement of the erythrocyte sedimentation rate: method validation and comparison. ACTA ACUST UNITED AC 2019; 57:1364-1373. [DOI: 10.1515/cclm-2019-0204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Development of automated analyzers for erythrocyte sedimentation rate (ESR) has imposed the need for extensive validation prior to their implementation in routine practice, to ensure comparability with the reference Westergren method. The aim of our study was to perform the analytical validation of two automated ESR analyzers, the Ves-Matic Cube 200 and the TEST1.
Methods
Validation was performed according to the recent International Council for Standardization in Hematology recommendations and included determination of intrarun and inter-run precision, assessment of sample carryover, hemolysis interference, sensitivity to fibrinogen, method comparison with the gold standard Westergren method and stability test.
Results
The highest intrarun imprecision was obtained for the low ESR range (33.5% for Ves-Matic Cube; 37.3% for TEST1) while inter-run coefficients of variation on three levels were much better for the TEST1 (0%, 2% and 1.2%) compared to the Ves-Matic Cube 200 on two levels (24.9% and 5.8%). Both Ves-Matic Cube 200 and TEST1 showed no statistically significant difference when compared with Westergren. Bland-Altman analysis yielded overall insignificant mean biases for all comparisons, but a wider dispersion of results and 95% limits of agreement for comparisons including the Ves-Matic Cube 200. Carryover was considered insignificant, while hemolysis had a negative effect on all assessed ESR methods. The highest sensitivity to fibrinogen was observed for the Ves-Matic Cube 200, followed by Westergren and the least sensitive was the TEST1.
Conclusions
The obtained results proved the analytical validity of the TEST1 and the Ves-Matic Cube 200, and high comparability with the gold standard Westergren method, showing obvious improvements in standardization of ESR methods.
Collapse
|
23
|
Butcovan D, Mocanu V, Haliga RE, Ioan BG, Danciu M, Tinica G. Sub-classification of non-inflammatory and inflammatory surgical aortic aneurysms and the association of histological characteristics with potential risk factors. Exp Ther Med 2019; 18:3046-3052. [PMID: 31572544 PMCID: PMC6755460 DOI: 10.3892/etm.2019.7903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to analyze the histological characteristics of surgical thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) specimens on the basis of the most recent consensus documents on non-inflammatory and inflammatory lesions. The current study also aimed to establish an association with various risk factors. Aortic wall specimens were collected from 52 patients (38 men and 14 women; age, 19–80 years) undergoing surgery for aortic dilatation at The Cardiovascular Disease Institute (Iasi, Romania). For histological evaluation, the aortic specimens (39 TAAs and 13 AAAs) were stained with hematoxylin-eosin, Van Giessen, alcian blue and Movat pentachrome. The specimens were evaluated and graded according to the severity of histopathological conditions: Fragmentation of elastic fibers, medial mucoid accumulation, smooth muscle cell loss and medial fibrosis. The severity of atherosclerotic lesions in surgically resected segments of the aorta were graded as follows: i) mild=1; ii) moderate=2; and iii) severe=3. The risk factors associated with TAA were the male sex (80%), smoking (56%), hypertension (33%) and bicuspid aortic valve (13%). Advanced age (70 years), male sex (69%) and smoking (54%) were determined to be the risk factors of AAA. The histopathological abnormalities included medial degeneration (MD) (82%), atherosclerosis (ATS) (42%) and aortitis (10%). MD was the leading histopathological diagnosis in TAA and the severity of lesions were graded as follows: Mild (8% of cases), moderate (44% of cases) and severe (31% of cases). Severe atherosclerotic lesions were identified in AAA (100% of cases). In the present study, medial degenerative aortic lesions (1, mild; 2, moderate; and 3, severe) significantly correlated with advanced age (>65 years; r=−0.39; P<0.01) and male sex (r=0.27; P<0.05). Significant correlations were also identified between atherosclerotic aortic lesions (1, mild; 2, moderate; and 3, severe) and advanced age (>65 years) (r=−0.40, P<0.01) or smoking (r=−0.29; P<0.05). Advanced age, male sex and smoking were determined to be the main risk factors for the development of degenerative aortic aneurysms.
