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The standard model of particle physics is both incredibly successful and glaringly incomplete. Among the questions left open is the striking imbalance of matter and antimatter in the observable universe1, which inspires experiments to compare the fundamental properties of matter/antimatter conjugates with high precision2-5. Our experiments deal with direct investigations of the fundamental properties of protons and antiprotons, performing spectroscopy in advanced cryogenic Penning trap systems6. For instance, we previously compared the proton/antiproton magnetic moments with 1.5 parts per billion fractional precision7,8, which improved upon previous best measurements9 by a factor of greater than 3,000. Here we report on a new comparison of the proton/antiproton charge-to-mass ratios with a fractional uncertainty of 16 parts per trillion. Our result is based on the combination of four independent long-term studies, recorded in a total time span of 1.5 years. We use different measurement methods and experimental set-ups incorporating different systematic effects. The final result, [Formula: see text], is consistent with the fundamental charge-parity-time reversal invariance, and improves the precision of our previous best measurement6 by a factor of 4.3. The measurement tests the standard model at an energy scale of 1.96 × 10-27 gigaelectronvolts (confidence level 0.68), and improves ten coefficients of the standard model extension10. Our cyclotron clock study also constrains hypothetical interactions mediating violations of the clock weak equivalence principle (WEPcc) for antimatter to less than 1.8 × 10-7, and enables the first differential test of the WEPcc using antiprotons11. From this interpretation we constrain the differential WEPcc-violating coefficient to less than 0.030.
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Efficient cooling of trapped charged particles is essential to many fundamental physics experiments1,2, to high-precision metrology3,4 and to quantum technology5,6. Until now, sympathetic cooling has required close-range Coulomb interactions7,8, but there has been a sustained desire to bring laser-cooling techniques to particles in macroscopically separated traps5,9,10, extending quantum control techniques to previously inaccessible particles such as highly charged ions, molecular ions and antimatter. Here we demonstrate sympathetic cooling of a single proton using laser-cooled Be+ ions in spatially separated Penning traps. The traps are connected by a superconducting LC circuit that enables energy exchange over a distance of 9 cm. We also demonstrate the cooling of a resonant mode of a macroscopic LC circuit with laser-cooled ions and sympathetic cooling of an individually trapped proton, reaching temperatures far below the environmental temperature. Notably, as this technique uses only image-current interactions, it can be easily applied to an experiment with antiprotons1, facilitating improved precision in matter-antimatter comparisons11 and dark matter searches12,13.
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We demonstrate a new temperature record for image-current mediated sympathetic cooling of a single proton in a cryogenic Penning trap by laser-cooled ^{9}Be^{+}. An axial mode temperature of 170 mK is reached, which is a 15-fold improvement compared to the previous best value. Our cooling technique is applicable to any charged particle, so that the measurements presented here constitute a milestone toward the next generation of high-precision Penning-trap measurements with exotic particles.
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We demonstrate efficient subthermal cooling of the modified cyclotron mode of a single trapped antiproton and reach particle temperatures T_{+}=E_{+}/k_{B} below 200 mK in preparation times shorter than 500 s. This corresponds to the fastest resistive single-particle cyclotron cooling to subthermal temperatures ever demonstrated. By cooling trapped particles to such low energies, we demonstrate the detection of antiproton spin transitions with an error rate <0.000 023, more than 3 orders of magnitude better than in previous best experiments. This method has enormous impact on multi-Penning-trap experiments that measure magnetic moments with single nuclear spins for tests of matter and antimatter symmetry, high-precision mass spectrometry, and measurements of electron g factors bound to highly charged ions that test quantum electrodynamics and establish standards for magnetometry.
