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Fedorinova EE, Bulanov NM, Meshkov AD, Borodin OO, Smitienko IO, Chachilo EV, Nartov AA, Filatova AL, Naumov AV, Novikov PI, Moiseev SV. Clinical Manifestations and Prognosis of Giant Cell Arteritis: A Retrospective Cohort Study. DOKL BIOCHEM BIOPHYS 2024; 517:250-258. [PMID: 39002010 DOI: 10.1134/s1607672924700984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 07/15/2024]
Abstract
The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA). MATERIALS AND METHODS . A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan-Meier method. RESULTS . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0-54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. CONCLUSIONS : Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.
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Affiliation(s)
- E E Fedorinova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia.
| | - N M Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A D Meshkov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - O O Borodin
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - I O Smitienko
- International Institute of Postgraduate Medical Education, Moscow, Russia
| | - E V Chachilo
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A A Nartov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - A L Filatova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
| | - A V Naumov
- Russian Gerontological Research and Clinical Center, Moscow, Russia
| | - P I Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
| | - S V Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University of the Ministry of Health Care of the Russian Federation (Sechenov University), Moscow, Russia
- Moscow State University, Moscow, Russia
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Haaversen ACB, Brekke LK, Kermani TA, Molberg Ø, Diamantopoulos AP. Vascular ultrasound as a follow-up tool in patients with giant cell arteritis: a prospective observational cohort study. Front Med (Lausanne) 2024; 11:1436707. [PMID: 39135716 PMCID: PMC11317465 DOI: 10.3389/fmed.2024.1436707] [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: 05/22/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Objectives To evaluate relapses in giant cell arteritis (GCA), investigate the utility of vascular ultrasound to detect relapses, and develop and assess a composite score for GCA disease activity (GCAS) based on clinical symptoms, ultrasound imaging activity, and C-reactive protein (CRP). Methods Patients with GCA were prospectively followed with scheduled visits, including assessment for clinical relapse, protocol ultrasound examination, and CRP. At each visit, patients were defined as having ultrasound remission or relapse. GCAS was calculated at every visit. Results The study included 132 patients, with a median follow-up time of 25 months [interquartile range (IR) 21]. The clinical relapse rate was 60.6%. There were no differences in relapse rates between GCA subtypes (cranial-GCA, large vessel (LV)-GCA, and mixed-GCA) (p = 0.83). Ultrasound yielded a sensitivity of 61.2% and a specificity of 72.3% for diagnosing GCA- relapse in our cohort. In 7.7% of follow-up visits with clinical relapses, neither high CRP nor findings of ultrasound relapse were registered. In comparison, in 10.3% of follow-up visits without symptoms of clinical relapse, there were both a high CRP and findings of ultrasound relapse. Conclusion We found moderate sensitivity and specificity for ultrasound as a monitoring tool for relapse in this prospective cohort of GCA patients. The extent or subtype of vasculitis at the diagnosis did not influence the number of relapses. Based on a combination of clinical symptoms, elevated CRP, and ultrasound findings, a composite score for GCA activity is proposed.
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Affiliation(s)
- Anne C. B. Haaversen
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene Kristin Brekke
- Department of Rheumatology, Hospital for Rheumatic Diseases, Haugesund, Norway
| | - Tanaz A. Kermani
- Department of Rheumatology, University of California, Los Angeles, CA, United States
| | - Øyvind Molberg
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Rheumatology, Rikshospitalet, Oslo, Norway
| | - Andreas P. Diamantopoulos
- Division of Internal Medicine, Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
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Alba MA, Kermani TA, Unizony S, Murgia G, Prieto-González S, Salvarani C, Matteson EL. Relapses in giant cell arteritis: Updated review for clinical practice. Autoimmun Rev 2024; 23:103580. [PMID: 39048072 DOI: 10.1016/j.autrev.2024.103580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 07/20/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Abstract
Giant cell arteritis (GCA), the most common primary vasculitis in adults, is a granulomatous systemic vasculitis usually affecting the aorta and its major branches, particularly the carotid and vertebral arteries. Although remission can be achieved in most patients with GCA using high-dose glucocorticoids (GC), relapses are frequent, occurring in >40% of GC-only treated patients, mostly during the first two years after diagnosis. Relapsing courses lead to high GC exposure, increasing the risk of treatment-related adverse effects. Although tocilizumab is an efficacious GC-sparing therapy that allows increased sustained remission and reduced cumulative GC doses, relapses are common after drug discontinuation. This narrative review examines the most relevant features of relapses in GCA, including its definition, classification, frequency, clinical, laboratory, and imaging characteristics, chronology, probable pathophysiology, and predictive factors. In addition, we discuss treatment options for relapsing patients and the effect of relapses on patient outcomes.
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Affiliation(s)
- Marco A Alba
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
| | - Tanaz A Kermani
- Division of Rheumatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sebastian Unizony
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Murgia
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Sergio Prieto-González
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Nielsen MK, Nielsen AW, Donskov AO, Hansen IT, Nielsen BD, Mørk C, Hauge EM, Keller KK. Taper versus discontinuation of tocilizumab in patients with giant cell arteritis: Real-world experience from a tertiary center. Semin Arthritis Rheum 2024; 68:152508. [PMID: 38981187 DOI: 10.1016/j.semarthrit.2024.152508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Following the approval of tocilizumab (TCZ) for giant cell arteritis (GCA), recent studies have shown a high relapse frequency after abrupt discontinuation of TCZ. However, a thorough exploration of TCZ tapering compared to abrupt discontinuation has never been undertaken. Likewise, adverse events have only been scarcely investigated in routine care. This study aimed to compare the incidence of relapses in GCA patients undergoing TCZ tapering compared to abrupt discontinuation. METHODS We performed a single-center retrospective cohort study from 2012 to 2022. Data from GCA patients treated with TCZ was obtained from the Electronic Patients Record. Relapse-free survival is reported in Kaplan-Meier plots and tapering versus abrupt discontinuation were compared using a Wilcoxon-Brewlos-Gehan test. RESULTS We included 155 patients receiving TCZ treatment for GCA, of which 104 discontinued TCZ. Among the 104 patients discontinuing TCZ, 42 (40 %) experienced a relapse within the first year. A total of 57 patients underwent taper with 6/38 (16 %) and 2/19 (11 %) relapsing while receiving TCZ every second or third week, respectively. In comparison, 59 patients underwent abrupt discontinuation with 27 (46 %) relapsing during follow-up. The patients undergoing abrupt TCZ discontinuation demonstrated a significantly shorter time to relapse compared to all tapered patients (p = 0.02) as well as patients tapered from weekly TCZ treatment to every second week (p < 0.01). Furthermore, 15 % of patients discontinued TCZ due to adverse events. CONCLUSION This is the first study indicating that TCZ taper induced longer relapse-free survival than abrupt discontinuation, implying that taper may be favored over discontinuation in patients with GCA.
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Affiliation(s)
- Marc K Nielsen
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark.
| | - Andreas W Nielsen
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - Agnete O Donskov
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
| | - Ib T Hansen
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - Berit D Nielsen
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus, Denmark; Horsens Regional Hospital, Department of Internal Medicine, Horsens, Denmark
| | - Christoffer Mørk
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark
| | - Ellen M Hauge
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - Kresten K Keller
- Aarhus University Hospital, Department of Rheumatology, Aarhus, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
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Nielsen BD, Kristensen S, Donskov A, Terslev L, Dreyer LW, Colic A, Hetland ML, Højgaard P, Ellingsen T, Hauge EM, Chrysidis S, Keller KK. The DANIsh VASculitis cohort study: protocol for a national multicenter prospective study including incident and prevalent patients with giant cell arteritis and polymyalgia rheumatica. Front Med (Lausanne) 2024; 11:1415076. [PMID: 39026552 PMCID: PMC11256208 DOI: 10.3389/fmed.2024.1415076] [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: 04/09/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
The DANIsh VASculitis cohort study, DANIVAS, is an observational national multicenter study with the overall aim to prospectively collect protocolized clinical data and biobank material from patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) diagnosed and/or followed at Danish rheumatology departments. A long-term key objective is to investigate whether the use of new clinically implemented diagnostic imaging modalities facilitates disease stratification in the GCA-PMR disease spectrum. In particular, we aim to evaluate treatment requirements in GCA patients with and without large-vessel involvement, treatment needs in PMR patients with and without subclinical giant cell arteritis, and the prognostic role of imaging with respect to aneurysm development. Hence, in GCA and PMR, imaging stratification is hypothesized to be able to guide management strategies. With an established infrastructure within rheumatology for clinical studies in Denmark, the infrastructure of the Danish Rheumatologic Biobank, and the possibility to cross-link data with valid nationwide registries, the DANIVAS project holds an exceptional possibility to collect comprehensive real-world data on diagnosis, disease severity, disease duration, treatment effect, complications, and adverse events. In this paper, we present the research protocol for the DANIVAS study. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT05935709.
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Affiliation(s)
- Berit D. Nielsen
- Department of Medicine, The Regional Hospital in Horsens, Horsens, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Salome Kristensen
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Agnete Donskov
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Terslev
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Wohlfahrt Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ada Colic
- Department of Rheumatology, Zealand University Hospital, Køge, Denmark
| | - Merete Lund Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pil Højgaard
- Department of Medicine (2), Holbæk Hospital, Holbæk, Denmark
| | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stavros Chrysidis
- Department of Rheumatology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Kresten K. Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lee JI, Park JW, Jung Y, Shin K, Choi SR, Kang EH, Lee YJ, Yoo JJ, Ha YJ. Clinical characteristics and courses of Korean patients with giant cell arteritis: a multi-center retrospective study. JOURNAL OF RHEUMATIC DISEASES 2024; 31:160-170. [PMID: 38957359 PMCID: PMC11215252 DOI: 10.4078/jrd.2024.0007] [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: 01/17/2024] [Revised: 04/15/2024] [Accepted: 04/27/2024] [Indexed: 07/04/2024]
Abstract
Objective Giant cell arteritis (GCA) is a large-vessel vasculitis that primarily affects elderly individuals. However, data regarding Korean patients with GCA are scarce owing to its extremely low prevalence in East Asia. This study aimed to investigate the clinical characteristics of Korean patients with GCA and their outcomes, focusing on relapse. Methods The medical records of 27 patients with GCA treated at three tertiary hospitals between 2007 and 2022 were retrospectively reviewed. Results Seventeen (63.0%) patients were females, and the median age at diagnosis was 75 years. Large vessel involvement (LVI) was detected in 12 (44.4%) patients, and polymyalgia rheumatica (PMR) was present in 14 (51.9%) patients. Twelve (44.4%) patients had fever at onset. The presence of LVI or concurrent PMR at diagnosis was associated with a longer time to normalization of the C-reactive protein level (p=0.039) or erythrocyte sedimentation rate (p=0.034). During follow-up (median 33.8 months), four (14.8%) patients experienced relapse. Kaplan-Meier analyses showed that relapse was associated with visual loss (p=0.008) and the absence of fever (p=0.004) at onset, but not with LVI or concurrent PMR. Conclusion Concurrent PMR and LVI were observed in approximately half of Korean patients with GCA, and the elapsed time to normalization of inflammatory markers in these patients was longer. The relapse rate in Korean GCA is lower than that in Western countries, and afebrile patients or patients with vision loss at onset have a higher risk of relapse, suggesting that physicians should carefully monitor patients with these characteristics.
