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Brazilian Journal of Cardiovascular... Aug 2019The roles that aortitis plays in the development of annuloaortic ectasia (AAE) remain uncertain, while clinical features of AAE in arteritis are largely unknown. This... (Review)
Review
The roles that aortitis plays in the development of annuloaortic ectasia (AAE) remain uncertain, while clinical features of AAE in arteritis are largely unknown. This study was designed to highlight the clinical features of AAE, the treatments of choice, and the causative relations between aortitis and AAE. The morphology of the aortic valve leaflets was normal in half of the patients, while the valves were thin and overstretched in the other half. Most patients had an aortic aneurysm. Half of the patients had severe aortic valve insufficiency, and one-quarter of them had dilation of the sinuses of Valsalva. Takayasu arteritis was prone to develop coronary artery lesions, whereas giant cell arteritis were not. Aortic branch lesions in Takayasu arteritis were stenotic or occlusive in 92.9% of the patients, while in giant cell arteritis, they were all dilated lesions. Most patients (94.7%) required surgical treatment with steroid therapy. However, long-term follow-up results showed a higher anastomotic dehiscence rate, particularly in patients with Takayasu arteritis. Further morphometric and pathological research on AAE in arteritis should be undertaken, and more feasible measures should be warranted for preventing postoperative anastomotic dehiscence.
Topics: Aortic Aneurysm, Thoracic; Giant Cell Arteritis; Humans; Postoperative Complications; Takayasu Arteritis
PubMed: 31454202
DOI: 10.21470/1678-9741-2018-0252 -
Seminars in Arthritis and Rheumatism Oct 2020Takayasu arteritis (TAK) is a chronic inflammatory vasculitis of unknown origin affecting large vessels, predominantly the aorta and its main branches. TAK usually... (Review)
Review
Takayasu arteritis (TAK) is a chronic inflammatory vasculitis of unknown origin affecting large vessels, predominantly the aorta and its main branches. TAK usually affects young women and the management of pregnancy during this vasculitis may be a challenging situation. After a review of the literature, we analysed the data of 505 pregnancies in 373 TAK patients. We discuss main results to clarify if the pregnancy outcome is affected by TAK, especially during disease clinical onset or disease activity. We also discuss the potential impact of pregnancy on TAK prognosis. Disease activity of TAK appears independently associated with a poor pregnancy outcome. More than 5% of pregnant women with TAK develop a life-threatening maternal cardiovascular complication. A good control of TAK disease activity and arterial hypertension before conception and during pregnancy is critical to improve both maternal and foetal outcomes. Pregnancies in the setting of TAK should be considered high-risk, requiring a close collaboration between specialists involved in the care of TAK and obstetricians.
Topics: Aorta; Female; Humans; Hypertension; Pregnancy; Pregnancy Outcome; Prognosis; Takayasu Arteritis
PubMed: 32911287
DOI: 10.1016/j.semarthrit.2020.08.001 -
Frontiers in Immunology 2022Vasculitis is an inflammation of the blood vessels caused by autoimmunity and/or autoinflammation, and recent advances in research have led to a better understanding of... (Review)
Review
Vasculitis is an inflammation of the blood vessels caused by autoimmunity and/or autoinflammation, and recent advances in research have led to a better understanding of its pathogenesis. Glucocorticoids and cyclophosphamide have long been the standard of care. However, B-cell depletion therapy with rituximab has become available for treating antineutrophil cytoplasmic antibody-associated vasculitis (AAV). More recently, avacopan, an inhibitor of the complement 5a receptor, was shown to have high efficacy in remission induction against AAV. Thus, treatment options for AAV have been expanded. In contrast, in large vessel vasculitis (LVV), including giant cell arteritis and Takayasu arteritis, tocilizumab, an IL-6 receptor antagonist, was shown to be effective in suppressing relapse and has steroid-sparing effects. However, the relapse rate remains high, and other therapeutic options have long been awaited. In the last decade, Janus kinase (JAK) inhibitors have emerged as therapeutic options for rheumatoid arthritis (RA). Their efficacy has been proven in multiple studies; thus, JAK inhibitors are expected to be promising agents for treating other rheumatic diseases, including LVV. This mini-review briefly introduces the mechanism of action of JAK inhibitors and their efficacy in patients with RA. Then, the pathophysiology of LVV is updated, and a rationale for treating LVV with JAK inhibitors is provided with a brief introduction of our preliminary results using a mouse model. Finally, we discuss the newly raised safety concerns regarding JAK inhibitors and future perspectives for treating LVV.