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OBJECTIVE: Interleukin-33 (IL-33) has been investigated as a mediator in the pathogenesis of fibrosis in lung, liver, and heart. There is accumulating evidence for the involvement of the IL-33/IL-33 receptor ST2L signalling pathway in systemic sclerosis (SSc). Little is known about the role of serum sST2 in SSc, which is the subject of the present investigation. METHOD: Serum levels of sST2 were measured in 49 patients with SSc, recruited prospectively between November 2017 and March 2019. Patients were divided into those with progressive and those with stable disease. Receiver operating characteristics (ROC) curve analysis was applied to study sST2 as a marker for identifying patients with progressive disease. We used multivariate logistic regression analysis to evaluate the predictive value of sST2 for progressive disease after adjustment for potential confounding factors. RESULTS: Serum sST2 levels in patients with progressive disease were significantly elevated compared with patients with stable disease (mean ± sem: 50.4 ± 4.7 ng/mL vs 29.2 ± 2.97 ng/mL, p < 0.001). ROC curve analysis identified an sST2 cut-off value of 37.8 ng/mL as optimal for discriminating patients with progressive disease from those with stable disease (sensitivity 80.0%, specificity 79.3%, area under the curve 0.80). After controlling for potential confounding factors (age, gender, C-reactive protein, pro-brain natriuretic peptide, and sum of internal medicine comorbidities), sST2 remained predictive of progressive disease (odds ratio 1.070, 95% confidence interval 1.017-1.126, p < 0.009). CONCLUSION: In the present study, sST2 serum levels were predictive of disease progression in patients with SSc.
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Interleucina-33 , Escleroderma Sistêmico , Biomarcadores , Progressão da Doença , Humanos , Proteína 1 Semelhante a Receptor de Interleucina-1 , Prognóstico , Curva ROC , Escleroderma Sistêmico/diagnósticoRESUMO
Rheumatology training is reorganized with the implementation of the revision of the training regulations for German physicians (MWBO) to become a specialist in internal medicine and rheumatology. This article focusses on novel aspects including far-reaching waiver of reference numbers, the professionally recommended training plan, the elogbook, the regulation of specific training periods and the requirement of reapplication for the training authorization in addition to the contents of training. These aspects involve direct consequences for trainees and trainers.
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Médicos , Reumatologia , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna/educação , Reumatologia/educação , EspecializaçãoRESUMO
This article focuses on the training situation of rheumatologists from the perspective of trainers regarding the existing and potentially increasing deficits of specialists for internal medicine and rheumatology. According to the new regulations defining the rheumatologist training, a substantial part of the training schedule is required to be completed in a hospital setting in order to become a specialist rheumatologist. In this context, the increased training capacity necessitates additional hospital training positions. In addition, the rheumatology residents desire a structured training program. Significantly, the work-life balance is an important factor to make working as a specialist for internal medicine and rheumatology more attractive.
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Reumatologia , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna , Reumatologistas , Reumatologia/educação , EspecializaçãoRESUMO
BACKGROUND: Water retention is a typical feature of acute inflammatory episodes, chiefly implemented by the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. This is an important compensatory mechanism counteracting expected water loss, e.g., due to sweating. Both the SNS and HPA axis are activated in polymyalgia rheumatica (PMR). As retention mechanisms may similarly apply in this disease, we hypothesized increased water retention in PMR. METHODS: Using bioimpedance analysis body composition was investigated in 64 healthy controls and 32 treatment-naive PMR patients. All PMR patients satisfied the 2012 EULAR/ACR classification criteria for PMR. 32 PMR patients were tested before and after 7 days of glucocorticoid-based therapy. Serum levels of pro-atrial natriuretic peptide (proANP) were investigated in all PMR patients and 15 healthy controls. RESULTS: Extracellular water (ECW) was markedly higher in PMR patients than in controls (mean⯱ SD: 49.1⯱ 6.0% versus 36.3⯱ 2.5% of total body water, pâ¯< 0.001). Patients with PMR demonstrated significantly higher serum levels of proANP compared to controls. Even before glucocorticoid treatment was initiated, systolic and diastolic blood pressure were higher in PMR patients compared to controls. Extracellular water levels did not change in PMR patients upon 7 days of intensified treatment. CONCLUSION: This study demonstrated increased extracellular water and elevated serum levels of proANP as signs of fluid overload in patients with PMR. Volume changes are imprinted as long-lasting mechanisms as water distribution is not affected by short-term anti-inflammatory therapy.