Collapse
Affiliation(s)
- Doina Butcovan
- Department of Cardiovascular Surgery, "Prof George Georgescu" Institute of Cardiovascular Diseases, Iasi 700503, Romania.,Department of Morpho-Functional Sciences-Pathology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Veronica Mocanu
- Department of Morpho-Functional Sciences-Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Raluca Ecaterina Haliga
- Department of Morpho-Functional Sciences-Pathophysiology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania.,Department of Internal Medicine-Toxicology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Beatrice Gabriela Ioan
- Department of Internal Medicine-Legal Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania.,Institute of Legal Medicine, Iasi 700455, Romania
| | - Mihai Danciu
- Department of Morpho-Functional Sciences-Pathology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Grigore Tinica
- Department of Cardiovascular Surgery, "Prof George Georgescu" Institute of Cardiovascular Diseases, Iasi 700503, Romania.,Department of Surgery-Cardiac Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi 700115, Romania
| |
Collapse
|
24
|
Abstract
Giant cell arteritis (GCA) is an inflammatory vasculitis typically affecting elderly that can potentially cause vision loss. Studies have demonstrated that early recognition and initiation of treatment can improve visual prognosis in patients with GCA. This review addresses the benefits of early diagnosis and treatment, and discusses the available treatment options to manage the disease.
Collapse
Affiliation(s)
- Iyza F Baig
- McGovern Medical School, The University of Texas Health Science Center in Houston, Houston, TX, USA
| | - Alexis R Pascoe
- McGovern Medical School, The University of Texas Health Science Center in Houston, Houston, TX, USA
| | - Ashwini Kini
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA,
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA, .,Department of Ophthalmology, Baylor College of Medicine,Houston, TX, USA, .,Department of Ophthalmology, .,Department of Neurology, .,Department of Neurosurgery, Weill Cornell Medical College, Houston, TX, USA, .,The University of Texas Medical Branch, Galveston, TX, USA, .,The Universityof Texas MD Anderson Cancer Center, Houston, TX, USA, .,Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA,
| |
Collapse
|
25
|
The incidence of giant cell arteritis in Slovenia. Clin Rheumatol 2018; 38:285-290. [DOI: 10.1007/s10067-018-4236-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
|
26
|
Gale S, Wilson JC, Chia J, Trinh H, Tuckwell K, Collinson N, Dimonaco S, Jick S, Meier C, Mohan SV, Sarsour K. Risk Associated with Cumulative Oral Glucocorticoid Use in Patients with Giant Cell Arteritis in Real-World Databases from the USA and UK. Rheumatol Ther 2018; 5:327-340. [PMID: 29752705 PMCID: PMC6251855 DOI: 10.1007/s40744-018-0112-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Treatment of giant cell arteritis (GCA) involves immediate initiation of high-dose glucocorticoid therapy with slow tapering of the dose over many months. Chronic exposure to glucocorticoids is associated with serious comorbidities. The objective of this analysis was to determine the glucocorticoid exposure and risk of glucocorticoid-related adverse events (AEs) in real-world patients with GCA. METHODS Data from the Truven Healthcare MarketScan® database (from January 1, 2000, to June 30, 2015) and the Clinical Practice Research Datalink (CPRD; from January 1, 1995, to August 31, 2013) were used to retrospectively analyze patients aged ≥ 50 years with GCA in the USA and UK, respectively. Outcomes included oral glucocorticoid use (cumulative prednisone-equivalent exposure), glucocorticoid-related AEs and the association of AE risk with glucocorticoid exposure over 52 weeks. RESULTS Of the 4804 patients in the US MarketScan database and 3973 patients in the UK CPRD database included, 71.3 and 74.6% were women and mean age was 73.4 and 73.0 years, respectively. Median starting glucocorticoid dose and cumulative glucocorticoid dose at 52 weeks were 20-50 mg/day and 4000-4800 mg, respectively. The most frequent glucocorticoid-related AEs were hypertension and eye, bone health, and glucose tolerance conditions. In the first year after diagnosis, the likelihood of any glucocorticoid-related AE was significantly increased for each 1 g increase in cumulative glucocorticoid dose in the US and UK cohorts (odds ratio [95% CI], 1.170 [1.063, 1.287] and 1.06 [1.03, 1.09], respectively; P < 0.05 for both). Similar trends were observed for the risk of glucocorticoid-related AEs over full follow-up (mean, USA: 3.9 years, UK: 6.3 years). CONCLUSIONS In real-world patients with GCA, increased cumulative glucocorticoid exposure was associated with an increased risk of glucocorticoid-related AEs. FUNDING F. Hoffmann-La Roche Ltd. Plain language summary available for this article.
