ABSTRACT
Giant cell arteritis (GCA) is a medium- and large-vessel systemic vasculitis. It is common among people aged 50 years and older. GCA presents with cranial manifestations of headache, visual symptoms, cerebrovascular events, and systemic manifestations. The diagnosis of GCA is confirmed with a positive temporal artery biopsy. Treatment of GCA consists of high-dose steroids with slow tapering over 18 to 24 months and steroid-sparing therapy to maintain remission. Due to the risk of the most feared complication of GCA, irreversible visual loss, once GCA is suspected, high-dose steroids should be commenced immediately, and a temporal artery biopsy should be done not beyond one to two weeks after starting steroids to avoid the effects of steroids on the result of the temporal artery biopsy. There are orbital radiological findings reported in patients with an atypical presentation of GCA on MRI; these findings include non-specific orbital inflammation, optic nerve inflammation, optic nerve sheath inflammation, and optic chiasm enhancement.
ABSTRACT
Introduction Rheumatoid arthritis and its treatment have different effects on weight gain. This study examined the effect of tumor necrosis factor (TNF) inhibitors on weight gain in patients with seropositive rheumatoid arthritis compared with non-TNF therapy and disease activity. Methods A retrospective cohort study was conducted in Prince Mohammad bin Abdulaziz Hospital for all patients aged ≥ 18-year-old diagnosed with seropositive rheumatoid arthritis and started on TNF inhibitors or non-TNF biologics in outpatient clinics since 2015. Patients were excluded if they were pregnant, had an uncontrolled underlying metabolic disease, were post-bariatric, or had a history of malabsorption. We also excluded individuals on treatment for congestive heart failure or end-stage renal disease. Results A total of 116 patients with rheumatoid arthritis were reviewed between 2015 and 2019. Only 69 patients met the inclusion criteria (51 and 18) in the TNF-a (alpha) and non-TNF-a inhibitor groups, respectively. The weight change from pre-treatment to post-treatment showed an average increase of 1.2 kg (95% CI: -0.68-3.17) in the TNF-a inhibitor group while in the non- TNF-a inhibitor group, the average increase in weight was 2.67 kg (95% CI: -0.44-5.78). Over the period of two years, there was no statistical difference in weight gain in both groups or in relation to disease activity. Conclusion The results of this study did not show a significant increase in weight gain in seropositive patients with rheumatoid arthritis who were treated with TNF or non-TNF inhibitors.
ABSTRACT
OBJECTIVE: To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events. METHODS: A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6-12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded. RESULTS: Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached high cholesterol levels ≥ 5.2 mmol/L and LDL ≥ 3.37 mmol/L in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months), P 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg, P 0.03). CONCLUSION: There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.