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Polimialgia Reumática , Fator Natriurético Atrial , Espaço Extracelular , Humanos , Sistema Hipotálamo-Hipofisário , Sistema Hipófise-Suprarrenal , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamento farmacológico , ÁguaRESUMO
In 2010 there were more than 200 million cases of malaria, and at least 655,000 deaths. The World Health Organization has recommended artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria caused by the parasite Plasmodium falciparum. Artemisinin is a sesquiterpene endoperoxide with potent antimalarial properties, produced by the plant Artemisia annua. However, the supply of plant-derived artemisinin is unstable, resulting in shortages and price fluctuations, complicating production planning by ACT manufacturers. A stable source of affordable artemisinin is required. Here we use synthetic biology to develop strains of Saccharomyces cerevisiae (baker's yeast) for high-yielding biological production of artemisinic acid, a precursor of artemisinin. Previous attempts to produce commercially relevant concentrations of artemisinic acid were unsuccessful, allowing production of only 1.6 grams per litre of artemisinic acid. Here we demonstrate the complete biosynthetic pathway, including the discovery of a plant dehydrogenase and a second cytochrome that provide an efficient biosynthetic route to artemisinic acid, with fermentation titres of 25 grams per litre of artemisinic acid. Furthermore, we have developed a practical, efficient and scalable chemical process for the conversion of artemisinic acid to artemisinin using a chemical source of singlet oxygen, thus avoiding the need for specialized photochemical equipment. The strains and processes described here form the basis of a viable industrial process for the production of semi-synthetic artemisinin to stabilize the supply of artemisinin for derivatization into active pharmaceutical ingredients (for example, artesunate) for incorporation into ACTs. Because all intellectual property rights have been provided free of charge, this technology has the potential to increase provision of first-line antimalarial treatments to the developing world at a reduced average annual price.
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Artemisininas/metabolismo , Artemisininas/provisão & distribuição , Vias Biossintéticas , Saccharomyces cerevisiae/metabolismo , Antimaláricos/economia , Antimaláricos/isolamento & purificação , Antimaláricos/metabolismo , Antimaláricos/provisão & distribuição , Artemisininas/química , Artemisininas/economia , Artemisininas/isolamento & purificação , Biotecnologia , Fermentação , Engenharia Genética , Malária Falciparum/tratamento farmacológico , Dados de Sequência Molecular , Saccharomyces cerevisiae/classificação , Saccharomyces cerevisiae/genética , Saccharomyces cerevisiae/crescimento & desenvolvimento , Oxigênio Singlete/metabolismoRESUMO
The goal of the ASACUSA-CUSP collaboration at the Antiproton Decelerator of CERN is to measure the ground-state hyperfine splitting of antihydrogen using an atomic spectroscopy beamline. A milestone was achieved in 2012 through the detection of 80 antihydrogen atoms 2.7 m away from their production region. This was the first observation of 'cold' antihydrogen in a magnetic field free region. In parallel to the progress on the antihydrogen production, the spectroscopy beamline was tested with a source of hydrogen. This led to a measurement at a relative precision of 2.7×10-9 which constitutes the most precise measurement of the hydrogen hyperfine splitting in a beam. Further measurements with an upgraded hydrogen apparatus are motivated by CPT and Lorentz violation tests in the framework of the Standard Model Extension. Unlike for hydrogen, the antihydrogen experiment is complicated by the difficulty of synthesizing enough cold antiatoms in the ground state. The first antihydrogen quantum states scan at the entrance of the spectroscopy apparatus was realized in 2016 and is presented here. The prospects for a ppm measurement are also discussed.This article is part of the Theo Murphy meeting issue 'Antiproton physics in the ELENA era'.
