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Clinical and Experimental Rheumatology 2020
Topics: Giant Cell Arteritis; Humans; Skull; Temporal Arteries
PubMed: 32301431
DOI: No ID Found -
Neurology India 2021
Topics: Arteritis; Brain Injuries; Giant Cell Arteritis; Humans; Infarction; Vascular Diseases
PubMed: 34507475
DOI: 10.4103/0028-3886.325359 -
Scientific Reports Nov 2020Giant cell arteritis (GCA, also called temporal arteritis) is a rare and Takayasu arteritis (TA) is an even rarer autoimmune disease (AID), both of which present with...
Giant cell arteritis (GCA, also called temporal arteritis) is a rare and Takayasu arteritis (TA) is an even rarer autoimmune disease (AID), both of which present with inflammatory vasculitis of large and medium size arteries. The risk factors are largely undefined but disease susceptibility has been associated with human leukocyte antigen locus. Population-level familial risk is not known. In the present nation-wide study we describe familial risk for GCA and for GCA and TA with any other AID based on the Swedish hospital diagnoses up to years 2012. Family relationships were obtained from the Multigeneration Register. Familial standardized incidence ratios (SIRs) were calculated for offspring whose parents or siblings were diagnosed with GCA, TA or any other AID. The number of GCA patients in the offspring generation was 4695, compared to 209 TA patients; for both, familial patients accounted for 1% of all patients. The familial risk for GCA was 2.14, 2.40 for women and non-significant for men. GCA was associated with 10 other AIDs and TA was associated with 6 other AIDs; both shared associations with polymyalgia rheumatica and rheumatoid arthritis. The results showed that family history is a risk factor for GCA. Significant familial associations of both GCA and TA with such a number of other AIDs provide evidence for polyautoimmunity among these diseases.
Topics: Arthritis, Rheumatoid; Autoimmune Diseases; Family; Female; Genetic Predisposition to Disease; Giant Cell Arteritis; Humans; Male; Medical History Taking; Polymyalgia Rheumatica; Risk; Sweden; Takayasu Arteritis
PubMed: 33257751
DOI: 10.1038/s41598-020-77857-7 -
Journal of the American College of... Jan 2023
Topics: Humans; Takayasu Arteritis; Angioplasty, Balloon; Treatment Outcome; Stents
PubMed: 36599611
DOI: 10.1016/j.jacc.2022.11.009 -
Current Opinion in Rheumatology May 2020Giant cell arteritis (GCA) has classically been diagnosed by temporal artery biopsy and treated with high-dose, long-term glucocorticoid therapy. Noninvasive imaging... (Review)
Review
PURPOSE OF REVIEW
Giant cell arteritis (GCA) has classically been diagnosed by temporal artery biopsy and treated with high-dose, long-term glucocorticoid therapy. Noninvasive imaging increasingly is employed for diagnostic purposes, but further studies are needed to determine the role of imaging in monitoring longitudinal disease activity. Glucocorticoid-sparing therapy mitigates the numerous adverse effects of glucocorticoids. This review addresses new developments in these areas.
RECENT FINDINGS
For diagnosis, when performed at a center with expertise in its use, temporal artery ultrasound has an estimated sensitivity and specificity of 78 and 79%, respectively. State-of-the-art time-of-flight positron emission tomography/computed tomography (PET/CT) has an estimated sensitivity and specificity of 71 and 91%, respectively. The sensitivities of both imaging modalities decrease following glucocorticoid administration. Tocilizumab is an effective glucocorticoid-sparing therapy, demonstrating sustained glucocorticoid-free remission in 56% of patients receiving weekly tocilizumab compared with 18% of patients receiving a 52-week prednisone taper. The traditional acute phase reactants are of no value in patients treated with interleukin-6 receptor (IL6-R) blockade, and thus, the development of new biomarkers is an important priority in the field.
SUMMARY
Noninvasive imaging techniques are increasingly used in the absence of temporal artery biopsy to confirm diagnostic suspicions of GCA. Tocilizumab reduces the cumulative glucocorticoid exposure and increases the rate of sustained remission. Ongoing efforts are directed towards new methods to identify disease flares.
