Clinical Manifestations and Prognosis of Giant Cell Arteritis: A Retrospective Cohort Study.

The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA). MATERIALS AND METHODS: . A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory, and instrumental data and three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Rheumatologic Associations (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n = 61), contrast-enhanced computed tomography (n = 5), CT angiography (n = 6), magnetic resonance imaging (n = 4), MR angiography (n = 3), and 18F-FDG PET/CT (n = 47). Overall and recurrence-free survival rates were analyzed using survival tables and Kaplan-Meier method. RESULTS: . The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%), and symptoms of rheumatic polymyalgia (56.6%). Changes in temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n = 158), methotrexate was used in 49 out of 158 patients, leflunomide in 9 patients. In 45 (28.5%) out of 158 patients, a stable remission was achieved as a result of GC monotherapy; in 120 (75.9%) patients, long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0-54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% CI 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI 42.0; 62.8]. Twelve (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined. CONCLUSIONS: : Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

Tumor necrosis factor alpha inhibitors in patients with Takayasu's arteritis refractory to standard immunosuppressive treatment: cases series and review of the literature.

The objective of this study was to report the long-term use of tumor necrosis factor (TNF) inhibitors in case series of patients with Takayasu's arteritis refractory to standard immunosuppressive treatment. Nine women (median age of 29 years) with refractory Takayasu's arteritis were treated with TNF inhibitors. Prior to TNF inhibitor administration, all patients received standard immunosuppressive treatment for 16 to 112 months including steroids and immunomodulators. All but one patient presented with high activity of disease (median ESR 80 mm/h, C-reactive protein level 16.8 mg/l, interleukin-6 level 7.2 pg/ml) that was confirmed with positron emission tomography (PET) with (18)F-deoxyglucose. Eight patients were treated with infliximab and one was treated with adalimumab, respectively. The median duration of treatment was 36 months (12 to 84 months). For induction treatment, we used infliximab 200-300 mg every 4-6 weeks and adalimumab 40 mg every 2 weeks. The treatment resulted in complete remission in five (55.6%) patients and incomplete remission in three (33.3%) patients. We were able to taper the dose of prednisone to ≤10 mg daily in all patients. Median levels of ESR, C-reactive protein, and interleukin-6 diminished to 20 mm/h, 1.0 mg/l, and 1.0 pg/ml, respectively. Repeated PET showed lower activity of vasculitis in six (85.7%) of seven patients. The treatment was safe and well-tolerated. Only one patient developed allergic reactions after infusions of infliximab. Four patients developed relapse of vasculitis when we tried to increase the dosing interval of infliximab to 6-8 weeks. TNF inhibitors were highly effective and safe in patients with refractory Takayasu's arteritis.

[Aortoarteritis in HBV-associated liver cirrhosis: diagnostics, therapeutic strategy, and prognosis].

A case of decompensated liver cirrhosis in a women with a long silent period of HBV infection is presented. The first manifestation was generalized vasculitis involving small and medium-size vessels and elastic-type arteries with the development of aortoarteritis. Proper interpretation of manifestations of viral liver cirrhosis allowed for immunosuppressive treatment in combination with effective antiviral drugs. As a result, aviremia, regression of vasculitis and portal hypertension along with considerable improvement of the prognosis were achieved.