Collapse
Affiliation(s)
- Sara Gale
- Genentech, Inc., South San Francisco, CA, USA.
| | - Jessica C Wilson
- Basel Pharmacoepidemiology Unit, University of Basel, Basel, Switzerland
| | - Jenny Chia
- Genentech, Inc., South San Francisco, CA, USA
| | - Huong Trinh
- Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | - Susan Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, USA
| | - Christoph Meier
- Basel Pharmacoepidemiology Unit, University of Basel, Basel, Switzerland.,Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, USA
| | | | | |
Collapse
|
27
|
Konishi C, Nakagawa K, Nakai E, Nishi K, Ishikawa R, Uematsu S, Nakao S, Taki M, Morita K, Hee HM, Yoshimura C, Wakayama T, Nishizaka Y. Interstitial Lung Disease as an Initial Manifestation of Giant Cell Arteritis. Intern Med 2017; 56:2633-2637. [PMID: 28883253 PMCID: PMC5658531 DOI: 10.2169/internalmedicine.8861-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Interstitial lung disease (ILD) has rarely been reported as a manifestation of giant cell arteritis (GCA). We herein report a unique case of GCA in a 76-year-old woman who presented with ILD as an initial manifestation of GCA. Ten years before admission, she had been diagnosed with granulomatous ILD of unknown etiology. Corticosteroid therapy induced remission. One year after the cessation of corticosteroid therapy, she was admitted with a persistent fever. After admission, she developed left oculomotor paralysis. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) proved extremely useful in establishing the diagnosis. Our case promotes awareness of GCA as a possible diagnosis for granulomatous ILD with unknown etiology.
Collapse
Affiliation(s)
| | | | - Erika Nakai
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | - Kenta Nishi
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | | | - Shinya Uematsu
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | - Satoshi Nakao
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | - Masato Taki
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | - Kyohei Morita
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | - Hwang Moon Hee
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | - Chie Yoshimura
- Department of Pulmonology, Osaka Red Cross Hospital, Japan
| | | | | |
Collapse
|
28
|
Chandra A, Stone CR, Li WA, Geng X, Ding Y. The cerebral circulation and cerebrovascular disease II: Pathogenesis of cerebrovascular disease. Brain Circ 2017; 3:57-65. [PMID: 30276306 PMCID: PMC6126265 DOI: 10.4103/bc.bc_11_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/20/2017] [Accepted: 06/01/2017] [Indexed: 12/12/2022] Open
Abstract
In this paper, we review the cerebral circulation and cerebrovascular disease (CVD) with an overview of the major types of CVD pathogenesis. These, as categorized here, are as follows: occlusive injury intrinsic to blood vessels, occlusive injury extrinsic to blood vessels, cerebral hypoperfusion, and cerebral hemorrhage. Following an overview of each of these categories, we conclude with a discussion of cerebral edema to illustrate how the pathological origins we covered can progress clinically. The content of this paper sets the stage for the detailed, clinically oriented discussion of stroke with which our series culminates in its subsequent Part III.
Collapse
Affiliation(s)
- Ankush Chandra
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher R Stone
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - William A Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
29
|
[Guidelines from the DOG, RG and BVA: retinal artery occlusion : November 2016 status]. Ophthalmologe 2017; 114:120-131. [PMID: 28160122 DOI: 10.1007/s00347-016-0435-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
30
|
[Ocular myositis as a rare cause of vision loss]. DER NERVENARZT 2016; 88:415-418. [PMID: 28005144 DOI: 10.1007/s00115-016-0272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ocular myositis is a rare disease characterized by painful diplopia but loss of vision rarely occurs. The article reviews the literature focusing on the differential diagnostics. We report the case of an 80-year-old women suffering from slowly progressive loss of vision in the left eye. Diplopia was only present at the beginning and there was only moderate pain. Computed tomography and magnetic resonance imaging revealed a swelling of the left medial, lateral and inferior rectus muscles of the orbit leading to compression of the optic nerve in the orbital cone. An intravenous prednisolone stoss therapy (1000 mg per day for 3 consecutive days) was initiated, followed by oral medication of 100 mg per day then tapering over 10 weeks. Vision improved and no relapses were observed. Physicians should be aware of this rare disease to ensure quick diagnosis and treatment of ocular myositis.