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Affiliation(s)
- Jee-In Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Department of Internal Medicine, Seoul, Korea
| | - Youjin Jung
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Department of Internal Medicine, Seoul, Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Se Rim Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul University College of Medicine, Seoul, Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul University College of Medicine, Seoul, Korea
| | - Jong Jin Yoo
- Division of Rheumatology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul University College of Medicine, Seoul, Korea
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Delort D, Philip R, Gallou S, Dumont A, Deshayes S, Boutemy J, Maigné G, Martin Silva N, Nguyen A, Launoy G, Launay L, Aouba A, de Boysson H. Assessment of social deprivation and socioeconomic factors in patients with giant cell arteritis. Joint Bone Spine 2024; 91:105742. [PMID: 38795764 DOI: 10.1016/j.jbspin.2024.105742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Diane Delort
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Rémi Philip
- Department of Internal Medicine, Caen University Hospital, Caen, France; Normandie University, UNICAEN, Caen, France
| | - Sophie Gallou
- Department of Internal Medicine, Caen University Hospital, Caen, France; Normandie University, UNICAEN, Caen, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Caen, France; Normandie University, UNICAEN, Caen, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | | | - Alexandre Nguyen
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Guy Launoy
- Normandie University, UNICAEN, Caen, France
| | - Ludivine Launay
- Centre de lutte contre le cancer François-Baclesse, Inserm-UCN U1086 Anticipe, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; Normandie University, UNICAEN, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France; Normandie University, UNICAEN, Caen, France.
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Peyrac G, Mageau A, Gaudemer A, Benali K, Rohmer J, Alexandra JF, Strukov A, Ottaviani S, Papo T, Sacre K. Limb arteries involvement assessed by FDG/PET CT at diagnosis of giant cell arteritis and risk of relapse: An observational study. Joint Bone Spine 2024; 91:105734. [PMID: 38631525 DOI: 10.1016/j.jbspin.2024.105734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/18/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Steroids and anti-IL6 biotherapy are highly effective in obtaining remission in patients with giant cell arteritis (GCA) but the risk of relapses remains high. We aimed to identify predictors of relapse in GCA. METHODS All consecutive patients admitted with a new diagnosis of GCA - according to the 2022 American College of Rheumatology/EULAR (ACR/EULAR) classification criteria - between May 2011 and May 2022 were eligible for this study. The primary outcome was the GCA relapse rate over the 36-months follow up. Factors associated with the primary outcome and time to first relapse were analyzed. RESULTS One hundred and eight patients (74 [69-81] years, 64.8% women) with a new diagnosis of GCA were studied. GCA was biopsy-proven in 65 (60.2%) cases. Ninety-eight (90.7%) FDG/PET CT scans performed at diagnosis were available for review. All patients received steroids given for 21.0 [18.0-28.5] months, associated with methotrexate (n=1, 0.9%) or tocilizumab (n=2, 1.9%). During a median follow-up of 27.5 [11.4-35.0] months, relapse occurred in 40 (37%) patients. Multivariable Cox regression model, including general signs, gender, aortic wall thickness, FDG uptake in arterial wall and IV steroid pulse as covariates, showed that both general signs (HR 2.0 [1.0-4.0, P<0.05) and FDG uptake in limb arteries (HR 2.7 [1.3-5.5], P<0.01) at diagnosis were associated with GCA relapse. CONCLUSION FDG uptake in limb arteries at diagnosis is a predictor of relapse in newly diagnosed GCA.
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Affiliation(s)
- Geoffroy Peyrac
- Departement de Médecine Interne, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Arthur Mageau
- Departement de Médecine Interne, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Augustin Gaudemer
- Departement de Radiologie, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Khadija Benali
- Departement de Médecine Nucléaire, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Julien Rohmer
- Departement de Médecine Interne, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Jean-Francois Alexandra
- Departement de Médecine Interne, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Andrey Strukov
- Departement d'Information Médicale, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Sebastien Ottaviani
- Departement de Rhumatologie, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Thomas Papo
- Departement de Médecine Interne, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France
| | - Karim Sacre
- Departement de Médecine Interne, Université Paris-Cité, Assistance publique-Hopitaux de Paris, Hôpital Bichat, Paris, France.
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Gallou S, Agard C, Dumont A, Deshayes S, Boutemy J, Maigné G, Martin Silva N, Nguyen A, Philip R, Espitia O, Aouba A, de Boysson H. Evolution and outcomes of aortic dilations in giant cell arteritis. Eur J Intern Med 2024:S0953-6205(24)00146-8. [PMID: 38580542 DOI: 10.1016/j.ejim.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES To identify factors associated with the progression of giant cell arteritis (GCA)-related or associated aortic dilations. METHODS In this retrospective study, 47 GCA patients with aortic dilation were longitudinally analyzed. Each patient underwent ≥2 imaging scans of the aorta during the follow-up. Three progression statuses of aortic dilations were distinguished: fast-progressive (FP) defined by a progression of the aortic diameter ≥5 mm/year or ≥1 cm/2 years, slow progressive (SP) by a progression of the aortic diameter >1 mm during the follow-up, and not progressive (NP) when aortic diameter remained stable. RESULTS Among the 47 patients with aortic dilation, the thoracic section was involved in 87 % of patients. Within a total follow-up of 89 [6-272] months, we identified 13 (28 %) patients with FP dilations, and 16 (34 %) and 18 (38 %) patients with SP and NP dilations, respectively. No differences regarding baseline characteristics, cardiovascular risk factors or treatments were observed among the 3 groups. However, FP patients more frequently showed atheromatous disease (p = 0.04), with a more frequent use of statins (p = 0.04) and antiplatelet agents (p = 0.02). Among the 27 (57 %) patients with aortitis, aortic dilation developed on an inflammatory segment in 23 (85 %). Among the FP patients who underwent aortic surgery with available histology (n = 3), all presented active vasculitis. CONCLUSION This study suggests that aortic inflammation, as well as atheromatous disease, might participate in the fast progression of aortic dilation in GCA.
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Affiliation(s)
- Sophie Gallou
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Christian Agard
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | | | - Alexandre Nguyen
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Rémi Philip
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Olivier Espitia
- Nantes Université, CHU Nantes, Service de Médecine Interne, Nantes F-44000, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Caen Normandie, Caen, France.
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10
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Tsalapaki C, Lazarini A, Argyriou E, Dania V, Boki K, Evangelatos G, Iliopoulos A, Pappa M, Sfikakis PP, Tektonidou MG, Georgountzos A, Kaltsonoudis E, Voulgari P, Drosos AA, Theotikos E, Papagoras C, Dimitroulas T, Garyfallos A, Kataxaki E, Vosvotekas G, Boumpas D, Hadziyannis E, Vassilopoulos D. Glucocorticoid discontinuation rate and risk factors for relapses in a contemporary cohort of patients with giant cell arteritis. Rheumatol Int 2024; 44:603-610. [PMID: 38300269 PMCID: PMC10914919 DOI: 10.1007/s00296-023-05527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
The rates of relapses and therapy discontinuation in patients with giant cell arteritis (GCA) in the modern therapeutic era have not been defined. We aimed to evaluate the glucocorticoid (GC) discontinuation rate and the factors associated with relapses in a contemporary GCA cohort. Patient and treatment data were collected cross-sectionally at first evaluation and 2 years later (second evaluation), in a multicenter, prospective GCA cohort. Predictors of relapses were identified by logistic regression analyses. 243 patients with GCA were initially included (67% women, mean age at diagnosis: 72.1 years, median disease duration: 2 years) while 2 years later complete data for 160 patients were available and analyzed. All patients had received GCs at diagnosis (mean daily prednisolone dose: 40 mg) while during follow-up, 37% received non-biologic and 16% biologic agents, respectively. At second evaluation, 72% of patients were still on therapy (GCs: 58% and/or GC-sparing agents: 29%). Relapses occurred in 27% of patients during follow-up; by multivariable logistic regression analysis, large vessel involvement at diagnosis [odds ratio (OR) = 4.22], a cardiovascular event during follow-up (OR = 4.60) and a higher initial GC daily dose (OR = 1.04), were associated with these relapses. In this large, real-life, contemporary GCA cohort, the rates of GC discontinuation and relapses were 40% and 27%, respectively. Large vessel involvement, a higher GC dose at diagnosis and new cardiovascular events during follow-up were associated with relapses.
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Affiliation(s)
- Christina Tsalapaki
- School of Medicine, General Hospital of Athens "Hippokration", 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens, 114 Vass. Sophias Ave., 115 27, Athens, Greece
| | - Argyro Lazarini
- General Hospital "Asklepieio", Rheumatology Clinic, Athens, Greece
| | | | - Vassiliki Dania
- General Hospital "Sismanogleio", Rheumatology Clinic, Athens, Greece
| | - Kyriaki Boki
- General Hospital "Sismanogleio", Rheumatology Clinic, Athens, Greece
| | | | | | - Maria Pappa
- School of Medicine, General Hospital "Laiko", 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- School of Medicine, General Hospital "Laiko", 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- School of Medicine, General Hospital "Laiko", 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | - Charalampos Papagoras
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | | | | | | | - Dimitrios Boumpas
- School of Medicine, 4th Department of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Emilia Hadziyannis
- School of Medicine, General Hospital of Athens "Hippokration", 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens, 114 Vass. Sophias Ave., 115 27, Athens, Greece
| | - Dimitrios Vassilopoulos
- School of Medicine, General Hospital of Athens "Hippokration", 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens, 114 Vass. Sophias Ave., 115 27, Athens, Greece.
