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JAMA Internal Medicine Oct 2020Current clinical guidelines recommend selecting diagnostic tests for giant cell arteritis (GCA) based on pretest probability that the disease is present, but how pretest... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Current clinical guidelines recommend selecting diagnostic tests for giant cell arteritis (GCA) based on pretest probability that the disease is present, but how pretest probability should be estimated remains unclear.
OBJECTIVE
To evaluate the diagnostic accuracy of symptoms, physical signs, and laboratory tests for suspected GCA.
DATA SOURCES
PubMed, EMBASE, and the Cochrane Database of Systematic Reviews were searched from November 1940 through April 5, 2020.
STUDY SELECTION
Trials and observational studies describing patients with suspected GCA, using an appropriate reference standard for GCA (temporal artery biopsy, imaging test, or clinical diagnosis), and with available data for at least 1 symptom, physical sign, or laboratory test.
DATA EXTRACTION AND SYNTHESIS
Screening, full text review, quality assessment, and data extraction by 2 investigators. Diagnostic test meta-analysis used a bivariate model.
MAIN OUTCOME(S) AND MEASURES
Diagnostic accuracy parameters, including positive and negative likelihood ratios (LRs).
RESULTS
In 68 unique studies (14 037 unique patients with suspected GCA; of 7798 patients with sex reported, 5193 were women [66.6%]), findings associated with a diagnosis of GCA included limb claudication (positive LR, 6.01; 95% CI, 1.38-26.16), jaw claudication (positive LR, 4.90; 95% CI, 3.74-6.41), temporal artery thickening (positive LR, 4.70; 95% CI, 2.65-8.33), temporal artery loss of pulse (positive LR, 3.25; 95% CI, 2.49-4.23), platelet count of greater than 400 × 103/μL (positive LR, 3.75; 95% CI, 2.12-6.64), temporal tenderness (positive LR, 3.14; 95% CI, 1.14-8.65), and erythrocyte sedimentation rate greater than 100 mm/h (positive LR, 3.11; 95% CI, 1.43-6.78). Findings that were associated with absence of GCA included the absence of erythrocyte sedimentation rate of greater than 40 mm/h (negative LR, 0.18; 95% CI, 0.08-0.44), absence of C-reactive protein level of 2.5 mg/dL or more (negative LR, 0.38; 95% CI, 0.25-0.59), and absence of age over 70 years (negative LR, 0.48; 95% CI, 0.27-0.86).
CONCLUSIONS AND RELEVANCE
This study identifies the clinical and laboratory features that are most informative for a diagnosis of GCA, although no single feature was strong enough to confirm or refute the diagnosis if taken alone. Combinations of these symptoms might help direct further investigation, such as vascular imaging, temporal artery biopsy, or seeking evaluation for alternative diagnoses.
Topics: Biopsy; Blood Sedimentation; Clinical Laboratory Techniques; Giant Cell Arteritis; Humans; Physical Examination; Positron-Emission Tomography; Temporal Arteries; Ultrasonography
PubMed: 32804186
DOI: 10.1001/jamainternmed.2020.3050 -
Ugeskrift For Laeger Nov 2023Cranial and large vessel giant cell arteritis is a systemic vasculitis frequently found in Denmark. In recent years, considerable new knowledge has been gained in the... (Review)
Review
Cranial and large vessel giant cell arteritis is a systemic vasculitis frequently found in Denmark. In recent years, considerable new knowledge has been gained in the field of diagnostics and treatment of giant cell arteritis. In this review, the clinical and radiological findings, treatment options and effect and side effects of treatment with tocilizumab are reviewed in a Danish context.
Topics: Humans; Giant Cell Arteritis
PubMed: 37987451
DOI: No ID Found -
Deutsches Arzteblatt International Jun 2022Polymyalgia rheumatica (PMR) is among the most common inflammatory rheumatic diseases in older adults. Presumed risk factors include female sex, previous infections, and... (Review)
Review
BACKGROUND
Polymyalgia rheumatica (PMR) is among the most common inflammatory rheumatic diseases in older adults. Presumed risk factors include female sex, previous infections, and genetic factors. No epidemiological data on PMR in Germany have been available until now.
METHODS
This review is based on publications retrieved by a selective literature search in PubMed. Moreover, the administrative incidence and prevalence of PMR in the years 2011-2019 was determined from data of the AOK Baden-Württemberg statutory health insurance carrier for insurees aged 40 and older. In addition, we quantified the number of consultations with physicians involved in the diagnosis.