Collapse
|
31
|
Prakash S, Rathore C. Side-locked headaches: an algorithm-based approach. J Headache Pain 2016; 17:95. [PMID: 27770404 PMCID: PMC5074931 DOI: 10.1186/s10194-016-0687-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/04/2016] [Indexed: 01/03/2023] Open
Abstract
The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice. Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.
Collapse
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical institute and research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, 391760, Gujarat, India. .,Department of Neurology, Smt B. K. Shah Medical institute and research Centre, Piperia, Waghodia, Vadodara, 391760, Gujarat, India.
| | - Chaturbhuj Rathore
- Department of Neurology, Smt. B. K. Shah Medical institute and research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, 391760, Gujarat, India
| |
Collapse
|
32
|
Müller-Ladner U. Gut and Liver in Vasculitic Disorders. Dig Dis 2016; 34:546-51. [PMID: 27333193 DOI: 10.1159/000445260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although the gastrointestinal (GI) tract including its related organs is not generally regarded as one of the primary organ systems of primary and secondary vasculitic disorders, there are numerous mechanisms of these diseases operative in or around the different structures and compartments of the GI tract. KEY MESSAGES A majority of the respective clinical symptoms and problems are linked to an alteration of (peri)vascular homeostasis. Alteration of perivascular matrix metabolism can also affect the functional integrity and motility of the GI tract. Apart from the specific GI phenomena of the individual diseases as outlined in detail in this review, the epidemiology of GI involvement follows in general the characteristics of the respective underlying systemic disease. In addition, gender and age do neither influence the occurrence nor the severity of the GI manifestations significantly. With respect to clinical symptoms, vasculitides may result in abdominal pain, bleeding, ileus, intestinal necrosis and hematochezia because of reduced blood flow and hyper-acute occlusion in the antiphospholipid syndrome. Small-bowel involvement in vasculitic entities can cause pseudoobstruction, obstruction, malabsorption and bacterial overgrowth. Laboratory parameters can point to specific diseases but are frequently nonspecific. Thus, if biopsy fails or in unclear endoscopic situations, a variety of imaging techniques including Doppler ultrasound, abdominal CT, MRI and angiography are used and required for identification and localization of the underlying disease. Therapeutic strategies in vasculitides usually include corticosteroids and immunosuppressants, for example, cyclophosphamide in granulomatosis with polyangiitis and in panarteriitis nodosa but also biologics such as rituximab in ANCA-associated vasculitides. Virostatic drugs including interferon-α and ribavirin can be used in hepatitis B- and C-triggered vasculitides such as panarteriitis nodosa and hepatitis C-associated cryoglobulinemia. CONCLUSIONS Immediate diagnostic and therapeutic steps of action need to be performed if vasculitis of the GI tract is suspected in order to avoid irreversible damage to organs and to improve the well-being and life of the affected patient.
Collapse
Affiliation(s)
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik, Justus-Liebig University Giessen, Bad Nauheim, Germany
| |
Collapse
|
33
|
Töpel I, Zorger N, Steinbauer M. Inflammatory diseases of the aorta: Part 1: Non-infectious aortitis. GEFASSCHIRURGIE 2016; 21:80-86. [PMID: 27546992 PMCID: PMC4974292 DOI: 10.1007/s00772-016-0143-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aortitis is a term which encompasses inflammatory changes to the aortic wall from various pathogenic etiologies. Large vessel vasculitis, such as Takayasu arteritis and giant cell arteritis represent the most common entities; however, there is also an association with other rheumatological diseases. Chronic idiopathic periaortitis represents a distinct disease entity and infectious aortitis is a rare but life-threatening disease. Due to the diverse clinical pictures vascular surgeons often face a significant challenge in terms of making an accurate initial diagnosis. Treatment requires an interdisciplinary approach. This article describes the pathogenesis of the various forms of aortitis as well as the diagnostic methods and treatment approaches.