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11
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Chehem Daoud Chehem F, de Mornac D, Feuillet F, Liozon E, Samson M, Bonnotte B, de Boysson H, Guffroy A, Balquet MH, Ledoult E, Lavigne C, Trefond L, Smets P, Bodard Q, Fenot M, Richez C, Duffau P, Guillaud C, Espitia O, Agard C. Giant cell arteritis associated with scalp, tongue or lip necrosis: A French multicenter case control study. Semin Arthritis Rheum 2024; 64:152348. [PMID: 38091870 DOI: 10.1016/j.semarthrit.2023.152348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/03/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Scalp, tongue and/or lip necrosis are rare complications of GCA. OBJECTIVES To describe characteristics and outcome of patients with giant cell arteritis (GCA) -related scalp, tongue and/or lip necrosis. METHODS A retrospective nationwide multicenter study included 20 GCA patients with scalp, tongue, and/or lip necrosis diagnosed between 1998 and 2021 and 80 GCA control patients matched for age, sex and management period. Logistic regression analyses were conducted to identify baseline characteristics associated with scalp, tongue and/or lip necrosis. RESULTS Compared to controls, patients with scalp, tongue and/or lip necrosis showed significantly more cranial manifestations (headache, p=0.045; scalp tenderness, p=0.006; jaw claudication, p=0.02). No differences were observed between both groups regarding the occurrence of visual symptoms or large vessel involvement. At diagnosis, GCA patients with necrosis more likely received IV methylprednisolone infusions and higher doses of oral prednisone. There were no differences regarding vascular complications during follow up. Compared to controls, survival was decreased in GCA patients with necrosis (p=0.003). In a multivariable logistic regression model, scalp tenderness [odds ratio (OR) 4.81(95 % CI: 1.57, 14.79), p = 0.006] and cognitive disorder [OR 6.42 (95 % CI: 1.01, 40.60), p=0.048] were identified as factors associated to scalp, tongue, and/or lip necrosis. CONCLUSION Our results suggest that scalp, tongue, and/or lip necrosis is associated to higher mortality in GCA patients. Scalp tenderness and cognitive disorder were significant factors associated to this very rare complication of GCA.
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Affiliation(s)
| | - Donatienne de Mornac
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France
| | - Fanny Feuillet
- Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Eric Liozon
- Internal Medicine Department, Limoges University Hospital, Limoges, France
| | - Maxime Samson
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Bernard Bonnotte
- Internal Medicine and Clinical Immunology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - Hubert de Boysson
- Internal Medicine Department, Caen University Hospital, Caen, France
| | - Aurélien Guffroy
- Internal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Emmanuel Ledoult
- Internal Medicine Department, Lille University Hospital, Lille, France
| | - Christian Lavigne
- Internal Medicine Department, Angers University Hospital, Angers, France
| | - Ludovic Trefond
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Perrine Smets
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Quentin Bodard
- Internal medicine and Infectious Diseases Department, Departmental Hospital Centre, Angoulême, France
| | - Marion Fenot
- Dermatology Department, Departmental Hospital Centre, La Roche Sur Yon, France
| | - Christophe Richez
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, and CHU of Bordeaux, Department of Rheumatology, F-33000 Bordeaux, France
| | - Pierre Duffau
- University Bordeaux, CHU Bordeaux, Department of internal medicine, Bordeaux, France
| | - Constance Guillaud
- Internal Medicine Department, Henri Mondor University Hospital, Créteil, France
| | - Olivier Espitia
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France; L'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary diseases, F-44000 Nantes, France
| | - Christian Agard
- Department of internal medicine, Nantes Université, CHU Nantes, Nantes F-44000, France.
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12
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Shen J, Wu Y, Cao F, Huang H, Ma X, Zhang Y, Chen L. Effects of Huzhangoside C on Dextran Sodium Sulfate-Stimulated Colitis in Mice. J Med Food 2024; 27:35-46. [PMID: 38156815 DOI: 10.1089/jmf.2023.k.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Chronic inflammation is a major risk factor for cancer. Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract, ultimately leading to a breakdown of intestinal barrier function. Clematis florida var. plena is a folk prescription used to treat inflammation and rheumatism in She pharmacy. The bioactivity of C. florida var. plena is primarily due to triterpene saponins. Huzhangoside C (HZ) is an active component of C. florida var. plena. In this study, the anti-inflammatory effect of HZ on a mouse colitis model induced by dextran sulfate sodium (DSS) was investigated. Result indicated a notable reduction in body weight loss and colon length shortening in HZ-mediated mice compared to DSS-stimulated control mice. Furthermore, inflammatory signaling mechanisms involving interleukin-6 and tumor necrosis factor-α were suppressed in HZ-treated mice. HZ treatment significantly suppressed the expression of nuclear factor kappa B (NF-κB), STAT3, and iNOS in colon tissue. After HZ treatment, malondialdehyde and nitric oxide levels were significantly decreased, while Nrf-2, superoxide dismutase, and glutathione expression levels were notably improved. The result indicated that HZ could activate the Nrf-2 signal cascade, inhibit the expression of NF-κB, eNOS, and STAT3, and enhance the intestinal barrier function of DSS stimulated ulcerative colitis intestinal injury. The results suggest that HZ is potential anti-inflammatory agent for treating IBD.
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Affiliation(s)
- Jinhuang Shen
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Ying Wu
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Fan Cao
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Hongying Huang
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Xinhua Ma
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Yonghong Zhang
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Limin Chen
- Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, School of Pharmacy, Fujian Medical University, Fuzhou, China
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13
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Monti S, Milanesi A, Klersy C, Tomelleri A, Dagna L, Campochiaro C, Farina N, Muratore F, Galli E, Marvisi C, Bond M, Berti A, Bortolotti R, Padoan R, Schiavon F, Felicetti M, Nannini C, Cantini F, Giollo A, Rossini M, Conticini E, Frediani B, Conti F, Priori R, Sebastiani M, Cassone G, Quartuccio L, Treppo E, Bettio S, Hoxha A, Lovisotto M, Emmi G, Mattioli I, Leccese P, Caporali R, Argolini LM, Foti R, Visalli E, Colaci M, Salvarani C, Montecucco C. Age at diagnosis influences the clinical phenotype, treatment strategies and outcomes in patients with giant cell arteritis: results from the observational GCAGE study on a large cohort of 1004 patients. Ann Rheum Dis 2023; 82:1098-1106. [PMID: 37188498 DOI: 10.1136/ard-2023-223895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Immune and vascular ageing are proposed risk factors for giant cell arteritis (GCA). Data on the impact of age at diagnosis of GCA on the clinical presentation and course of the disease are scarce. METHODS Patients with GCA followed at referral centres within the Italian Society of Rheumatology Vasculitis Study Group were enrolled up to November 2021. Patients were grouped according to age at diagnosis: ≤64, 65-79 and ≥80 years old. RESULTS The study included 1004 patients, mean age 72.1±8.4, female 70.82%. Median follow-up duration was 49 (IQR 23-91) months. Patients in the oldest group (≥80 years) had significantly more cranial symptoms, ischaemic complications and risk for blindness compared with the groups 65-79 and ≤64 years (blindness: 36.98% vs 18.21% vs 6.19%; p<0.0001). Large-vessel-GCA was more frequent in the youngest group (65% of patients). Relapses occurred in 47% of patients. Age did not influence the time to first relapse, nor the number of relapses. Older age was negatively associated with the number of adjunctive immunosuppressants. Patients >65 years old had 2-3 fold increased risk for aortic aneurysm/dissection up to 60 months follow-up. Serious infections, but not other treatment-related complications (hypertension, diabetes, osteoporotic fractures), were significantly associated with older age. Mortality occurred in 5.8% of the population with age >65, cranial and systemic symptoms as independent risk factors. CONCLUSIONS The highest risk of ischaemic complications, aneurysm development, serious infections and the possible undertreatment make of GCA a very challenging disease in the oldest patients.
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Affiliation(s)
- Sara Monti
- Dipartimento di medicina interna e terapia medica, Universita degli Studi di Pavia, Pavia, Italy
- Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Milanesi
- Dipartimento di medicina interna e terapia medica, Universita degli Studi di Pavia, Pavia, Italy
- Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- UOS Epidemiologia Clinica e Biometria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Nicola Farina
- Unit of Immunology, Allergology and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Francesco Muratore
- Unit of Rheumatology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Galli
- Unit of Rheumatology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Marvisi
- University of Modena and Reggio Emilia, Modena, Italy
- Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Milena Bond
- Rheumatology, Santa Chiara Hospital of Trento, Trento, Italy
- Rheumatology, Brunico Hospital, Brunico, Italy
| | - Alvise Berti
- Center for Medical Sciences (CISMed), Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, and Division of Rheumatology, Santa Chiara Hospital, APSS, Trento, Italy
| | | | - Roberto Padoan
- Department of Medicine DIMED, Division of Rheumatology, University of Padua, Padova, Italy
| | - Franco Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Mara Felicetti
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Carlotta Nannini
- UOC Reumatologia ASl Toscana Centro, Santo Stefano Hospital Prato, Prato, Italy
| | - Fabrizio Cantini
- UOC Reumatologia ASl Toscana Centro, Santo Stefano Hospital Prato, Prato, Italy
| | - Alessandro Giollo
- Rheumatology Unit, Department of Medicine, University of Verona Faculty of Medicine and Surgery, Verona, Italy
- Rheumatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | | | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Roberta Priori
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Marco Sebastiani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Cassone
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
- Division of Rheumatology, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Elena Treppo
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
- Division of Rheumatology, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Ariela Hoxha
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital of Vicenza, Vicenza, Italy
- General Internal Medicine Unit and Thrombotic and Hemorragic Unit, Department of Medicine-DIMED, University of Padua, Padova, Italy
| | - Marco Lovisotto
- General Internal Medicine Unit and Thrombotic and Hemorragic Unit, Department of Medicine-DIMED, University of Padua, Padova, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Firenze, Italy
| | - Pietro Leccese
- Rheumatology Department of Lucania/IReL, Regional Hospital San Carlo, Potenza, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini, Milano, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milano, Italy
| | | | - Rosario Foti
- Rheumatology Unit, AOU San Marco, Catania, Catania, Italy
| | - Elisa Visalli
- Rheumatology Unit, AOU San Marco, Catania, Catania, Italy
| | - Michele Colaci
- Clinical and Experimental Medicine, Rheumatolgy Unit, University of Catania, Catania, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Carlomaurizio Montecucco
- Dipartimento di medicina interna e terapia medica, Universita degli Studi di Pavia, Pavia, Italy
- Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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14
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Mensch N, Hemmig AK, Aschwanden M, Imfeld S, Stegert M, Recher M, Staub D, Kyburz D, Berger CT, Daikeler T. Rapid glucocorticoid tapering regimen in patients with giant cell arteritis: a single centre cohort study. RMD Open 2023; 9:e003301. [PMID: 37460275 DOI: 10.1136/rmdopen-2023-003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES We evaluated the feasibility of a rapid glucocorticoid tapering regimen to reduce glucocorticoid exposure in patients with giant cell arteritis (GCA) treated with glucocorticoids only. METHODS Newly diagnosed patients with GCA treated with a planned 26-week glucocorticoid tapering regimen at the University Hospital Basel were included. Data on relapses, cumulative steroid doses (CSD) and therapy-related adverse effects were collected from patients' records. RESULTS Of 47 patients (64% women, median age 72 years), 32 patients (68%) had relapsed. Most relapses were minor (28/32) and 2/3 of those were isolated increased inflammatory markers (19/32). Among major relapses, one resulted in permanent vision loss. The median time until relapse was 99 days (IQR 71-127) and median glucocorticoid dose at relapse was 8 mg (IQR 5-16). Nine of 47 patients stopped glucocorticoids after a median duration of 35 weeks and did not relapse within 1 year. Median CSD at 12 months was 4164 mg which is lower compared with published data. Glucocorticoid-associated adverse effects occurred in 40% of patients, most frequently were new onset or worsening hypertension (19%), diabetes (11%) and severe infections (11%). CONCLUSION We could demonstrate that 32% of patients remained relapse-free and 19% off glucocorticoids at 1 year after treatment with a rapid glucocorticoid tapering regimen. Most relapses were minor and could be handled with temporarily increased glucocorticoid doses. Consequently, the CSD at 12 months was much lower than reported in published cohorts. Thus, further reducing treatment-associated damage in patients with GCA by decreasing CSD seems to be possible.