RESULTS
The annual age- and sex-standardized incidence and prevalence of PMR from 2011 to 2019 were 18.6/100 000 persons and 138.8/100 000 persons, respectively. The incidence was higher in women than in men (21.8/100 000 vs. 12.8/100 000 persons per year). 60% of the cases were diagnosed in primary care practices. The treatment of PMR with orally administered glucocorticoids usually results in a treatment response within a few days to weeks. Approximately 43% of patients experience recurrent symptoms within a year, requiring adjustment of the glucocorticoid dose. For older patients with impaired physical ability, additional non-pharmacological treatment with exercise programs plays an important role.
CONCLUSION
PMR usually takes an uncomplicated course under treatment and can be managed in primary care, but these patients are often multimorbid and require frequent follow-up. Along with research on the etiology of the disease, further studies are needed to identify the risk factors for a chronic course and to evaluate the potential effects of non-pharmacological measures.
Topics: Adult; Aged; Female; Giant Cell Arteritis; Glucocorticoids; Humans; Incidence; Male; Middle Aged; Polymyalgia Rheumatica; Prevalence
PubMed: 35635433
DOI: 10.3238/arztebl.m2022.0218 -
Annual Review of Medicine Jan 2024Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are large-vessel vasculitides affecting the aorta and its branches. Arterial damage from these diseases may... (Review)
Review
Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are large-vessel vasculitides affecting the aorta and its branches. Arterial damage from these diseases may result in ischemic complications, aneurysms, and dissections. Despite their similarities, the management of GCA and TAK differs. Glucocorticoids are used frequently but relapses are common, and glucocorticoid toxicity contributes to significant morbidity. Conventional immunosuppressive therapies can be beneficial in TAK, though their role in the management of GCA remains unclear. Tumor necrosis factor inhibitors improve remission rates and appear to limit vascular damage in TAK; these agents are not beneficial in GCA. Tocilizumab is the first biologic glucocorticoid-sparing agent approved for use in GCA and also appears to be effective in TAK. A better understanding of the pathogenesis of both conditions and the availability of targeted therapies hold much promise for future management.
Topics: Humans; Glucocorticoids; Giant Cell Arteritis; Takayasu Arteritis
PubMed: 37683286
DOI: 10.1146/annurev-med-060622-100940 -
La Tunisie Medicale May 2023Takayasu's Arteritis (TA) is a systemic vasculitis affecting the aorta and its main branches.
INTRODUCTION
Takayasu's Arteritis (TA) is a systemic vasculitis affecting the aorta and its main branches.
AIM
To describe the epidemiological, diagnostic, therapeutic and prognostic profile of TA in the referral departments of internal medicine in the Sousse region (Tunisia).
METHODS
This is a descriptive, retrospective and exhaustive study, carried out in the two departments of Internal Medicine of Sousse. Patients followed for AT, from 1996 to 2020 were included. The disease was defined according to the classification criteria of the American College of Rheumatology. Disease activity was assessed according to NIH criteria. Age referred to the date of diagnosis.
RESULTS
The study population consisted of 40 patients (Sahloul: n=32, Hached: n=8) with a sex ratio=0.17 and a median age=35 years (IIQ=[30-41]). The median diagnostic delay was 5 months (IIQ=[2-14]). The main clinical sign was pulse abolition and/or decrease (78%). Aortic stenosis was the main arterial lesion found (98%). Treatment was based on corticosteroids (95%) and immunosuppressants (42%). The prognosis of TA was often active (62%), with vascular co-morbidity (60%) and iatrogenic complications (35%).
CONCLUSION
The epidemiological-clinical profile of AT in the region of Sousse (Tunisia) was characterized by a female predominance, a diagnostic delay, a clinical polymorphism, and evolution towards vascular co-morbidities.
Topics: Humans; Female; Adult; Male; Takayasu Arteritis; Retrospective Studies; Tunisia; Delayed Diagnosis; Prognosis
PubMed: 38372522
DOI: No ID Found -
Annals of the Rheumatic Diseases Mar 2023Recent large-scale randomised trials demonstrate that immunomodulators reduce cardiovascular (CV) events among the general population. However, it is uncertain whether... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Recent large-scale randomised trials demonstrate that immunomodulators reduce cardiovascular (CV) events among the general population. However, it is uncertain whether these effects apply to rheumatoid arthritis (RA) and if certain treatment strategies in RA reduce CV risk to a greater extent.
METHODS
Patients with active RA despite use of methotrexate were randomly assigned to addition of a tumour necrosis factor (TNF) inhibitor (TNFi) or addition of sulfasalazine and hydroxychloroquine (triple therapy) for 24 weeks. Baseline and follow-up F-fluorodeoxyglucose-positron emission tomography/CT scans were assessed for change in arterial inflammation, an index of CV risk, measured as an arterial target-to-background ratio (TBR) in the carotid arteries and aorta.