Collapse
Affiliation(s)
- I. Töpel
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| | - N. Zorger
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - M. Steinbauer
- Klinik für Gefäßchirurgie, Krankenhaus Barmherzige Brüder, Prüfeninger Str. 86, 93049 Regensburg, Germany
| |
Collapse
|
34
|
Gehlen M, Schwarz-Eywill M, Schäfer N, Pfeiffer A, Bösenberg H, Maier A, Hinz C. [Brain stem infarction, temporal headache, and elevated inflammatory parameters in a 74-year-old man]. Internist (Berl) 2016; 57:604-9. [PMID: 27055655 DOI: 10.1007/s00108-016-0045-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report the case of a 74 year old man with a brain stem infarction, temporal headache and elevated inflammatory parameters. Giant cell arteritis with involvement of the temporal and vertebral arteries was proven by histology, duplex sonography and MRI. Although intensive immunosuppressive therapy was started, the patient developed two brain infarcts within 6 months. Initially, C‑reactive protein and erythrocyte sedimentation rate were significantly elevated, but normalized over time. Involvement of the vertebral artery in giant cell arteritis is thought to be rare; steroid refractory courses are very rare. Brain stem infarction might be the consequence.
Collapse
Affiliation(s)
- M Gehlen
- Abteilung für Rheumatologie und Osteologie, Klinik Der Fürstenhof, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland. .,Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland.
| | - M Schwarz-Eywill
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - N Schäfer
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - A Pfeiffer
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - H Bösenberg
- Evangelisches Krankenhaus, Universität Oldenburg, Campus Medizin, Oldenburg, Deutschland
| | - A Maier
- Nordwestdeutsches Rheumazentrum, St.-Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - C Hinz
- Abteilung für Rheumatologie und Osteologie, Klinik Der Fürstenhof, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| |
Collapse
|
35
|
Oeinck M, Rozeik C, Wattchow J, Meckel S, Schlageter M, Beeskow C, Reinhard M. Why a standard contrast-enhanced MRI might be useful in intracranial internal carotid artery stenosis. Neuroradiol J 2016; 29:208-12. [PMID: 26988083 DOI: 10.1177/1971400916638354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In patients with ischemic stroke of unknown cause cerebral vasculitis is a rare but relevant differential diagnosis, especially when signs of intracranial artery stenosis are found and laboratory findings show systemic inflammation. In such cases, high-resolution T1w vessel wall magnetic resonance imaging (MRI; 'black blood' technique) at 3 T is preferentially performed, but may not be available in every hospital. We report a case of an 84-year-old man with right hemispheric transient ischemic attack and signs of distal occlusion in the right internal carotid artery (ICA) in duplex sonography. Standard MRI with contrast agent pointed the way to the correct diagnosis since it showed an intramural contrast uptake in the right ICA and both vertebral arteries. Temporal artery biopsy confirmed the suspected diagnosis of a giant cell arteritis and dedicated vessel wall MRI performed later supported the suspected intracranial large artery inflammation. Our case also shows that early diagnosis and immunosuppressive therapy may not always prevent disease progression, as our patient suffered several infarcts in the left middle cerebral artery (MCA) territory with consecutive high-grade hemiparesis of the right side within the following four months.
Collapse
Affiliation(s)
- Maximilian Oeinck
- Department of Neurology, Neurocenter, University of Freiburg, Germany
| | | | - Jens Wattchow
- Department of Neurology, Kreiskliniken Lörrach, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Neurocenter, University of Freiburg, Germany
| | | | | | - Matthias Reinhard
- Department of Neurology, Neurocenter, University of Freiburg, Germany
| |
Collapse
|
36
|
Ponte C, Rodrigues AF, O’Neill L, Luqmani RA. Giant cell arteritis: Current treatment and management. World J Clin Cases 2015; 3:484-94. [PMID: 26090367 PMCID: PMC4468893 DOI: 10.12998/wjcc.v3.i6.484] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/28/2015] [Accepted: 03/30/2015] [Indexed: 02/05/2023] Open
Abstract
Glucocorticoids remain the cornerstone of medical therapy in giant cell arteritis (GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. Tocilizumab, a monoclonal IL-6 receptor blocker, has shown promising results in a number of case series and is now being tested in a multi-centre randomized controlled trial. Other targeted treatments, such as the use of abatacept, are also now under investigation in GCA. The need for surgical treatment is rare and should ideally be performed in a quiescent phase of the disease. Not all patients follow the same course, but there are no valid biomarkers to assess therapy response. Monitoring of disease progress still relies on assessing clinical features and measuring inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). Imaging techniques (e.g., ultrasound) are clearly important screening tools for aortic aneurysms and assessing patients with large-vessel involvement, but may also have an important role as biomarkers of disease activity over time or in response to therapy. Although GCA is the most common form of primary vasculitis, the optimal strategies for treatment and monitoring remain uncertain.