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Affiliation(s)
- Noemi Mensch
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | | | - Markus Aschwanden
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - Stephan Imfeld
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - Mihaela Stegert
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Mike Recher
- University Centre for Immunology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, Immunodeficiency, University of Basel, Basel, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Basel, Basel, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Basel, Basel, Switzerland
| | - Christoph T Berger
- University Centre for Immunology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Basel, Basel, Switzerland
- Department of Biomedicine, Translational Immunology, University of Basel, Basel, Switzerland
| | - Thomas Daikeler
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Basel, Basel, Switzerland
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15
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Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Ebbo M, Schleinitz N, Harlé JR, Jarrot PA, Kaplanski G, Berbis J, Boucekine M, Rossi P, Granel B. Predictors of Relapses or Recurrences in Patients With Giant Cell Arteritis: A Medical Records Review Study. J Clin Rheumatol 2023; 29:e25-e31. [PMID: 36727749 DOI: 10.1097/rhu.0000000000001942] [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: 02/03/2023]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most common systemic vasculitis in individuals aged ≥50 years. Its course is marked by a high relapse rate requiring long-term glucocorticoid use with its inherent adverse effects. We aimed to identify factors associated with relapses or recurrences in GCA at diagnosis. METHODS We reviewed the medical records of consecutive patients with GCA diagnosed between 2009 and 2019 and followed for at least 12 months. We recorded their characteristics at onset and during follow-up. Factors associated with relapses or recurrences were identified using multivariable analysis. RESULTS We included 153 patients, among whom 68% were female with a median age of 73 (47-98) years and a median follow-up of 32 (12-142) months. Seventy-four patients (48.4%) had at least 1 relapse or recurrence. Headache and polymyalgia rheumatica were the most frequent manifestations of relapses. The first relapse occurred at a median time of 13 months after the diagnosis, with a median dose of 5.5 (0-25) mg/d of glucocorticoids.In multivariable analysis, patients with relapses or recurrences had a higher frequency of cough and scalp tenderness at diagnosis (20.3% vs 5.1%; odds ratio [OR], 4.73; 95% confidence interval [CI], 1.25-17.94; p = 0.022; and 41.9% vs 29.1%; OR, 2.4; 95% CI, 1.07-5.39; p = 0.034, respectively). Patients with diabetes mellitus at diagnosis had fewer relapses or recurrences during follow-up (5.4% vs 19%; OR, 0.24; 95% CI, 0.07-0.83; p = 0.024). CONCLUSIONS Cough and scalp tenderness at diagnosis were associated with relapses or recurrences, whereas patients with diabetes experienced fewer relapses or recurrences.
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Affiliation(s)
- Quentin Gomes de Pinho
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Aurélie Daumas
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne, Gériatrie et Thérapeutique
| | - Audrey Benyamine
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Julien Bertolino
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Mikaël Ebbo
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Nicolas Schleinitz
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Jean-Robert Harlé
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Pierre André Jarrot
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique
| | - Gilles Kaplanski
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique
| | - Julie Berbis
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'Étude et de Recherche sur les Service de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Mohamed Boucekine
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'Étude et de Recherche sur les Service de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Pascal Rossi
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Brigitte Granel
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
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16
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Diagnostic validity of ultrasound including extra-cranial arteries in giant cell arteritis. Clin Rheumatol 2023; 42:1163-1169. [PMID: 36357632 DOI: 10.1007/s10067-022-06420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Color Doppler ultrasound (CDUS) of the temporal arteries (TA) is becoming the first test to be performed for suspected giant cell arteritis (GCA). Our aim was to assess the added value of including CDUS of large vessels (LV) in the diagnosis of GCA. METHODS We performed an observational and retrospective study of consecutive patients with suspected GCA. Baseline CDUS of the TA and LV (axillary, subclavian, and carotid) were conducted. We defined the CDUS finding as positive if the halo sign was present. RESULTS Of 198 patients with suspected GCA, 87 were eventually diagnosed with GCA: 45 (51.7%) had a cranial pattern exclusively, 31 (35.6%) had both a cranial and an LV pattern, and 11 (12.6%) had an isolated LV pattern. CDUS of the TA had a sensitivity of 83.9%, specificity of 97.3%, and positive and negative predictive values (PPV, NPV) of 96.1% and 88.5%, respectively. When LV was added, sensitivity increased to 96.6% and NPV to 98.2%. Specificity was 97.3% and PPV was 96.6%. As for LVs, the axillary, subclavian, and carotid arteries were involved in 87.8%, 77.4%, and 34.4%, respectively. Isolated axillary examination resulted in a loss of 12.2% of patients with LV involvement; however, inclusion of the axillary and subclavian arteries retained 100% of patients with LV involvement. CONCLUSIONS Detection of GCA by ultrasound should routinely include examinations of the TA and LV (at least the axillary and subclavian arteries) to improve diagnostic accuracy. More than 12% of patients in our cohort had isolated LV involvement. Key Points • Extracranial involvement in GCA is very common: half of patients have extracranial vasculitis and more than 12% isolated LV involvement that can be demonstrated with CDUS. • Adding a CDUS examination of LV to TA increased sensitivity (from 83.9 to 96.6%) and the negative predictive value (from 88.5 to 98.2%) for diagnosis of GCA. • In our cohort, if we only examined the axillary arteries, 12.2% of the CGA with LV involvement would not have been diagnosed. • We propose a CDUS protocol that includes examination of the TA and LV (at least the axillary and subclavian arteries) routinely in cases of suspected GCA.
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Lavergne A, Dumont A, Deshayes S, Boutemy J, Maigné G, Silva NM, Nguyen A, Gallou S, Philip R, Aouba A, de Boysson H. Efficacy and tolerance of methotrexate in a real-life monocentric cohort of patients with giant cell arteritis. Semin Arthritis Rheum 2023; 60:152192. [PMID: 36963127 DOI: 10.1016/j.semarthrit.2023.152192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES To assess the indications, efficiency and tolerance profiles of methotrexate (MTX) in patients with giant cell arteritis (GCA) in a real-life setting. METHODS From a monocentric database of >500 GCA patients, we retrospectively selected 49 patients who received MTX between 2010 and 2020. Cumulative glucocorticoid (GC) doses, the number of relapses and GC-related adverse events were recorded before, during and after MTX. We separately analyzed the 3 main indications of MTX, i.e., disease relapse, GC-sparing strategy, and GCA presentation. RESULTS With a median follow-up of 84 [10-255] months, 25 (51%) and 18/41 (44%) patients relapsed during MTX treatment and after its discontinuation, respectively. Among the 40 patients who relapsed before MTX, 26 (65%) experienced a new relapse after MTX introduction. Once MTX was introduced, 24 (49%) patients were able to discontinue GC after 20.5 [7-64] months. No significant difference in cumulative GC doses were noted before and after MTX introduction with a total GC dose of 14.7 [1.05-69.4] grams. At the last follow-up, MTX was discontinued in 41 patients, including 13 (32%) due to clinicobiological remission, 12 (30%) due to treatment failure and 15 (36%) due to side effects. CONCLUSION Our real-life study showed a modest beneficial effect of MTX on relapse in patients with GCA. However, we did not observe any GC-sparing effect in this study. Other studies are needed to assess the GC-sparing effect in patients in whom GC management is adapted from recent recommendations.
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Affiliation(s)
- Amandine Lavergne
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Samuel Deshayes
- Department of Internal Medicine, Caen University Hospital, Caen, France; Caen University-Normandie, Caen, France
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Gwénola Maigné
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | | | - Alexandre Nguyen
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Sophie Gallou
- Department of Internal Medicine, Caen University Hospital, Caen, France; Caen University-Normandie, Caen, France
| | - Rémi Philip
- Department of Internal Medicine, Caen University Hospital, Caen, France; Caen University-Normandie, Caen, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; Caen University-Normandie, Caen, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France; Caen University-Normandie, Caen, France.
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Springer JM, Kermani TA. Recent advances in the treatment of giant cell arteritis. Best Pract Res Clin Rheumatol 2023; 37:101830. [PMID: 37328409 DOI: 10.1016/j.berh.2023.101830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 06/18/2023]
Abstract
Giant cell arteritis (GCA) is a systemic, granulomatous, large-vessel vasculitis that affects individuals over the age of 50 years. Morbidity from disease includes cranial manifestations which can cause irreversible blindness, while extra-cranial manifestations can cause vascular damage with large-artery stenosis, occlusions, aortitis, aneurysms, and dissections. Glucocorticoids while efficacious are associated with significant adverse effects. Furthermore, despite treatment with glucocorticoids, relapses are common. An understanding of the pathogenesis of GCA has led to the discovery of tocilizumab as an efficacious steroid-sparing therapy while additional therapeutic targets affecting different inflammatory pathways are under investigation. Surgical treatment may be indicated in cases of refractory ischemia or aortic complications but data on surgical outcomes are limited. Despite the recent advances, many unmet needs exist, including the identification of patients or subsets of GCA who would benefit from earlier initiation of adjunctive therapies, patients who may warrant long-term immunosuppression and medications that sustain permanent remission. The impact of medications like tocilizumab on long-term outcomes, including the development of aortic aneurysms and vascular damage also warrants investigation.
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Affiliation(s)
- Jason M Springer
- Vanderbilt University Medical Center, 1161 21st Avenue Sound, T3113 Medical Center North, Nashville, TN, 37232, USA.
| | - Tanaz A Kermani
- University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA, 90404, USA.