Topics: Antibodies, Monoclonal, Humanized; Biopsy; Giant Cell Arteritis; Glucocorticoids; Humans; Positron Emission Tomography Computed Tomography; Prednisone; Sensitivity and Specificity; Temporal Arteries
PubMed: 32168069
DOI: 10.1097/BOR.0000000000000700 -
The Journal of Rheumatology Dec 2015The rarity of large vessel vasculitis (LVV) is a major factor limiting randomized controlled trials in LVV, resulting in treatment choices in these diseases that are... (Review)
Review
OBJECTIVE
The rarity of large vessel vasculitis (LVV) is a major factor limiting randomized controlled trials in LVV, resulting in treatment choices in these diseases that are guided mainly by observational studies and expert opinion. Further complicating trials in LVV is the absence of validated and meaningful outcome measures. The Outcome Measures in Rheumatology (OMERACT) vasculitis working group initiated the Large Vessel Vasculitis task force in 2009 to develop data-driven, validated outcome tools for clinical investigation in LVV. This report summarizes the progress that has been made on a disease activity assessment tool and patient-reported outcomes in LVV as well as the group's research agenda.
METHODS
The OMERACT LVV task force brought an international group of investigators and patient research partners together to work collaboratively on developing outcome tools. The group initially focused on disease activity assessment tools in LVV. Following a systematic literature review, an international Delphi exercise was conducted to obtain expert opinion on principles and domains for disease assessment. The OMERACT vasculitis working group's LVV task force is also conducting qualitative research with patients, including interviews, focus groups, and engaging patients as research partners, all to ensure that the approach to disease assessment includes measures of patients' perspectives and that patients have input into the research agenda and process.
RESULTS
The preliminary results of both the Delphi exercise and the qualitative interviews were discussed at the OMERACT 12 (2014) meeting and the completion of the analyses will produce an initial set of domains and instruments to form the basis of next steps in the research agenda.
CONCLUSION
The research agenda continues to evolve, with the ultimate goal of developing an OMERACT-endorsed core set of outcome measures for use in clinical trials of LVV.
Topics: Consensus Development Conferences as Topic; Delphi Technique; Female; Focus Groups; Giant Cell Arteritis; Humans; Male; Outcome Assessment, Health Care; Practice Guidelines as Topic; Qualitative Research; Radiography; Severity of Illness Index; Takayasu Arteritis; Vasculitis
PubMed: 26077399
DOI: 10.3899/jrheum.141144 -
Clinical and Experimental Rheumatology 2020Epidemiologic studies differ regarding overall survival in giant cell arteritis (GCA). In this review we evaluated longevity and the impact of several disease parameters... (Review)
Review
OBJECTIVES
Epidemiologic studies differ regarding overall survival in giant cell arteritis (GCA). In this review we evaluated longevity and the impact of several disease parameters on survival of GCA patients.
METHODS
Review of the medical literature during the period 1975-2018, using PubMed database.
RESULTS
Epidemiologic studies addressing the issue of survival in GCA patients used variable methods of calculating mortality rates in relation to background population or in relation to selected controls. Several epidemiologic studies found that survival of GCA patients was similar to that of the general population. Others reported increased mortality in patients with GCA, or in subgroups of GCA patients. 5-Year and 10-year survival rates differed considerably among studies: 5-year survival rates ranged between 60-90% (except for 2 extremes of 35% and 97%), and 10-year survival rates ranged between 48-81%. Reasons for these discrepancies are unclear, and may be related to differences in populations, in the period of the study, and in study methods. Several studies found that mortality was increased in female GCA patients, and some reported increased mortality early in the course of the disease (mostly within the first 2 years after diagnosis). The deleterious effect of vision loss on survival was noted in a few studies, although most studies did not address the issue of mortality in this particular subgroup of GCA patients.
CONCLUSIONS
Epidemiologic studies varied considerably in the reported outcomes of GCA patients: some found that the overall survival was similar to that of the general population while others reported increased mortality in GCA or in subgroups of GCA patients.
Topics: Databases, Factual; Female; Giant Cell Arteritis; Humans; Survival Rate
PubMed: 31969222
DOI: No ID Found -
Expert Review of Clinical Immunology Oct 2016
Topics: Aorta; Biomarkers; Giant Cell Arteritis; Humans; Practice Guidelines as Topic; Takayasu Arteritis
PubMed: 27551980
DOI: 10.1080/1744666X.2016.1224180 -
Frontiers in Immunology 2023Proteome analyses in patients with newly diagnosed, untreated giant cell arteritis (GCA) have not been reported previously, nor are changes of protein expression upon...