Collapse
|
37
|
Polymorphism of VEGF gene in susceptibility to chronic immune-mediated inflammatory diseases: a meta-analysis. Rheumatol Int 2015; 35:1351-60. [PMID: 26007152 DOI: 10.1007/s00296-015-3279-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
Background Vascular endothelial growth factor (VEGF) is an important angiogenic factor and may be connected with chronic immune-mediated inflammatory diseases (IMIDs) to some extent. However, previous researches about the relationship between the +405G>C (dbSNP: rs2010963) polymorphism in VEGF gene and the risk of IMIDs are controversial and inconsistent. So we conducted this meta-analysis to assess whether the relationship between the +405G>C polymorphism in the 5'-UTR region of VEGF gene and IMID susceptibility exists. Methods Our literature search was conducted on the PubMed, Embase, Web of science, Chinese National Knowledge Infrastructure, and Chinese Biomedical databases to retrieve for eligible studies. Odds ratios as well as their 95 % confidence intervals were utilized to deduce the possible relationship. Results A total number of 5175 patients with IMIDs and 7069 healthy controls from 27 case-control studies were included. For the overall eligible data collected in our meta-analysis, there was no marked relationship between +405G>C polymorphism and the risk of IMIDs. However, subgroup analysis by ethnicity suggested that +405C allele could be a protective factor for IMIDs in Asians, whereas an opposite conclusion was drawn in Caucasians. Conclusion Thus, we may come to the conclusion that the VEGF +405G>C polymorphism could be associated with IMIDs, and the correlation might vary with ethnic groups.
Collapse
|
38
|
Gehlen M, Schwarz-Eywill M, Schäfer N, Pfeiffer A, Woenkhaus J, Bräsen JH. [A 58-year-old patient with temporal headache, jaw claudication and B symptoms]. Z Rheumatol 2015; 74:359-62. [PMID: 25691108 DOI: 10.1007/s00393-014-1551-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CASE REPORT We report the case of a patient with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with involvement of the temporal artery, presenting with clinical manifestations of giant cell arteritis and temporal arteritis, such as temporal headache, jaw claudication, weight loss, night sweats and increased inflammatory parameters. The ultrasound scan showed a typical halo sign of the temporal artery. DIAGNOSTICS In the case of further atypical organ symptoms, e.g. hematuria and proteinuria, detailed differential diagnostic investigations are essential to clarify the situation. Histological findings from the affected organs play a decisive role. CONCLUSION An involvement of the temporal artery due to ANCA-associated vasculitis is extremely rare and may mimic giant cell arteritis. The exact diagnosis of ANCA-associated vasculitis is, however, important because this leads to a different approach concerning therapy and prognosis.
Collapse
Affiliation(s)
- M Gehlen
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Evangelisches Krankenhaus Oldenburg, Medizinischer Campus der Universität Oldenburg, European Medical School Oldenburg/ Groningen, Oldenburg, Deutschland,
| | | | | | | | | | | |
Collapse
|
39
|
Ouwendijk WJD, Verjans GMGM. Pathogenesis of varicelloviruses in primates. J Pathol 2015; 235:298-311. [PMID: 25255989 DOI: 10.1002/path.4451] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 01/01/2023]
Abstract
Varicelloviruses in primates comprise the prototypic human varicella-zoster virus (VZV) and its non-human primate homologue, simian varicella virus (SVV). Both viruses cause varicella as a primary infection, establish latency in ganglionic neurons and reactivate later in life to cause herpes zoster in their respective hosts. VZV is endemic worldwide and, although varicella is usually a benign disease in childhood, VZV reactivation is a significant cause of neurological disease in the elderly and in immunocompromised individuals. The pathogenesis of VZV infection remains ill-defined, mostly due to the species restriction of VZV that impedes studies in experimental animal models. SVV infection of non-human primates parallels virological, clinical, pathological and immunological features of human VZV infection, thereby providing an excellent model to study the pathogenesis of varicella and herpes zoster in its natural host. In this review, we discuss recent studies that provided novel insight in both the virus and host factors involved in the three elementary stages of Varicellovirus infection in primates: primary infection, latency and reactivation.