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19
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Hanberg JS, Miloslavsky EM. Steroid sparing in vasculitis: Myth or reality? Best Pract Res Clin Rheumatol 2023; 37:101843. [PMID: 37355346 DOI: 10.1016/j.berh.2023.101843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 06/26/2023]
Abstract
Glucocorticoids are the cornerstone of therapy for all forms of vasculitis. However, glucocorticoid treatment carries with it the risk of glucocorticoid toxicity. Recent research efforts in vasculitis have emphasized investigation into strategies that reduce glucocorticoid exposure. These strategies include the adoption of rapid-acting steroid-sparing agents, reduced-dose glucocorticoid induction regimens, the early introduction of steroid-sparing agents for maintenance therapy, and the extension of maintenance therapy to minimize glucocorticoid exposure associated with disease relapse. These are critical advances to move us toward the goal of glucocorticoid-free treatment of vasculitis. The evidence supporting each of these strategies and directions for future research are explored.
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Affiliation(s)
| | - Eli M Miloslavsky
- Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Monjo-Henry I, Fernández-Fernández E, Mostaza JM, Lahoz C, Molina-Collada J, de Miguel E. Ultrasound halo count in the differential diagnosis of atherosclerosis and large vessel giant cell arteritis. Arthritis Res Ther 2023; 25:23. [PMID: 36788547 PMCID: PMC9926809 DOI: 10.1186/s13075-023-03002-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To determine the diagnostic discriminant validity between large vessel giant cell arteritis (LV-GCA) and atherosclerosis using ultrasound (US) intima-media thickness (IMT) measurements. METHODS We included 44 patients with LV-GCA and 42 with high-risk atherosclerosis. US examinations of the axillary, subclavian, and common carotid arteries (CCA) were systematically performed using a MylabX8 system (Genoa, Italy) with a 4-15-MHz probe. IMT ≥ 1 mm was accepted as pathological. RESULTS The LV-GCA cohort included 24 females and 20 males with a mean age of 72.8 ± 7.6 years. The atherosclerosis group included 25 males and 17 females with a mean age of 70.8 ± 6.5 years. The mean IMT values of all arteries included were significantly higher in LV-GCA than in atherosclerosis. Among LV-GCA patients, IMT ≥ 1 mm was seen in 31 axillary, 30 subclavian, and 28 CCA. In the atherosclerotic cohort, 17 (38.6%) had IMT ≥ 1 mm with axillary involvement in 2 patients, subclavian in 3 patients, carotid distal in 14 patients (5 bilateral), and isolated carotid proximal affectation in 1 case. A cutoff point greater than 1 pathological vessel in the summative count of axillary and subclavian arteries or at least 3 vessels in the count of six vessels, including CCA, showed a precision upper 95% for GCA diagnosis. CONCLUSION The IMT is higher in LV-GCA than in atherosclerosis. The proposed US halo count achieves an accuracy of > 95% for the differential diagnosis between LV-GCA and atherosclerosis. The axillary and subclavian arteries have higher discriminatory power, while carotid involvement is less specific in the differential diagnosis.
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Affiliation(s)
- Irene Monjo-Henry
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain.
| | - Elisa Fernández-Fernández
- grid.81821.320000 0000 8970 9163Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - José María Mostaza
- grid.81821.320000 0000 8970 9163Department of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | - Carlos Lahoz
- grid.81821.320000 0000 8970 9163Department of Internal Medicine, Hospital Carlos III, Madrid, Spain
| | - Juan Molina-Collada
- grid.410526.40000 0001 0277 7938Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eugenio de Miguel
- grid.81821.320000 0000 8970 9163Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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21
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Moreel L, Betrains A, Molenberghs G, Vanderschueren S, Blockmans D. Epidemiology and predictors of relapse in giant cell arteritis: A systematic review and meta-analysis. Joint Bone Spine 2023; 90:105494. [PMID: 36410684 DOI: 10.1016/j.jbspin.2022.105494] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the timing of relapse, the prevalence of multiple relapses and the predictors of relapse in patients with giant cell arteritis (GCA). METHODS PubMed, Embase and Cochrane databases were searched from inception till November, 30 2021. Outcome measures include cumulative relapse rate (CRR) of first relapse at year 1, 2, and 5 after treatment initiation, CRR of second and third relapse and predictors of relapse. RESULTS Thirty studies (2595 patients) were included for timing of relapse, 16 studies (1947 patients) for prevalence of multiple relapses and 40 studies (4213 patients) for predictors of relapse. One-year, 2-year and 5-year CRRs were 32% [95% confidence interval (CI) 22-43%], 44% [95% CI 31-59%], and 47% [95% CI 27-67%], respectively. The duration of scheduled glucocorticoid therapy was negatively associated with the 1-year CRR (P=0.03). CRR of second and third relapse were 30% [95% CI 21-40] and 17% [95% CI 8-33%], respectively. Female sex (OR 1.43) and large vessel involvement (OR 2.04) were predictors of relapse. CONCLUSION Relapse occurred in almost half of GCA patients mainly during the first two years after diagnosis. One in three patients had multiple relapses. The optimal glucocorticoid tapering schedule, which seeks a balance between the lowest relapse risk and the shortest glucocorticoid duration, needs to be determined in future studies. Longer scheduled glucocorticoid therapy or early introduction of glucocorticoid-sparing agents may be warranted in female patients and patients with large vessel involvement.
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Affiliation(s)
- Lien Moreel
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
| | - Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), University of Leuven and Hasselt University, Leuven, Belgium
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Belgium
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22
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Farina N, Tomelleri A, Campochiaro C, Dagna L. Giant cell arteritis: Update on clinical manifestations, diagnosis, and management. Eur J Intern Med 2023; 107:17-26. [PMID: 36344353 DOI: 10.1016/j.ejim.2022.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Giant cell arteritis (GCA) is the most common vasculitis affecting people older than 50 years. The last decades have shed new light on the clinical paradigm of this condition, expanding its spectrum beyond cranial vessel inflammation. GCA can be now considered a multifaceted vasculitic syndrome encompassing inflammation of cranial and extra-cranial arteries and girdles, isolated or combined. Such heterogeneity often leads to diagnostic delays and increases the likelihood of acute and chronic GCA-related damage. On the other hand, the approach to suspected GCA patients has been revolutionized by the introduction of vascular ultrasound which allows a rapid, cost-effective, and non-invasive GCA diagnosis. Likewise, the use of tocilizumab is now part of the therapeutic algorithm of GCA and ensures a satisfactory disease control even in steroid-refractory patients. Nonetheless, some aspects of GCA still need to be clarified, including the clinical correlation of different histological patterns, and the prevention of long-term vascular complications. This narrative review depicts the diagnostic and therapeutic aspects of GCA most relevant in clinical practice, with a focus on clinical updates and novelties introduced over the last decade.
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Affiliation(s)
- Nicola Farina
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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23
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Dumont A, Labombarda F, Gallou S, Deshayes S, Nguyen A, Boutemy J, Martin-Silva N, Maigné G, Aouba A, de Boysson H. Preventive effect of beta-blockers in the development of aortic dilation in giant cell arteritis-related aortitis. Semin Arthritis Rheum 2022; 57:152117. [DOI: 10.1016/j.semarthrit.2022.152117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
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24
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Conticini E, Falsetti P, Baldi C, Fabiani C, Cantarini L, Frediani B. Routine color doppler ultrasonography for the early diagnosis of cranial giant cell arteritis relapses. Intern Emerg Med 2022; 17:2431-2435. [PMID: 36156190 DOI: 10.1007/s11739-022-03110-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Edoardo Conticini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Paolo Falsetti
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Caterina Baldi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Claudia Fabiani
- Department of Medicine, Surgery and Neuroscience, Ophthalmology Unit, University of Siena, Siena, Italy
| | - Luca Cantarini
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 16, 53100, Siena, Italy.
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Viale Mario Bracci, 16, 53100, Siena, Italy
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25
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Kraemer M, Becker J, Bley TA, Steinbrecher A, Minnerup J, Hellmich B. [Diagnostics and treatment of giant cell arteritis]. DER NERVENARZT 2022; 93:819-827. [PMID: 34734295 PMCID: PMC9363349 DOI: 10.1007/s00115-021-01216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
Giant cell arteritis (GCA) is the most common idiopathic systemic vasculitis in the age group over 50 years. It requires prompt diagnostics and treatment to avoid severe complications, such as visual loss or stroke. The tendency to relapse makes a glucocorticoid (GC) treatment necessary for several years and sometimes lifelong, which increases the risk of GC-induced long-term side effects. Therefore, additive GC-sparing treatment is recommended in the majority of patients. For this purpose, the anti-IL‑6 receptor antibody tocilizumab is available as an approved substance for subcutaneous application; alternatively, methotrexate (MTX) can be used (off-label).
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Affiliation(s)
- Markus Kraemer
- Klinik für Neurologie, Alfried Krupp Krankenhaus Rüttenscheid, Alfried-Krupp-Straße 21, 45130, Essen, Deutschland.
- Klinik für Neurologie, Medizinische Fakultät, Heinrich Heine Universität Düsseldorf, Düsseldorf, Deutschland.
| | - Jana Becker
- Klinik für Neurologie, Alfried Krupp Krankenhaus Rüttenscheid, Alfried-Krupp-Straße 21, 45130, Essen, Deutschland
- Klinik für Neurologie und klinische Neurophysiologie Philippusstift, Essen, Deutschland
| | - Thorsten Alexander Bley
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Jens Minnerup
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius-Klinik Kirchheim unter Teck, Kirchheim unter Teck, Deutschland
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26
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Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Schleinitz N, Ebbo M, Harlé J, Jarrot P, Kaplanski G, Berbis J, Boucekine M, Rossi P, Granel B. Facteurs de risque de rechute au diagnostic d’une artérite à cellules géantes : une étude rétrospective. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Das S, Goswami RP, Sinha D, Ghosal A, Datta A, Sarkar S. Efficacy of leflunomide as a steroid‐sparing agent in treatment of Indian giant cell arteritis patients: A 2‐year follow‐up study. Int J Rheum Dis 2022; 25:650-658. [DOI: 10.1111/1756-185x.14319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Shyamashis Das
- Department of Rheumatology Institute of Neurosciences Kolkata (I‐NK) Kolkata India
| | - Rudra Prosad Goswami
- Department of Rheumatology All India Institute of Medical Sciences New Delhi India
| | - Debanjali Sinha
- Department of Rheumatology Institute of Neurosciences Kolkata (I‐NK) Kolkata India
| | - Anirban Ghosal
- Department of Neurology Institute of Neurosciences Kolkata (I‐NK) Kolkata India
| | - Ashis Datta
- Department of Neurology Institute of Neurosciences Kolkata (I‐NK) Kolkata India
| | - Sanjukta Sarkar
- Department of Radiology Institute of Neurosciences Kolkata (I‐NK) Kolkata India
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Impact of Glucocorticoid Cumulative Doses in a Real-Life Cohort of Patients Affected by Giant Cell Arteritis. J Clin Med 2022; 11:jcm11041034. [PMID: 35207305 PMCID: PMC8875204 DOI: 10.3390/jcm11041034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives: To describe the impact of cumulative glucocorticoid (GC) doses on related adverse events (AEs) in giant cell arteritis (GCA) in a real-life setting. Methods: The medical charts of the last 139 consecutive GCA patients followed in a tertiary centre were retrospectively analysed. The cumulative GC doses were calculated, and the main GC-related AEs were collected during the follow-up. Results: After a median follow-up duration of 35.6 (2–111) months, the median cumulative GC dose in the 139 patients was 9184 (1770–24,640) mg, and 131 patients (94%) presented at least one GC-related AE. Infections (63%) were the most frequently reported GC-related AE, followed by metabolic events (63%), including weight gain in 51% of them. Cardiovascular and neuropsychiatric events occurred in 51% and 47% of patients, respectively. Osteoporotic fractures, muscular involvement, digestive events, geriatric deterioration, skin fragility, ophthalmologic complications and hypokalaemia were reported in <35% of patients. Cardiovascular events (p = 0.01), osteoporotic fractures (p = 0.004), cataract occurrence (p = 0.03), weight gain (p = 0.04) and infections (p = 0.01) were significantly associated with GC cumulative doses > 9 g. Longer GC durations were associated with cataract occurrence (p = 0.01), weight gain (p = 0.03) and all-grade infections (p = 0.048), especially herpes zoster occurrence (p = 0.003). Neuropsychiatric and metabolic events appeared within the first months after GC introduction, whereas herpes zoster recurred, and most cardiovascular AEs emerged after 1 year. Geriatric events, especially osteoporotic fractures, occurred 2 years after GC introduction. Conclusion: This study highlights how frequent GC-related AEs are and the impact of prolonged GC and cumulative doses.