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OBJECTIVE: To evaluate the safety and efficacy of therapy with biologics in patients with autoinflammatory diseases (AIF) or macrophage activating syndrome (MAS) in a real-life setting in Germany. METHODS: The German Register of Autoimmune Diseases 2 (GRAID2) is a retrospective, non-interventional, multicenter registry collecting data from all patients with inflammatory rheumatic diseases refractory to conventional therapy and treated with initial off-label biologics between August 2006 and December 2013. Patients with MAS could be included without prior treatment with a biologic agent. RESULTS: Data from 26 patients with AIF and 5 with MAS were collected. Of the AIF patients 13 (50%) were diagnosed with adult onset Still's disease (AOSD), 6 (23%) with familial Mediterranean fever (FMF), 4 (15.4%) with tumor necrosis factor-associated periodic syndrome (TRAPS), 1 (3.8%) patient with cryopyrin-associated periodic syndrome (CAPS) and 2 (8%) with undifferentiated fever syndromes. The 5 MAS patients suffered from rheumatoid arthritis (RA) with chronic myeloid leukemia, systemic lupus erythematosus and in 2 cases AOSD. In 1 patient a chronic neurological disease was documented without further differentiaton. All patients with TRAPS were primarily treated with etanercept and all CAPS patients with canakinumab. The AOSD and FMF patients were treated with anakinra as the first line off-label biologic in 6 out of 13 and 5 out of 6 cases, respectively. The MAS patients responded very well or well to therapy in 40% and 60% had a moderate response. There were no non-responders. Within the group of AIF patients the physicians documented a very effective or effective treatment in 38.5%, a moderate response in 30.8% and no response in 30.7%. The tolerance was very good in 5 out of 5 of the MAS and in 92% of the AIF patients. CONCLUSION: The data of this retrospective register provide indications for an effective and safe treatment with off-label biologic medication in patients with AIF and MAS in daily practice.
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Doenças Autoimunes , Produtos Biológicos , Uso Off-Label , Adulto , Doenças Autoimunes/tratamento farmacológico , Fatores Biológicos , Produtos Biológicos/uso terapêutico , Alemanha , Humanos , Sistema de Registros , Estudos RetrospectivosRESUMO
OBJECTIVES: The diagnosis of Whipple's disease (WD) is commonly confirmed by histology demonstrating Periodic Acid Schiff (PAS)-positive macrophages in the duodenal mucosa. Analysis of intestinal tissue or other specimens using polymerase chain reaction (PCR) is a more sensitive method. However, the relevance of positive PCR findings is still controversial. Therefore, we evaluated the relevance of histology and PCR findings to establishing the diagnosis of WD in a series of WD patients initially presenting with suspected rheumatic diseases. METHOD: Between 2006 and 2014, 20 patients with seronegative rheumatic diseases tested positive for Tropheryma whipplei (Tw) by PCR and/or histology and were enrolled in a retrospective analysis of the diagnostic value of both procedures. RESULTS: Seven of the 20 cases (35%) were diagnosed with 'classic' WD as indicated by PAS-positive macrophages. In the remaining 13 patients, the presence of Tw was detected by intestinal (n = 10) or synovial PCR analysis (n = 3). Two of the 20 patients (10%) with evidence of Tw did not respond to antibiotic therapy. They were not considered to suffer from WD. Therefore, relying only on histological findings of intestinal biopsies would have missed 11 (61%) of the 18 patients with WD in our cohort. In comparison, PCR of intestinal biopsies detected Tw-DNA in 14 (93%) of the 15 WD patients evaluated. Patients with a positive histology did not differ from PCR-positive patients with regard to sex, age, or duration of disease, but more often presented with gastrointestinal symptoms. CONCLUSIONS: A substantial number of WD patients present without typical intestinal histology findings. Additional PCR analysis of intestinal tissue or synovial fluid increased the sensitivity of the diagnostic evaluation and should be considered particularly in patients presenting with atypical seronegative rheumatic diseases and a high-risk profile for WD.
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Reação em Cadeia da Polimerase/métodos , Doenças Reumáticas/diagnóstico , Doença de Whipple/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doença de Whipple/patologiaRESUMO
The treatment of psoriatic arthritis (PsA) necessitates different and highly effective treatment strategies due to the diverse clinical manifestations. Drugs that exhibit efficacy for most of the musculoskeletal (e.g. arthritis, dactylitis, enthesitis and spondyloarthritis) and extra-articular manifestations (e.g. skin and nail lesions) are therefore of special interest. This review presents a selection of drugs for the treatment of PsA, which might be available within the (near) future. Based on an improved understanding of the pathopysiology of psoriasis as well as PsA, novel therapeutic approaches are under development. Results have already been obtained from phase 3 studies for tofacitinib, a Janus kinase inhibitor as well as for the antibodies brodalumab, bimekizumab and ABT-122 that inhibit the IL17-signaling pathway. The sphingolipid agonist ponesimod and the A3AR agonist CF101 represent "small molecules" similar to the Janus kinase inhibitors that will potentially extend the therapeutic options in the future.