Topics: Arteritis; Giant Cell Arteritis; Humans; Janus Kinase Inhibitors; Recurrence; Takayasu Arteritis
PubMed: 35432355
DOI: 10.3389/fimmu.2022.881705 -
Asia-Pacific Journal of Ophthalmology...Giant cell arteritis and Takayasu arteritis are large-vessel vasculitides that share multiple common features but also have significant differences in epidemiology,... (Review)
Review
Giant cell arteritis and Takayasu arteritis are large-vessel vasculitides that share multiple common features but also have significant differences in epidemiology, demographics, clinical presentation, evaluation, and treatment. Giant cell arteritis is more common in elderly patients of Caucasian descent versus Takayasu arteritis, which is more prevalent in younger patients of Asian descent. Although traditionally age has been the main criterion for differentiating the 2 etiologies, modifications in the diagnostic criteria have recognized the overlap between the 2 conditions. In this monograph, we review the diagnostic criteria for both conditions and describe the epidemiology, pathogenesis, histology, evaluation, and management for large-vessel vasculitis in ophthalmology. Additionally, we describe ocular imaging techniques that may be utilized by ophthalmologists to identify manifestations of large-vessel vasculiti- des in patients. Lastly, we compare and contrast the key clinical, laboratory, and pathologic features that might help ophthalmologists to differentiate the 2 entities.
Topics: Aged; Giant Cell Arteritis; Humans; Ophthalmology; Takayasu Arteritis
PubMed: 35533336
DOI: 10.1097/APO.0000000000000514 -
The Veterinary Clinics of North... Aug 1993Equine viral arteritis is an infrequently encountered contagious viral disease of equids that has assumed increased veterinary medical and economic significance since... (Review)
Review
Equine viral arteritis is an infrequently encountered contagious viral disease of equids that has assumed increased veterinary medical and economic significance since the 1984 epidemic in Thoroughbreds in Kentucky. The most important consequences of this infection are abortion in the mare and establishment of the carrier state in the stallion. Equine arteritis virus becomes localized in the reproductive tract of a relatively high percentage of infected stallions which serve as very efficient transmitters of the infection through direct or indirect venereal contact with susceptible mares. The long-term persistently infected stallion appears to play a major epidemiologic role in the dissemination and perpetuation of the virus in horse populations throughout the world. Aspects of the pathogenesis, immunity, and epidemiology of equine arteritis virus are discussed in relation to current methods for the diagnosis, treatment, and control of this disease.
Topics: Animals; Arteritis; Carrier State; Equartevirus; Female; Horse Diseases; Horses; Male; Virus Diseases
PubMed: 8395325
DOI: 10.1016/s0749-0739(17)30397-8 -
Best Practice & Research. Clinical... Feb 2018The prognosis of ANCA-associated vasculitis has been transformed in recent years. Once it was a set of invariably acute and fatal conditions, but these disorders are... (Review)
Review
The prognosis of ANCA-associated vasculitis has been transformed in recent years. Once it was a set of invariably acute and fatal conditions, but these disorders are currently considered to be chronic diseases. This change is largely attributable to earlier diagnosis and the careful application of immunotherapeutics. However, patients still experience premature mortality, relapse, comorbid ill health and poor quality of life. Mortality rates in large-vessel vasculitis are not comparable; however, morbidity and poor patient outcomes prevail. Toxicity secondary to glucocorticoids represents a common driver of poor outcomes across systemic vasculitis. The main thrust of future treatment strategies is to reduce if not eliminate exposure to these agents.
Topics: Giant Cell Arteritis; Humans; Prognosis; Quality of Life; Systemic Vasculitis; Takayasu Arteritis
PubMed: 30526894
DOI: 10.1016/j.berh.2018.08.011 -
Clinical Immunology (Orlando, Fla.) Sep 2019Giant cell arteritis and Takayasu arteritis are autoimmune vasculitides that cause aneurysm formation and tissue infarction. Extravascular inflammation consists of an... (Review)
Review
Giant cell arteritis and Takayasu arteritis are autoimmune vasculitides that cause aneurysm formation and tissue infarction. Extravascular inflammation consists of an intense acute phase response. Deeper understanding of pathogenic events in the vessel wall has highlighted the loss of tissue protective mechanisms, the intrusion of immune cells into "forbidden territory", and the autonomy of self-renewing vasculitic infiltrates. Adventitial vasa vasora critically control vessel wall access and drive differentiation of tissue-invasive T cells. Selected T cells establish tissue residency and build autonomous, self-sufficient inflammatory lesions. Pathogenic effector T cells intrude and survive due to failed immune checkpoint inhibition. Vasculitis-sustaining T cells and macrophages provide a broad portfolio of effector functions, involving heterogeneous populations of pro-inflammatory T cells and diverse macrophage subsets that ultimately induce wall capillarization and intimal hyperplasia. Redirecting diagnostic and therapeutic strategies from control of extravascular inflammatory markers to suppression of vascular inflammation will improve disease management.