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29
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An Updated Review of Cardiovascular Events in Giant Cell Arteritis. J Clin Med 2022; 11:jcm11041005. [PMID: 35207277 PMCID: PMC8878095 DOI: 10.3390/jcm11041005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis with a direct and indirect increased risk of acute and chronic vascular events, affecting large and medium vessels, and responsible for most of the morbidity and mortality of this disease. We aimed in this review to provide an updated synthesis of knowledge regarding cardiovascular events observed in GCA. By definition, GCA patients are over 50 and often over 70 years old, and subsequently also present age-related cardiovascular risk factors. In addition, the systemic and vascular inflammation as well as glucocorticoids (GC) probably contribute to an accelerated atherosclerosis and to vascular changes leading to arterial stenoses and aortic dilations and/or dissections. GCA-related ischemic complications, especially ophthalmologic events, stroke or myocardial infarcts are mostly observed within the first months after the diagnosis, being mainly linked to the vasculitic process. Conversely, aortic complications, including dilations or dissections, generally occur several months or years after the diagnosis, mainly in patients with large-vessel vasculitis. In these patients, other factors such as atherosclerosis, GC-related endothelial damage and vascular wall remodeling/healing probably contribute to the vascular events. GCA management includes the detection and treatment of these previous and newly induced cardiovascular risk factors. Hence, the use of cardiovascular treatments (e.g., aspirin, anticoagulation, statins, anti-hypertensive treatments) should be evaluated individually. Aortic structural changes require regular morphologic evaluations, especially in patients with previous aortitis. The initial or secondary addition of immunosuppressants, especially tocilizumab, an anti-IL-6 receptor antibody, is discussed in patients with GCA-related cardiovascular complications and, more consensually, to limit GC-mediated comorbidities.
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Ramon A, Greigert H, Ornetti P, Bonnotte B, Samson M. Mimickers of Large Vessel Giant Cell Arteritis. J Clin Med 2022; 11:jcm11030495. [PMID: 35159949 PMCID: PMC8837104 DOI: 10.3390/jcm11030495] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023] Open
Abstract
Giant cell arteritis (GCA) is a large-vessel granulomatous vasculitis occurring in patients over 50-year-old. Diagnosis can be challenging because there is no specific biological test or other diagnoses to consider. Two main phenotypes of GCA are distinguished and can be associated. First, cranial GCA, whose diagnosis is usually confirmed by the evidence of a non-necrotizing granulomatous panarteritis on temporal artery biopsy. Second, large-vessel GCA, whose related symptoms are less specific (fever, asthenia, and weight loss) and for which other diagnoses must be implemented if there is neither cephalic GCA nor associated polymyalgia rheumatica (PMR) features chronic infection (tuberculosis, Coxiella burnetti), IgG4-related disease, Erdheim Chester disease, and other primary vasculitis (Behçet disease, relapsing polychondritis, or VEXAS syndrome). Herein, we propose a review of the main differential diagnoses to be considered regarding large vessel vasculitis.
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Affiliation(s)
- André Ramon
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Correspondence:
| | - Hélène Greigert
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- Vascular Medicine Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Paul Ornetti
- Rheumatology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France;
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, 21000 Dijon, France
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences et Du Sport, 21000 Dijon, France
| | - Bernard Bonnotte
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
| | - Maxime Samson
- INSERM, EFS BFC, UMR 1098, RIGHT Graft-Host-Tumor Interactions/Cellular and Genetic Engineering, Bourgogne Franche-Comté University, 21000 Dijon, France; (H.G.); (B.B.); (M.S.)
- Internal Medicine and Clinical Immunology Department, Dijon-Bourgogne University Hospital, 21000 Dijon, France
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Mahr A, Hachulla E, de Boysson H, Guerroui N, Héron E, Vinzio S, Broner J, Lapébie FX, Michaud M, Sailler L, Zenone T, Djerad M, Jouvray M, Shipley E, Tieulie N, Armengol G, Bouldoires B, Viallard JF, Idier I, Paccalin M, Devauchelle-Pensec V. Presentation and Real-World Management of Giant Cell Arteritis (Artemis Study). Front Med (Lausanne) 2021; 8:732934. [PMID: 34859001 PMCID: PMC8631900 DOI: 10.3389/fmed.2021.732934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Few studies of daily practice for patients with giant cell arteritis (GCA) are available. This French study aimed to describe the characteristics and management of GCA in a real-life setting. Methods: Cross-sectional, non-interventional, multicenter study of patients ≥50 years old who consulted hospital-based specialists for GCA and were under treatment. Patient characteristics and journey, diagnostic methods and treatments were collected. Descriptive analyses were performed. Results: In total, 306 patients (67% females, mean age 74 ± 8 years old) were recruited by 69 physicians (internists: 85%, rheumatologists: 15%); 13% of patients had newly diagnosed GCA (diagnosis-to-visit interval <6 weeks). Overall median disease duration was 13 months (interquartile range 5–26). Most patients were referred by general practitioners (56%), then ophthalmologists (10%) and neurologists (7%). Most common comorbidities were hypertension (46%), psychiatric disorders (10%), dyslipidemia (12%), diabetes (9%), and osteoporosis (6%). Initial GCA presentations included cranial symptoms (89%), constitutional symptoms (74%), polymyalgia rheumatica (48%), and/or other extra-cranial manifestations (35%). Overall, 85, 31, 26, and 30% of patients underwent temporal artery biopsy, high-resolution temporal artery Doppler ultrasonography, 18FDG-PET, and aortic angio-CT, respectively. All patients received glucocorticoids, which were ongoing for 89%; 29% also received adjunct medication(s) (methotrexate: 19%, tocilizumab: 15%). A total of 40% had relapse(s); the median time to the first relapse was 10 months. Also, 37% had comorbidity(ies) related to or aggravated by glucocorticoids therapy. Conclusion: This large observational study provides insight into current medical practices for GCA. More than one third of patients had comorbidities related to glucocorticoid therapy for a median disease duration of 13 months. Methotrexate and tocilizumab were the most common adjunct medications.
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Affiliation(s)
- Alfred Mahr
- Department of Internal Medicine, University Hospital Paris (AP-HP, Saint Louis), Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Nassim Guerroui
- Department of Rheumatology, European Hospital of Marseille, Marseille, France
| | - Emmanuel Héron
- Department of Internal Medicine, Hospital Quinze-Vingts, Internal Medicine, Paris, France
| | - Stéphane Vinzio
- Department of Internal Medicine, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Jonathan Broner
- Department of Internal Medicine, University Hospital Centre Nimes, Nimes, France
| | | | - Martin Michaud
- Department of Internal Medicine, Hopital Joseph Ducuing Toulouse, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, University Hospital of Toulouse, Toulouse, France
| | - Thierry Zenone
- Department of Internal Medicine, General Hospital of Valence, Valence, France
| | - Mohamed Djerad
- Department of Internal Medicine, General Hospital of Nevers, Nevers, France
| | - Mathieu Jouvray
- Department of Internal Medicine, General Hospital of Arras, Arras, France
| | - Emilie Shipley
- Department of Rheumatology, General Hospital of Dax, Dax, France
| | - Nathalie Tieulie
- Department of Rheumatology, University Hospital of Nice, Nice, France
| | - Guillaume Armengol
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Bastien Bouldoires
- Department of Internal Medicine, Civil Hospital of Colmar, Colmar, France
| | | | - Isabelle Idier
- Medical Affairs, Chugai Pharma France, Paris La Défense, Paris, France
| | - Marc Paccalin
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
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Tomelleri A, van der Geest KSM, Sebastian A, van Sleen Y, Schmidt WA, Dejaco C, Dasgupta B. Disease stratification in giant cell arteritis to reduce relapses and prevent long-term vascular damage. THE LANCET RHEUMATOLOGY 2021. [DOI: 10.1016/s2665-9913(21)00277-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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de Mornac D, Espitia O, Néel A, Connault J, Masseau A, Espitia-Thibault A, Artifoni M, Achille A, Wahbi A, Lacou M, Durant C, Pottier P, Perrin F, Graveleau J, Hamidou M, Hardouin JB, Agard C. Large-vessel involvement is predictive of multiple relapses in giant cell arteritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211009029. [PMID: 34046092 PMCID: PMC8135215 DOI: 10.1177/1759720x211009029] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Giant cell arteritis (GCA) is the most common systemic vasculitis. Relapses are frequent. The aim of this study was to identify relapse risk factors in patients with GCA with complete large-vessel imaging at diagnosis. Methods: Patients with GCA followed in our institution between April 1998 and April 2018 were included retrospectively. We included only patients who had undergone large vascular imaging investigations at diagnosis by computed tomography (CT)-scan and/or positron emission tomography (PET)-scan and/or angio-magnetic resonance imaging (MRI). Clinical, biological, and radiological data were collected. Relapse was defined as the reappearance of GCA symptoms, with concomitant increase in inflammatory markers, requiring treatment adjustment. Relapsing patients (R) and non-relapsing patients (NR) were compared. Relapse and multiple relapses (>2) risk factors were identified in multivariable Cox analyses. Results: This study included 254 patients (73.2% women), with a median age of 72 years at diagnosis and a median follow up of 32.5 months. At diagnosis, 160 patients (63%) had an inflammatory large-vessel involvement on imaging, 46.1% (117 patients) relapsed at least once, and 21.3% (54 patients) had multiple relapses. The median delay of first relapse after diagnosis was 9 months. The second relapse delay was 21.5 months. NR patients had more stroke at diagnosis than R (p = 0.03) and the brachiocephalic trunk was involved more frequently on CT-scan (p = 0.046), as carotids (p = 0.02) in R patients. Multivariate Cox model identified male gender [hazard ratio (HR): 0.51, confidence interval (CI) (0.27–0.96), p = 0.04] as a relapse protective factor, and peripheral musculoskeletal manifestations [HR: 1.74 (1.03–2.94), p = 0.004] as a relapse risk factor. Peripheral musculoskeletal manifestations [HR: 2.78 (1.23–6.28), p = 0.014], negative temporal artery biopsy [HR: 2.29 (1.18–4.45), p = 0.015], large-vessel involvement like upper limb ischemia [HR: 8.84 (2.48–31.56), p = 0.001] and inflammation of arm arteries on CT-scan [HR: 2.39 (1.02–5.58), p = 0.04] at diagnosis were risk factors of multiple relapses. Conclusion: Male gender was a protective factor for GCA relapse and peripheral musculoskeletal manifestations appeared as a relapsing risk factor. Moreover, this study identified a particular clinical phenotype of multi-relapsing patients with GCA, characterized by peripheral musculoskeletal manifestations, negative temporal artery biopsy, and large-vessel involvement with upper limb ischemia or inflammation of arm arteries. Plain language Summary At giant cell arteritis diagnosis, large-vessel inflammatory involvement is predictive of multiple relapses
