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Therapeutische Umschau. Revue... Jun 2022Large Vessel Vasculitides: Giant Cell Arteritis and Takayasu Arteritis - Similarities and Differences According to the Chapel Hill Consensus Conference Nomenclature of...
Large Vessel Vasculitides: Giant Cell Arteritis and Takayasu Arteritis - Similarities and Differences According to the Chapel Hill Consensus Conference Nomenclature of 2012, giant cell arteritis (GCA) and Takayasu arteritis (TAK) belong to the idiopathic large vessel vasculitides. While GCA is a typical disease of the elderly, TAK begins in adolescence and young adulthood, sometimes even in childhood. In both diseases, immune-mediated granulomatous vascular wall inflammation of the aorta and its major branches leads to the formation of stenoses, occlusions, and aneurysms. The reduced blood flow to downstream organs causes the characteristic symptoms such as visual disturbance, ischemic muscle pain, and dysesthesias. Typically, a pronounced systemic reaction with constitutional symptoms such as temperature elevation, fatigue, and weight loss is present. If GCA or TAK is suspected, vasculitis should always be confirmed by imaging (ultrasound, MRI, or PET-CT) and/or histology. In addition to induction therapy with glucocorticoids, steroid-sparing immunosuppressants such as tocilizumab and infliximab have become increasingly important in recent years, prompting the EULAR to update its recommendations for the management of large-vessel vasculitis in 2018.
Topics: Adolescent; Adult; Aged; Giant Cell Arteritis; Humans; Magnetic Resonance Imaging; Positron Emission Tomography Computed Tomography; Takayasu Arteritis; Ultrasonography; Young Adult
PubMed: 35583023
DOI: 10.1024/0040-5930/a001353 -
Current Opinion in Rheumatology May 2016This article critically reviews the advances in medical management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) with a focus on recent developments in... (Review)
Review
PURPOSE OF REVIEW
This article critically reviews the advances in medical management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) with a focus on recent developments in targeted biologic therapy.
RECENT FINDINGS
The role of biologics in the treatment of large vessel vasculitis (LVV) is expanding. TNFα inhibitors appear to be effective in the treatment of TAK but have little benefit in GCA. Preliminary clinical trial data suggest that abatacept and tocilizumab reduce the risk of relapse in GCA. Increasing observational evidence supports the use of interleukin-6 inhibitors in TAK. Based on a small open-label study, ustekinumab appears safe and potentially effective for refractory GCA. A possible role of B cell dysregulation may contribute to pathogenic mechanisms in LVV, but support for the use of B cell depleting therapy is limited.
SUMMARY
Interleukin-6 inhibitors appear efficacious in the treatment of refractory cases of LVV; however, utility in newly diagnosed immunosuppressive-naïve patients is less well established. Abatacept and ustekinumab are promising targets for therapy in LVV but further investigation is needed before routine use is considered.
Topics: Biological Factors; Disease Management; Giant Cell Arteritis; Humans; Immunotherapy; Takayasu Arteritis
PubMed: 26885650
DOI: 10.1097/BOR.0000000000000265 -
Reumatologia Clinica 2017
Topics: Giant Cell Arteritis; Humans; Takayasu Arteritis
PubMed: 27349811
DOI: 10.1016/j.reuma.2016.05.004 -
Cardiology in Review 2014Coronary artery disease (CAD) is the leading cause of death in the United States. Although CAD was formerly considered a lipid accumulation-mediated disease, it has now... (Review)
Review
Coronary artery disease (CAD) is the leading cause of death in the United States. Although CAD was formerly considered a lipid accumulation-mediated disease, it has now been clearly shown to involve an ongoing inflammatory response. Advances in basic science research have established the crucial role of inflammation in mediating all stages of CAD. Today, there is convincing evidence that multiple interrelated immune mechanisms interact with metabolic risk factors to initiate, promote, and ultimately activate lesions in the coronary arteries. This review aims to provide current evidence pertaining to the role of inflammation in the pathogenesis of CAD and discusses the impact of inflammatory markers and their modification on clinical outcomes.
Topics: Anti-Inflammatory Agents; Arteritis; Biomarkers; C-Reactive Protein; Chemokine CCL2; Coronary Artery Disease; Humans; Interleukins; Risk Factors; Tumor Necrosis Factor-alpha
PubMed: 24441047
DOI: 10.1097/CRD.0000000000000006 -
Internal Medicine (Tokyo, Japan) Oct 2018
Topics: Arteritis; Giant Cell Arteritis; Humans; Myelodysplastic Syndromes; Takayasu Arteritis
PubMed: 29780150
DOI: 10.2169/internalmedicine.1059-18 -
Arthritis Care & Research Nov 2020To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). (Observational Study)
Observational Study
OBJECTIVE
To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA).
METHODS
Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort.
RESULTS
A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage.
CONCLUSION
Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis.