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Artrite Psoriásica , Imunossupressores , Psoríase , Artrite Psoriásica/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Psoríase/tratamento farmacológicoRESUMO
Epidemiological studies suggest a viral etiology in approximately 1% of patients presenting with acute arthritis. The arthritogenic effect of viral infections may be related to viral invasion of synovial cells, the cellular and humoral immune response to viral antigens or by induction of autoimmunity. Viral arthritis can mimic rheumatoid arthritis by presenting as a symmetrical polyarticular disease often accompanied by a rash and influenza-like symptoms. Serological testing for pathogen-specific IgM and IgG antibodies is frequently performed for establishing a viral etiology of arthritis. Virus isolation from the joints or detection of viral nucleic acids in the synovium or synovial fluid is only rarely successful and does not always provide proof of a viral origin of arthritis. While viral arthritis in most cases is self-limiting, protracted disease can occur.
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Artrite Infecciosa/diagnóstico , Doença Aguda , Formação de Anticorpos/imunologia , Antígenos Virais/imunologia , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/imunologia , Artrite Infecciosa/virologia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Doenças Autoimunes/virologia , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/imunologia , Comparação Transcultural , Estudos Transversais , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/epidemiologia , Eritema Infeccioso/imunologia , Eritema Infeccioso/virologia , Hepatite Viral Humana/diagnóstico , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/imunologia , Hepatite Viral Humana/virologia , Humanos , Imunidade Celular/imunologia , Imunoglobulina G/metabolismo , Imunoglobulina M/metabolismo , Membrana Sinovial/imunologia , Membrana Sinovial/virologiaRESUMO
Due to the increasing prevalence of gout, particularly in old age, the disease is becoming of increasing importance in Germany. Gout is one of the most common forms of recurrent inflammatory arthritis and is induced by the deposition of monosodium urate crystals in synovial fluid and other tissues. The principal goals of therapy in chronic gout are the symptomatic treatment of the acute joint inflammation and the causal treatment of the underlying metabolic cause, the hyperuricemia. Only a consistent and permanent reduction of the serum uric acid level ultimately results in an efficient avoidance of further gout attacks and therefore the prevention of structural damage. Due to an often inadequate treatment of gout, the target of healing the disease is often not achieved. A correct and timely diagnosis and adequate assessment of comorbidities associated with gout are, however, of substantial importance for patient and physician to achieve remission of the disease. In order to create a solid basis for a timely and effective treatment of affected patients, in 2016 the German Society of Rheumatology (DGRh) initiated the development of S2e guidelines on gouty arthritis for specialists. This article summarizes these S2e guidelines on the management of gouty arthritis in the specialist sector.