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Affiliation(s)
| | - Olivier Espitia
- Department of Internal Medicine, CHU Nantes, 1 Place Alexis Ricordeau, Nantes, 44093, France
| | - Antoine Néel
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Jérôme Connault
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Agathe Masseau
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Mathieu Artifoni
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Aurélie Achille
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Anaïs Wahbi
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Mathieu Lacou
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Cécile Durant
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Pierre Pottier
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - François Perrin
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Julie Graveleau
- Department of Internal Medicine, Saint-Nazaire Hospital, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
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Chen F, Li Y, Zhou H, Sun C, Li S, Wang L, Li X, Liu X. Analysis of Development Mechanism of Giant Cell Arteritis in Nude Mouse Model through Color Duplex Sonography and Computerized Tomography Nanocontrast Agent. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6627925. [PMID: 33928153 PMCID: PMC8053047 DOI: 10.1155/2021/6627925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022]
Abstract
To explore the application value of color duplex sonography and enhanced computerized tomography (CT) inspection based on a nanocontrast agent in diagnosis and pathogenesis in giant cell arteritis (GCA), the GCA nude mouse model was constructed. In this study, 40 healthy male BalB/c nude mice aged 6-8 weeks were randomly divided into a control group (no model) and an experimental group (model), with 20 mice in each group, and the temporal artery tissue of GCA patients diagnosed as positive by temporal artery biopsy was implanted into nude mice to construct a GCA nude mouse model. Abdominal aortic biopsy and immunohistochemistry were used to verify the success of the GCA nude mouse model. All nude mice were subjected to color duplex sonography and enhanced CT examination based on a nanocontrast agent. At the same time, the basic indicators such as body weight, temperature, white blood cell (WBC), lymphocytes (LYM), hemoglobin (HGB), and platelet (PLT) were measured, and the protein expression levels of interleukin-6 (IL-6) and signal transducer and activator of transcription 3 (STAT3) were detected by immunohistochemistry. The results showed that the temporal artery wall of the nude mice in the experimental group thickened and the lumen was significantly narrowed, indicating that the cell arteritis model of nude mice was successfully constructed; ultrasound examination showed that the right superficial temporal artery vascular cavity narrowed, the blood flow signal changed like a filling defect around the periphery, and there was a low echo halo. CT examination showed that the left superficial temporal artery narrowed, and the inner diameter of the narrow segment of blood vessels changed like a bead. The body weight of nude mice in the experimental group decreased significantly after the modeling was completed (P < 0.05); after modeling, the body temperature of the nude mice in the experimental group increased significantly (P < 0.05); LYM and HGB values of nude mice in the experimental group were significantly lower than those in the control group (P < 0.05); the content of IL-6, STAT3, IL-6, and STAT3 proteins in the arterial tissue of nude mice in the experimental group was lower than that of the control group (P < 0.05), indicating that color duplex sonography and CT contrast agent technology can be used in the diagnosis and development mechanism research of GC.
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Affiliation(s)
- Fugang Chen
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
| | - Yang Li
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
| | - Hongyan Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
| | - Chuang Sun
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
| | - Sun Li
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
| | - Lu Wang
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
| | - Xin Li
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
| | - Xiaoqiang Liu
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian 116031, China
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Deshayes S, Ly KH, Rieu V, Maigné G, Silva NM, Manrique A, Monteil J, de Boysson H, Aouba A. Steroid-sparing effect of anakinra in giant-cell arteritis: a case series with clinical, biological and iconographic long-term assessments. Rheumatology (Oxford) 2021; 61:400-406. [PMID: 33742671 DOI: 10.1093/rheumatology/keab280] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The treatment of giant cell arteritis (GCA) relies on corticosteroids but is burdened by a high rate of relapses and adverse effects. Anti-interleukin-6 treatments show a clear benefit with a significant steroid-sparing effect, but late relapses occur after treatment discontinuation. In addition to interleukin-6, interleukin-1 also appears to play a significant role in GCA pathophysiology. We report herein the efficacy of anakinra, an interleukin-1 receptor antagonist, in 6 GCA patients exhibiting corticosteroid dependence or resistance, specifically analyzing the outcome of aortitis in 4 of them. METHODS This retrospective study analyzed the cases of all GCA patients treated with anakinra from the French Study Group for Large Vessel Vasculitis. RESULTS After a median duration of anakinra therapy of 19 [18-32] months, all 6 patients exhibited complete clinical and biological remission. Among the 4 patients with large-vessel involvement, 2 had a disappearance of aortitis under anakinra, and 2 showed a decrease in vascular uptake. After a median follow-up of 56 [48-63] months, corticosteroids were discontinued in 4 patients, and corticosteroid dosage could be decreased to 5 mg/day in 2 patients. One patient relapsed 13 months after anakinra introduction in the context of increasing the daily anakinra injection interval to every 48 hours. Three patients experienced transient injection-site reactions, and 1 patient had pneumonia. CONCLUSION In this short series, anakinra appears to be an efficient and safe steroid-sparing agent in refractory GCA, with a possible beneficial effect on large-vessel involvement.
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Affiliation(s)
- Samuel Deshayes
- Service de Médecine Interne, CHU de Caen Normandie, 14000 Caen, France.,Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, 14000 Caen, France
| | - Kim-Heang Ly
- Service de Médecine Interne A, CHU Dupuytren, 87000 Limoges, France.,Faculté de médecine, laboratoire d'immunologie, EA3842, 87025 Limoges, France
| | - Virginie Rieu
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Gwénola Maigné
- Service de Médecine Interne, CHU de Caen Normandie, 14000 Caen, France
| | | | - Alain Manrique
- Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, 14000 Caen, France.,Service de Médecine Nucléaire, CHU de Caen Normandie, 14000 Caen, France
| | - Jacques Monteil
- Service de Médecine Nucléaire, CHU Dupuytren, 87000 Limoges, France
| | - Hubert de Boysson
- Service de Médecine Interne, CHU de Caen Normandie, 14000 Caen, France.,Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, 14000 Caen, France
| | - Achille Aouba
- Service de Médecine Interne, CHU de Caen Normandie, 14000 Caen, France.,Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen Normandie, 14000 Caen, France
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[Glucocorticoids in the treatment of giant cell arteritis : How much, how long and how to spare?]. Z Rheumatol 2021; 80:322-331. [PMID: 33710440 DOI: 10.1007/s00393-021-00975-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 10/21/2022]
Abstract
Treatment of giant cell arteritis (GCA) with high-dose glucocorticoids (GC) regularly leads to a control of the inflammatory activity, so that high-dose GC is still the recommended standard treatment in the current guidelines; however, after discontinuation of GC treatment or reduction of the GC dosage, relapses occur in up to 70% of patients in the further course of the disease, making it necessary to resume treatment or increase the dosage. As a consequence many patients therefore have to be treated with GC often in high doses over several years, which results in a high cumulative exposure to GC. The risk for GC-associated diseases, such as diabetes, glaucoma, osteoporosis or severe infections is therefore significantly increased for patients with giant cell arteritis. For patients with GC-associated comorbidities or increased risk of developing them or patients with a relapse, the current guidelines therefore recommend GC-sparing treatment with tocilizumab or alternatively methotrexate. It is currently unclear over what period of time patients should be treated with GC and GC-sparing treatment, since high-quality study data on de-escalation strategies for GCA are currently still lacking. Decisions on treatment duration and intensity must therefore be made individually for each patient, taking into account general and patient-specific risk factors for a GC-dependent course, GCA-associated vascular damage (stenoses, aneurysms, visual loss) and treatment-associated complications.
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Espitia O, Blonz G, Urbanski G, Landron C, Connault J, Lavigne C, Roblot P, Maillot F, Audemard-Verger A, Artifoni M, Durant C, Guyomarch B, Hamidou M, Magnant J, Agard C. Symptomatic aortitis at giant cell arteritis diagnosis: a prognostic factor of aortic event. Arthritis Res Ther 2021; 23:14. [PMID: 33413605 PMCID: PMC7792092 DOI: 10.1186/s13075-020-02396-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Giant cell arteritis (GCA) is frequently associated with aortic involvement that is likely to cause life-threatening structural complications (aneurysm, dissection). Few studies have investigated the occurrence of these complications, and no predictive factor has been identified so far. The aim of this study was to investigate factors associated with the risk of aortic complications in a cohort of GCA aortitis. Methods Data of all patients managed with aortitis (CT or 18 FDG PET) at the diagnosis of GCA in five hospitals from May 1998 and April 2019 were retrospectively collected. Clinical features were compared according to the presence of aortitis symptoms. The predictive factors of occurrence or aggravation of aortic structural abnormalities were investigated. Results One hundred and seventy-one patients with GCA aortitis were included; 55 patients (32%) had symptoms of aortitis (dorsal/lumbar/abdominal pain, aortic insufficiency) at diagnosis. The median follow-up was 38 months. Aortic complications occurred after a median time of 32 months. There were 19 new aortic aneurysms or complications of aneurysm and 5 dissections. Survival without aortic complication was significantly different between the symptomatic and non-symptomatic groups (Log rank, p = 0.0003). In multivariate analysis the presence of aortitis symptoms at diagnosis (HR 6.64 [1.95, 22.6] p = 0.002) and GCA relapse (HR 3.62 [1.2, 10.9] p = 0.02) were factors associated with the occurrence of aortic complications. Conclusion In this study, the presence of aortitis symptoms at the diagnosis of GCA aortitis and GCA relapse were independent predictive factors of occurrence of aortic complications during follow-up.
