Updates in the Diagnosis and Management of Giant Cell Arteritis.

PURPOSE OF REVIEW: Giant cell arteritis is a systemic large vessel vasculitis that affects the older population and can cause progressive and at times, devastating complications including vision loss. While this has been commonly diagnosed and treated among vasculitides, the treatment options are limited and can have long-term adverse effects. The purpose of our review on GCA is to identify and discuss the pathophysiology and clinical aspects of GCA as they relate to the most recent data. The review will describe any new data on the diagnosis and treatment of this systemic large vessel vasculitis. RECENT FINDINGS: The latest data suggests that the mainstay of treatment of GCA remains glucocorticoids but alternate agents are being identified and used in an attempt to reduce the cumulative exposure to glucocorticoids and reduce treatment-related adverse effects while managing and maintaining remission of this systemic disease. There is much more information to collect in terms of identification and standardization of the optimal length of time to treat with glucocorticoids as well as regarding the long-term efficacy of alternate treatments. In addition, investigation continues to identify measureable risk factors to predict outcomes of individual patients with this diagnosis.

Clinically Amyopathic Dermatomyositis Complicated by Pleural Effusion Case Report, Literature Review, and Proposed Mechanism.

Polymyositis-dermatomyositis (PM-DM) is a chronic inflammatory disorder that mainly involves muscles and skin. Clinically amyopathic dermatomyositis (CADM) is a unique subset of PM-DM with typical skin manifestations but little or no evidence of musculoskeletal involvement. Many cases of dermatomyositis and CADM are associated with internal malignancy, but pulmonary manifestations can also been seen; the most common of which is interstitial lung disease. Pleural effusion is a rare complication and may be difficult to differentiate from other causes, such as infections, heart failure, or malignancy. We report a patient with CADM complicated by rapidly progressive pleural effusions. Based on findings of this patient, as well as literature review, we suggest that the etiology of massive pleural effusion in this setting is most likely related to local immune pleuritis associated with underlying interstitial lung disease due to dermatomyositis. Optimal management should be individualized and may include immunosuppressive agents, as well as antimicrobials, and potentially other agents.