Topics: Anti-Inflammatory Agents; Cytokines; Giant Cell Arteritis; Humans; Intercellular Signaling Peptides and Proteins; Peptide Hydrolases; Takayasu Arteritis
PubMed: 30772599
DOI: 10.1016/j.clim.2019.02.007 -
Giant Cell Arteritis: Advances in Understanding Pathogenesis and Implications for Clinical Practice.Cells Jan 2024Giant cell arteritis (GCA) is a noninfectious granulomatous vasculitis of unknown etiology affecting individuals older than 50 years. Two forms of GCA have been... (Review)
Review
Giant cell arteritis (GCA) is a noninfectious granulomatous vasculitis of unknown etiology affecting individuals older than 50 years. Two forms of GCA have been identified: a cranial form involving the medium-caliber temporal artery causing temporal arteritis (TA) and an extracranial form involving the large vessels, mainly the thoracic aorta and its branches. GCA generally affects individuals with a genetic predisposition, but several epigenetic (micro)environmental factors are often critical for the onset of this vasculitis. A key role in the pathogenesis of GCA is played by cells of both the innate and adaptive immune systems, which contribute to the formation of granulomas that may include giant cells, a hallmark of the disease, and arterial tertiary follicular organs. Cells of the vessel wall cells, including vascular smooth muscle cells (VSMCs) and endothelial cells, actively contribute to vascular remodeling responsible for vascular stenosis and ischemic complications. This review will discuss new insights into the molecular and cellular pathogenetic mechanisms of GCA, as well as the implications of these findings for the development of new diagnostic biomarkers and targeted drugs that could hopefully replace glucocorticoids (GCs), still the backbone of therapy for this vasculitis.
Topics: Humans; Giant Cell Arteritis; Endothelial Cells; Glucocorticoids
PubMed: 38334659
DOI: 10.3390/cells13030267 -
Polish Archives of Internal Medicine Jun 2022Large vessel vasculitis (LVV), including Takayasu arteritis (TAK) and giant cell arteritis (GCA), causes granulomatous vascular inflammation mainly in large vessels, and...
Large vessel vasculitis (LVV), including Takayasu arteritis (TAK) and giant cell arteritis (GCA), causes granulomatous vascular inflammation mainly in large vessels, and is the most common primary vasculitis in adults. Vascular inflammation may evoke many clinical features including vision impairment, stroke, limb ischemia, and aortic aneurysms. The best way to diagnose LVV is to combine medical history, physical examination, various laboratory tests, and imaging modalities. Progress in imaging modalities facilitated early diagnosis and follow‑up of the disease activity. Conventional angiography is no longer the gold standard for the diagnosis of TAK. Similarly, temporal artery biopsy is no longer the only tool for diagnosing cranial GCA. In selected cases, color Doppler ultrasound may be used for this purpose. Despite some similarities, TAK and GCA differ in many aspects and they are different diseases. They also have different clinical subtypes. The presence of aortitis does not always implicate the diagnosis of TAK or GCA; infectious aortitis, as well as noninfectious aortitis associated with other autoimmune rheumatic diseases should be excluded. Treatment of LVV includes glucocorticoids (GCs), conventional immunosuppressive agents, and biological drugs. Tumor necrosis factor inhibitors are ineffective in GCA but effective in TAK. On the other hand, tocilizumab may be used to treat both diseases. Promising targeted therapies evaluated in ongoing clinical trials include, for example, anti‑IL‑12/23 (ustekinumab), anti‑IL‑17 (secukinumab), anti‑IL‑1 (anakinra), anti‑IL‑23 (guselkumab), anti‑cytotoxic T‑lymphocyte antigen 4 (abatacept), Janus kinase inhibitors (tofacitinib and upadacitinib), anti‑granulocyte / macrophage colony‑stimulating factor (mavrilimumab), and endothelin receptor (bosentan) therapies.
Topics: Adult; Aortitis; Giant Cell Arteritis; Glucocorticoids; Humans; Inflammation; Takayasu Arteritis
PubMed: 35699647
DOI: 10.20452/pamw.16272 -
Anales de Pediatria (Barcelona, Spain :... Mar 2003Takayasu's arteritis is a rare vasculitis in the pediatric population that affects the aorta and its branches. There are few studies with an appropriate number of...
BACKGROUND
Takayasu's arteritis is a rare vasculitis in the pediatric population that affects the aorta and its branches. There are few studies with an appropriate number of patients and follow-up.
OBJECTIVE
To describe the clinical manifestations, laboratory alterations, radiological findings, and treatment in eight children and adolescents with Takayasu's arteritis.
METHODS
A retrospective analysis of patients' records from 1990 to 2001 was performed.
RESULTS
There were six girls and two boys. The mean age at disease onset was five years and five months. The most common clinical manifestations were systemic findings and cardiovascular, dermatological and neurological abnormalities. In all patients inflammatory activity was high and in three patients the Mantoux test was strongly positive. The most common radiological findings were type IV and V. Treatment included steroids, methotrexate, cyclophosphamide, intravenous gamma globulin, and vascular surgery. Three patients presented sequelae.
CONCLUSIONS
Takayasu's arteritis produces considerable morbidity and mortality. To make an early diagnosis, pediatricians should be aware of inflammatory systemic manifestations and cardiovascular abnormalities. To gain further knowledge of this entity prospective and ideally multicenter studies are required.
Topics: Child; Child, Preschool; Female; Humans; Infant; Male; Retrospective Studies; Takayasu Arteritis
PubMed: 12628090
DOI: No ID Found