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Affiliation(s)
- Olivier Espitia
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
| | - Gauthier Blonz
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Cédric Landron
- Department of Internal Medicine, CHU Poitiers, Poitiers, France
| | - Jérôme Connault
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Pascal Roblot
- Department of Internal Medicine, CHU Poitiers, Poitiers, France
| | | | | | - Mathieu Artifoni
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Cécile Durant
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Béatrice Guyomarch
- Research Department, Methodology and Biostatistics Platform, CHU Nantes, Nantes, France
| | - Mohamed Hamidou
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Julie Magnant
- Department of Internal Medicine, CHRU Tours, Tours, France
| | - Christian Agard
- Department of Internal Medicine, CHU Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
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Monti S, Bartoletti A, Bellis E, Delvino P, Montecucco C. Fast-Track Ultrasound Clinic for the Diagnosis of Giant Cell Arteritis Changes the Prognosis of the Disease but Not the Risk of Future Relapse. Front Med (Lausanne) 2020; 7:589794. [PMID: 33364248 PMCID: PMC7753207 DOI: 10.3389/fmed.2020.589794] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Color Duplex sonography (CDS) of temporal arteries and large vessels (LV) is a recently validated diagnostic methodology for Giant Cell Arteritis (GCA). CDS combined with a fast-track approach (FTA) has improved the early diagnosis of the disease. Objectives: To assess FTA effects on the prevention of permanent visual loss (PVL), relapse and late complications of GCA compared to conventional practice. To assess the impact of COVID-19 pandemic on outcomes of GCA patients assessed with FTA. Methods: GCA patients diagnosed up to June 2020 at the Rheumatology Department, University of Pavia, were included. FTA was implemented since October 2016. FTA consists in the referral within 1 working day of a suspected GCA case to an expert rheumatologist who performs clinical evaluation and CDS. Results: One hundred sixty patients were recruited [female 120 (75%), mean age 72.4 ± 8.2 years]. Sixty-three (39.4%) evaluated with FTA, 97 (60.6%) with conventional approach. FTA patients were older (75.1 ± 7.6 vs. 70.6 ± 8.2 years old; p < 0.001). Median follow-up duration was shorter in the FTA group compared to the conventional one (0.9 vs. 5.0 years; p < 0.001). There was no difference between the two cohorts regarding major vessel district involvement (LV-GCA 17.5% vs. 22.7%; p = 0.4). PVL occurred in 8 (12.7%) FTA patients and 26 (26.8%) conventional ones (p = 0.03). The relative risk of blindness in the conventional group was 2.11 (95% C.I. 1.02–4.36; P = 0.04) as compared to FTA. Median symptom latency of patients experiencing PVL was higher in the conventional group (23 days IQR 12–96 vs. 7 days IQR 4–10, p = 0.02). During COVID-19 there was a significant increase in the occurrence of PVL (40%) including bilateral blindness despite a regularly operating FTA clinic. Cumulative incidence of relapses and time to first relapse did not change after FTA introduction (P = 0.2). No difference in late complications (stenosis/aneurysms) was detected. Conclusions: FTA including CDS evaluation contributed to a substantial reduction of PVL in GCA by shortening the time to diagnosis and treatment initiation. Relapse rate did not change upon FTA introduction, highlighting the need for better disease activity monitoring and treatment strategies optimization based on risk stratification that would predict the occurrence of relapse during glucocorticoid de-escalation.
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Affiliation(s)
- Sara Monti
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy.,PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Alice Bartoletti
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Elisa Bellis
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Paolo Delvino
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy.,PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
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Abstract
Purpose of Review Guidelines for the management of large vessel vasculitides have been recently updated by several scientific societies. We have evaluated the current recommendations for treatment of giant cell arteritis (GCA) and Takayasu arteritis (TA) and addressed potential future therapeutic strategies. Recent Findings While glucocorticoids (GCs) remain the gold standard for induction of remission, many patients relapse and acquire high cumulative GC exposure. Thus, GC-sparing therapies such as methotrexate are recommended for selected patients with GCA and all patients with TA. Recent high-quality evidence shows that tocilizumab is an effective GC-sparing agent in GCA. Non-biologic and biologic immunomodulators also appear to have GC-sparing properties in TA. Summary Tocilizumab is now considered to be part of the standard treatment for GCA, particularly with relapsing disease, but questions on its use such as length of treatment and monitoring of disease activity remain open. High-quality evidence to guide treatment of TA is still lacking.
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Liozon E, Dumonteil S, Parreau S, Gondran G, Bezanahary H, Palat S, Ly KH, Fauchais AL. Risk profiling for a refractory course of giant cell arteritis: The importance of age and body weight: "Risk profiling for GC resistance in GCA". Semin Arthritis Rheum 2020; 50:1252-1261. [PMID: 33065420 DOI: 10.1016/j.semarthrit.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a disease that relapses often, and some patients run a refractory course. Although prompt recognition of resistant GCA is a major issue, there is no well-recognized, baseline risk factor for poor response to glucocorticoid (GC) treatment. METHODS We included all patients consecutively diagnosed with GCA and homogeneously treated since 1976 in a single department and regularly followed-up for at least 18 months. Using a set of customized criteria defining response to GCs, we separated patients into highly responsive, usually responsive, dependent on GCs, and resistant to GCs. We determined which of the baseline variables were associated with GC-resistance and conducted factor analyses of mixed data and decision tree analyses. We also determined whether being GC-resistant was associated with poorer tolerance to GCs and higher death rates. RESULTS In all, 455 patients were followed for 93.4 ± 67.6 (standard deviation) months; 41 (9%) and 21 (4.6%) patients developed GC-dependent and GC-resistant disease, respectively. Factor analyses suggested an association between clinical pattern and degree of responsiveness to GCs; The decision tree analyses, built on an age at GCA onset 〈 66 years and body weight 〉 71 kg, delineated a high risk profile (44% of the patients who featured both characteristics were GC-resistant vs. less than 3% who featured neither, p < 0.001). Infections were more prevalent in the GC-resistant or GC-dependent patients, but without decreasing their survival. CONCLUSION Extra-cranial, large-vessel GCA may be associated with prolonged GC requirements. A simple combination of age and body weight defined a subgroup of patients at high risk for developing GC resistance. Our findings need confirmation in prospective controlled studies.
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Affiliation(s)
- Eric Liozon
- Departments of 1Internal Medicine, University Hospital of Limoges, France.
| | - Stéphanie Dumonteil
- Departments of 1Internal Medicine, University Hospital of Limoges, France; Functional Unit of Clinical Research and Biostatistics, Limoges School of Medicine, Limoges Cedex, France
| | - Simon Parreau
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Guillaume Gondran
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Holy Bezanahary
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Sylvain Palat
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Kim-Heang Ly
- Departments of 1Internal Medicine, University Hospital of Limoges, France
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Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica. Nat Rev Rheumatol 2020; 16:481-495. [DOI: 10.1038/s41584-020-0458-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
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Muratore F, Boiardi L, Restuccia G, Cavazza A, Catanoso M, Macchioni P, Spaggiari L, Cimino L, Aldigeri R, Pipitone N, Fontana A, Casali M, Croci S, Salvarani C. Relapses and long-term remission in large vessel giant cell arteritis in northern Italy: Characteristics and predictors in a long-term follow-up study. Semin Arthritis Rheum 2020; 50:549-558. [DOI: 10.1016/j.semarthrit.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022]
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[The current place of non-invasive large-vessel imaging in the diagnosis and follow-up of giant cell arteritis]. Rev Med Interne 2020; 41:756-768. [PMID: 32674899 DOI: 10.1016/j.revmed.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022]
Abstract
Large vessel involvement in giant cell arteritis has long been described, although its right frequency and potential prognostic value have only been highlighted for two decades. Large vessel involvement not only is associated with a high incidence of late aortic aneurysms, but also might cause greater resistance to glucocorticoids and longer treatment duration, as well as worse late cardiovascular outcomes. These data were brought to our attention, thanks to substantial progress recently made in large vessel imaging. This relies on four single, often complementary, approaches of varying availability: colour Doppler ultrasound, contrast-enhanced computed tomography with angiography and, magnetic resonance imaging, which all demonstrate homogeneous circumferential wall thickening and describe structural changes; 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT), which depicts wall inflammation and assesses many vascular territories in the same examination. In addition, integrated head-and-neck PET/CT can accurately and reliably diagnose cranial arteritis. All four procedures exhibit high diagnostic performance for a large vessel arteritis diagnosis so that the choice is left to the physician, depending on local practices and accessibility; the most important is to carry out the chosen modality without delay to avoid false or equivocal results, due to early vascular oedema changes as a result of high dose glucocorticoid treatment. Yet, ultrasound study of the superficial cranial and subclavian/axillary arteries remains a first line assessment aimed at strengthening and expediting the clinical diagnosis as well as raising suspicion of large-vessel involvement. In treated patients, vascular imaging results are poorly correlated with clinical-biological controlled disease so that it is strongly recommended not to renew imaging studies unless a large vessel relapse or complication is suspected. On the other hand, a structural monitoring of aorta following giant cell arteritis is mandatory, but uncertainties remain regarding the best procedural approach, timing of first control and spacing between controls. Individuals at greater risk of developing aortic complication, e.g. those with classic risk factors for aneurysm and/or visualised aortitis, should be monitored more closely.
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Mollan SP, Paemeleire K, Versijpt J, Luqmani R, Sinclair AJ. European Headache Federation recommendations for neurologists managing giant cell arteritis. J Headache Pain 2020; 21:28. [PMID: 32183689 PMCID: PMC7079499 DOI: 10.1186/s10194-020-01093-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIM Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. METHODS The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience. RESULTS Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA. CONCLUSION The present article will outline recent advances made in the diagnosis and management of GCA.
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Affiliation(s)
- S. P. Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - K. Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - J. Versijpt
- Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - R. Luqmani
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kennedy Institute of Rheumatology, Roosevelt Drive, Headington, Oxford, OX3 7FY UK
| | - A. J. Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- Department of Neurology, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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Role of positron emission tomography in the assessment of disease burden and risk of relapse in patients affected by giant cell arteritis. Clin Rheumatol 2019; 39:1277-1281. [DOI: 10.1007/s10067-019-04808-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/27/2019] [Accepted: 10/02/2019] [Indexed: 01/18/2023]
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Apport de l’imagerie (hors Doppler) pour le diagnostic et le suivi de l’artérite à cellules géantes. Presse Med 2019; 48:931-940. [DOI: 10.1016/j.lpm.2019.07.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 01/17/2023] Open
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