Collapse
|
40
|
Brückner M, Bettenworth D, Hengst K, Weckesser M, Willeke P, Heidemann J. Giant cell arteritis exclusively detected by 18F-fluorodeoxyglucose positron emission tomography: a case report. J Med Case Rep 2014; 8:356. [PMID: 25348576 PMCID: PMC4219628 DOI: 10.1186/1752-1947-8-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/27/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction This case of giant cell arteritis is noteworthy because it evaded standard diagnostic criteria and only emerged as fever of unknown origin. In this regard, we present 18F-fluorodeoxyglucose positron emission tomography as a valid diagnostic method. Case presentation This case report describes a 58-year-old Caucasian woman who is a cigarette smoker with a 10-week history of fever of unknown origin, night sweats and weight loss of 12kg. Initially, clinical presentation was suspicious of malignant disease. Laboratory findings detected significantly elevated inflammatory blood parameters including C-reactive protein and elevated erythrocyte sedimentation rate (110mm/hour). Extensive diagnostic workup including microbiological and rheumatological assessment, ultrasonography, endoscopy and computed tomography of abdomen and thorax did not indicate any septic or malignant focus. Eventually, 18F-fluorodeoxyglucose positron emission tomography was able to reveal arteritis of her aortic arch and supraaortic branches. Subsequently, she commenced steroid and methotrexate therapy that led to sustained remission. Conclusions This case of giant cell arteritis may promote discussion regarding a more specific classification for this disease entity. Furthermore, it confirms that 18F-fluorodeoxyglucose positron emission tomography might serve as a valuable tool for diagnosis of giant cell arteritis, because it could facilitate an accurate and non-invasive detection of lesions of large vessels.
Collapse
Affiliation(s)
- Markus Brückner
- Department of Medicine B, University of Münster, Albert-Schweitzer-Campus 1, D-48129 Münster, Germany.
| | | | | | | | | | | |
Collapse
|
41
|
Mortensen K, Lichtenberg J, Thomsen PD, Larsson LI. Spontaneous fusion between cancer cells and endothelial cells. Cell Mol Life Sci 2004; 61:2125-31. [PMID: 15316661 PMCID: PMC11138582 DOI: 10.1007/s00018-004-4200-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endothelial cells line the inside of blood and lymphatic vessels, and cancer cells must cross this barrier, first to gain access to the circulation, and, second, to exit and metastasize. How this occurs is incompletely understood. We now demonstrate that human cancer cells are able to fuse with endothelial cells to form hybrid cells displaying proteins and chromosomal markers characteristic of both parent cells. The hybrid cells are viable and capable of undergoing mitosis. Fusions between cancer cells and endothelial cells were shown to occur both in vitro, in co-cultures of human breast cancer cells and endothelial cells, and in vivo, following intravascular dissemination of human breast cancer cells in nude mice. These observations demonstrate a new type of cancer-endothelial cell interaction that may be of fundamental importance to the process of metastasis.
Collapse
Affiliation(s)
- K. Mortensen
- Department of Anatomy and Physiology, KVL, Gronnegaardsvej 7, 1870 Frederiksberg C Copenhagen, Denmark
| | | | - P. D. Thomsen
- Department of Anatomy and Physiology, KVL, Gronnegaardsvej 7, 1870 Frederiksberg C Copenhagen, Denmark
| | - L.-I. Larsson
- Department of Anatomy and Physiology, KVL, Gronnegaardsvej 7, 1870 Frederiksberg C Copenhagen, Denmark
| |
Collapse
|