OBJECTIVE
Proteome analyses in patients with newly diagnosed, untreated giant cell arteritis (GCA) have not been reported previously, nor are changes of protein expression upon treatment with glucocorticoids (GC) and/or tocilizumab (TCZ) known. The GUSTO trial allows to address these questions, provides the opportunity to learn about the differential effects of GC and TCZ on proteomics and may help to identify serum proteins to monitor disease activity.
METHODS
Serum samples obtained from 16 patients with new-onset GCA at different time points (day 0, 3, 10, and week 4, 24, 52) during the GUSTO trial (NCT03745586) were examined for 1436 differentially expressed proteins (DEPs) based on proximity extension assay technology. The patients received 500 mg methylprednisolone intravenously for 3 consecutive days followed by TCZ monotherapy.
RESULTS
When comparing day 0 (before the first GC infusion) with week 52 (lasting remission), 434 DEPs (213↑, 221↓) were identified. In response to treatment, the majority of changes occurred within 10 days. GC inversely regulated 25 proteins compared to remission. No difference was observed between weeks 24 and 52 during established remission and ongoing TCZ treatment. Expression of CCL7, MMP12, and CXCL9 was not regulated by IL6.
CONCLUSION
Disease-regulated serum proteins improved within 10 days and were normalized within 24 weeks, showing a kinetic corresponding to the gradual achievement of clinical remission. The proteins inversely regulated by GC and TCZ shed light on the differential effects of the two drugs. CCL7, CXCL9, and MMP12 are biomarkers that reflect disease activity despite normalized C-reactive protein levels.
Topics: Giant Cell Arteritis; Humans; Proteomics; Glucocorticoids
PubMed: 37287970
DOI: 10.3389/fimmu.2023.1165758 -
BMC Pediatrics Jan 2022Stroke is a lethal complication of polyarteritis in children. Takayasu arteritis is a rare disease with an unknown etiology and is known to mainly affect young women. In...
BACKGROUND
Stroke is a lethal complication of polyarteritis in children. Takayasu arteritis is a rare disease with an unknown etiology and is known to mainly affect young women. In this report, we present the case of a Chinese boy diagnosed with TA results in stroke, originally presenting in the context of latent tuberculosis infection and then developing active tuberculosis.
CASE PRESENTATION
The patient was a 14-year-old child who developed a latent tuberculosis infection at age 5 after coming in close contact with his grandfather, who had tuberculosis. However, he did not receive any anti-tuberculosis medications at that time. At age 9, he was hospitalized for symptoms of "dizziness and headache" and was diagnosed with Takayasu arteritis and hypertension; however, tuberculosis was not diagnosed. Only antihypertensive drugs were administered without considering the possible pathogenic factors of tuberculosis infection. At age 14, he was rehospitalized for "fever and cough" and was diagnosed with active pulmonary tuberculosis as an analysis of his fiberoptic bronchoscopy sample using the Gene-Xpert assay was positive for Mycobacterium tuberculosis. However, after 2 months of taking oral anti-tuberculosis drugs, his blood pressure continued to rise, and he presented with numbness and weakness of the right limb and a deviation of the right side of his mouth. Computed tomography angiography of his head and neck revealed that the walls of the left subclavian artery and bilateral vertebral arteries were thickened, and the lumen was significantly narrowed. In a recent examination, magnetic resonance imaging and diffusion-weighted imaging of the head showed infarctions in the right basal ganglia area close to the left lateral ventricle. Our patient was treated with methotrexate, tocilizumab and glucocorticoids to control he continued active vasculitis.
CONCLUSIONS
The possible association of tuberculosis and Takayasu arteritis complicated by stroke needs to be considered, especially in children who had prior contact with a family member with tuberculosis infection. The temporal relationship between TA and infection with Mycobacterium tuberculosis in our patient suggests a compelling link that demands further investigation.
Topics: Adolescent; Angiography; Child; Child, Preschool; Computed Tomography Angiography; Female; Humans; Male; Stroke; Takayasu Arteritis; Tuberculosis
PubMed: 35057771
DOI: 10.1186/s12887-022-03125-4