Topics: Adult; Arteries; Cluster Analysis; Female; Giant Cell Arteritis; Humans; Male; Prevalence; Prospective Studies; Takayasu Arteritis; Vascular Diseases
PubMed: 31444857
DOI: 10.1002/acr.24055 -
BMJ Case Reports Jul 2021This is a case report of 'familial giant cell arteritis' in three siblings from northwest India. This is the first case report of 'familial giant cell arteritis' in a...
This is a case report of 'familial giant cell arteritis' in three siblings from northwest India. This is the first case report of 'familial giant cell arteritis' in a non-Caucasian family.
Topics: Giant Cell Arteritis; Humans; India; Siblings
PubMed: 34301685
DOI: 10.1136/bcr-2021-243304 -
Immunoglobulin G4-related coronary periarteritis: a systematic literature review with a case series.Clinical Rheumatology Aug 2022We aimed to assess the clinical and radiological characteristics of immunoglobulin G4-related coronary periarteritis through a systematic literature review and from our... (Review)
Review
We aimed to assess the clinical and radiological characteristics of immunoglobulin G4-related coronary periarteritis through a systematic literature review and from our case series. In the systematic literature review, we assessed English language manuscripts on immunoglobulin G4-related coronary periarteritis cases. Additionally, we identified patients with immunoglobulin G4-related coronary periarteritis at St. Luke's International Hospital in Tokyo, Japan, from 2014 to 2020. We summarized patients' demographics, immunoglobulin-G and -G4 titers, site and morphological features of the coronary lesion, and other organ involvements. We identified 38 cases from the literature and four patients from our institute. Coronary lesions were detected using coronary computed tomography in 40 (95.2%) patients. Mass-like or diffuse wall-thickening lesion was the most frequently observed type in 33 (78.6%) patients. No trends at the site of the coronary arteries were identified. Overall, 32 (76.1%) patients had multiple-organ involvement, of which the most common lesion was peri-aortitis in 21 (50.0%) patients. Ten (23.8%) patients with an isolated coronary lesion had significantly lower immunoglobulin-G4 titers than those with other organ involvements (immunoglobulin-G4: 261 [161.0, 564.0] vs. 1355.0 [320.8, 2480.0] mg/dL, p = 0.033). The wall-thickening lesions responded well to immunosuppressive treatments. Mass-like or diffuse wall-thickening on coronary computed tomography is a characteristic radiographic finding of immunoglobulin G4-related coronary periarteritis, which can occur in any branch. Immunoglobulin G4-related coronary periarteritis showed similar characteristics to other organ lesions, including its relatively low serum immunoglobulin-G4 level in patients with a single-organ disease and its high responsiveness to glucocorticoids.
Topics: Aortitis; Arteritis; Coronary Vessels; Heart; Humans; Immunoglobulin G
PubMed: 35445950
DOI: 10.1007/s10067-022-06179-y -
International Journal of Rheumatic... Sep 2023
Topics: Humans; Takayasu Arteritis; Interleukin-10; Inflammation
PubMed: 37664962
DOI: 10.1111/1756-185X.14807 -
Journal of Cutaneous Pathology Dec 2016There is controversy on whether lymphocytic thrombophilic arteritis (LTA) and macular arteritis (MA) are a different entity from cutaneous polyarteritis nodosa (C-PAN).
BACKGROUND
There is controversy on whether lymphocytic thrombophilic arteritis (LTA) and macular arteritis (MA) are a different entity from cutaneous polyarteritis nodosa (C-PAN).
OBJECTIVE
To evaluate the controversy on LTA/MA by examining the morphologic changes during the dynamic inflammatory process.
MATERIALS AND METHODS
A clinical and histopathological investigation of 46 biopsy specimens from 21 histopathologically proven C-PAN patients at our hospital was performed.
RESULTS
Most of the biopsy findings revealed arteritis in the subacute and reparative stages. Coexistence of different stages was found in over half of the specimens. Two biopsy specimens consistent with LTA/MA showed coexisting histologically proven (subacute stage) C-PAN in other lesions. Analyses of the longitudinal sections showed focal and segmental arteritis. Patients overall improved well with compression stockings, anti-inflammatory agents, a prostaglandin analog and antiplatelet agents. Currently, three patients are medication free and only require compression stockings.
CONCLUSION
LTA/MA seems to be part of the spectrum of C-PAN. The vasculitic lesions of C-PAN are segmental and focal, and coexist in different stages. As the chronic stage of C-PAN can be mistaken as LTA/MA, it is necessary to perform multiple biopsies, serial sections and analyses of longitudinal sections to confirm the main finding of vasculitis.
Topics: Adolescent; Adult; Aged; Arteritis; Female; Humans; Male; Middle Aged; Polyarteritis Nodosa; Retrospective Studies; Skin Diseases; Young Adult
PubMed: 27592619
DOI: 10.1111/cup.12809