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Artrite Gotosa/diagnóstico , Artrite Gotosa/terapia , Hiperuricemia/diagnóstico , Hiperuricemia/terapia , Guias de Prática Clínica como Assunto , Reumatologia/normas , Antirreumáticos/uso terapêutico , Artrite Gotosa/etiologia , Tomada de Decisão Clínica/métodos , Diagnóstico Diferencial , Medicina Baseada em Evidências/normas , Alemanha , Supressores da Gota/uso terapêutico , Humanos , Hiperuricemia/complicações , Avaliação de Resultados em Cuidados de Saúde/normas , Resultado do Tratamento , Uricosúricos/uso terapêuticoRESUMO
BACKGROUND: There is growing interest in glutamatergic agents in depression, particularly ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist. We aimed to assess the efficacy of ketamine in major depressive episodes. METHOD: We searched EMBASE, PsycINFO, CENTRAL, and Medline from 1962 to January 2014 to identify double-blind, randomized controlled trials with allocation concealment evaluating ketamine in major depressive episodes. Clinical remission, response and depressive symptoms were extracted by two independent raters. The primary outcome measure was clinical remission at 24 h, 3 days and 7 days post-treatment. Analyses employed a random-effects model. RESULTS: Data were synthesized from seven RCTs employing an intravenous infusion and one RCT employing intranasal ketamine, representing 73 subjects in parallel arms and 110 subjects in cross-over designs [n = 34 with bipolar disorder (BD), n = 149 with major depressive disorder (MDD)]. Ketamine was associated with higher rates of clinical remission relative to comparator (saline or midazolam) at 24 h [OR 7.06, number needed to treat (NNT) = 5], 3 days (OR 3.86, NNT = 6), and 7 days (OR 4.00, NNT = 6), as well as higher rates of clinical response at 24 h (OR 9.10, NNT = 3), 3 days (OR 6.77, NNT = 3), and 7 days (OR 4.87, NNT = 4). A standardized mean difference of 0.90 in favor of ketamine was observed at 24 h based on depression rating scale scores, with group comparisons revealing greater efficacy in unipolar depression compared to bipolar depression (1.07 v. 0.68). Ketamine was associated with transient psychotomimetic effects, but no persistent psychosis or affective switches. CONCLUSION: Our meta-analysis suggests that single administrations ketamine are efficacious in the rapid treatment of unipolar and bipolar depression. Additional research is required to determine optimal dosing schedules, route, treatment schedules, and the potential efficacy of other glutamatergic agents.
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Transtorno Depressivo Maior/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/farmacologia , Ketamina/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Antagonistas de Aminoácidos Excitatórios/administração & dosagem , Humanos , Ketamina/administração & dosagemRESUMO
BACKGROUND: Medical institutions often spend a lot of time and money to obtain external certification of clinical excellence and the quality of clinical care, with the purported aim of attracting patients. There is, however, little evidence about the role of certification in patients' choice of institution to receive elective inpatient treatment. OBJECTIVE: On admission 413 consecutive patients were anonymously surveyed about the reasons for choosing this institution, a tertiary care rheumatology department, which is currently certified by the cooperation for transparency and quality in healthcare (KTQ) and by the German Association of Rheumatological Acute Care Hospitals (VRA). In a self-administered questionnaire, patients reported reasons for their choice of institution, allowing for more than one reason. RESULTS: Patients reported recommendation by the primary care physician (48 %), recommendation by the attending rheumatologist (39 %), own (30 %) or family/friends (18 %) positive experience as the main reasons for choosing this institution. Certificates of clinical excellence were given as a reason by only 3 % of patients. Similar results were obtained from 42 referring physicians, of which 5 % regarded the KTQ certification and 2 % the VRA certification as one of the decisive factors. CONCLUSION: The results suggest that certification does not meaningfully influence patient choice of clinic for elective inpatient treatment and therefore does not contribute to patient acquisition.
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Certificação/estatística & dados numéricos , Competência Clínica/normas , Preferência do Paciente/estatística & dados numéricos , Seleção de Pacientes , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Reumatologia/normas , Inquéritos e Questionários , Adulto JovemRESUMO
Giant cell arteritis (GCA) and Takayasu arteritis (TA) are the two diseases characterized as large vessel vasculitis (LVV) and are autoimmune diseases with granulomatous inflammation that affect medium and large sized arteries. These diseases are accompanied by symptoms of systemic inflammatory reactions typically including fatigue, weight loss and low grade fever as well as elevation of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. More specific symptoms include headache and visual symptoms for GCA and arm or leg claudication, renal hypertension and angina pectoris for TA. Imaging studies to demonstrate inflammatory vascular wall lesions and biopsy of the temporal artery for GCA are the most relevant diagnostic procedures. Treatment relies mainly on glucocorticoids. Methotrexate seems to have a moderate glucocorticoid-sparing effect but evidence for other immunosuppressants, including azathioprine, tocilizumab and cyclophosphamide is limited. Revascularization methods might also be required in TA.