RESULTS
115 patients completed the protocol. The two treatment groups were well balanced with a median age of 58 years, 71% women, 57% seropositive and a baseline disease activity score in 28 joints of 4.8 (IQR 4.0, 5.6). Baseline TBR was similar across the two groups. Significant TBR reductions were observed in both groups-ΔTNFi: -0.24 (SD=0.51), Δtriple therapy: -0.19 (SD=0.51)-without difference between groups (difference in Δs: -0.02, 95% CI -0.19 to 0.15, p=0.79). While disease activity was significantly reduced across both treatment groups, there was no association with change in TBR (β=0.04, 95% CI -0.03 to 0.10).
CONCLUSION
We found that addition of either a TNFi or triple therapy resulted in clinically important improvements in vascular inflammation. However, the addition of a TNFi did not reduce arterial inflammation more than triple therapy.
TRIAL REGISTRATION NUMBER
NCT02374021.
Topics: Humans; Female; Middle Aged; Male; Antirheumatic Agents; Cardiovascular Diseases; Tumor Necrosis Factor-alpha; Risk Factors; Arthritis, Rheumatoid; Methotrexate; Immunologic Factors; Heart Disease Risk Factors; Arteritis; Treatment Outcome
PubMed: 36450449
DOI: 10.1136/ard-2022-223302 -
CMAJ : Canadian Medical Association... May 2023
Topics: Humans; Takayasu Arteritis; Patients
PubMed: 37127311
DOI: 10.1503/cmaj.230077-f -
Ugeskrift For Laeger Mar 2023
Topics: Humans; Giant Cell Arteritis; Scalp
PubMed: 36999299
DOI: No ID Found -
Clinical and Experimental Rheumatology Apr 2023Large-vessel vasculitides (LVVs) include giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Even if similar, these two entities differ in terms of treatment and... (Review)
Review
Large-vessel vasculitides (LVVs) include giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Even if similar, these two entities differ in terms of treatment and outcomes.High doses of glucocorticoids (GCs) are still the first choice for the treatment of both conditions. However, adjunctive therapies are recommended in selected patients in order to decrease the risk of relapse and the amount of side effects related to GCs. Tumour necrosis factor α inhibitors (TNFis) and tocilizumab (TCZ) are used for the treatment of LVVs, with some differences. In GCA, TCZ has been proved to be effective and safe in inducing remission with some open questions still remaining, whereas data about TNFis are scarce and non-conclusive. On the contrary, in TAK either TNFis or TCZ seem to be able to control symptoms and angiographic progression in refractory forms.However, their place in the management of treatment must still be clarified, and as a result the American College of Rheumatology and EULAR guidelines slightly differ in the recommendations about when and what treatment to start. Thus, the aim of this review is to look at the evidence on the use of TNFis and TCZ in LVVs, outlining the pros and cons of both therapies.
Topics: Humans; Tumor Necrosis Factor Inhibitors; Giant Cell Arteritis; Glucocorticoids; Antibodies, Monoclonal, Humanized; Takayasu Arteritis
PubMed: 37073638
DOI: 10.55563/clinexprheumatol/cj4ea8 -
The Pan African Medical Journal 2017Cannabis is the most consumed psychoactive substance by young people. Chronic use of cannabis can lead to cannabis arteritis, which is a very rare peripheral vascular...
Cannabis is the most consumed psychoactive substance by young people. Chronic use of cannabis can lead to cannabis arteritis, which is a very rare peripheral vascular disease similar to Buerger's disease. It is affecting young adults, especially men, consuming cannabis. A 27-year old woman, with no particular past medical history except for long-term use of cannabis and tobacco developed a digital necrosis in the left hand. She denied using other illicit drugs. Doppler ultrasound examination of the upper limbs was unremarkable. Toxicological analysis revealed the presence of cannabis in both biological fluid and hair strand. Despite medical treatment, cessation of the cannabis and tobacco consumption and hyperbaric oxygen therapy, an amputation of necrotic parts was then required. This case shows the prolonged use of cannabis could be a risk factor for young adult arteritis. Faced with a rapidly progressive arteritis occurring in young adult, the physician should consider the history of use of cannabis. Hair analysis can be useful for confirmation of the chronic consumption of drugs.
Topics: Adult; Amputation, Surgical; Arteritis; Female; Humans; Hyperbaric Oxygenation; Marijuana Abuse; Necrosis; Risk Factors
PubMed: 28451030
DOI: 10.11604/pamj.2017.26.53.11694