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1.
Ann Rheum Dis ; 79(3): 393-399, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900304

RESUMO

OBJECTIVES: Ultrasound of temporal and axillary arteries may reveal vessel wall inflammation in patients with giant cell arteritis (GCA). We developed a ultrasound scoring system to quantify the extent of vascular inflammation and investigated its diagnostic accuracy and association with clinical factors in GCA. METHODS: This is a prospective study including 89 patients suspected of having GCA, of whom 58 had a confirmed clinical diagnosis of GCA after 6 months follow-up. All patients underwent bilateral ultrasound examination of the three temporal artery (TA) segments and axillary arteries, prior to TA biopsy. The extent of vascular inflammation was quantified by (1) counting the number of TA segments and axillary arteries with a halo and (2) calculating a composite Halo Score that also incorporated the thickness of each halo. RESULTS: Halo counts and Halo Scores showed moderate diagnostic accuracy for a clinical diagnosis of GCA. They correlated positively with systemic inflammation. When compared with the halo count, the Halo Score correlated better with C-reactive protein (CRP) levels and allowed to firmly establish the diagnosis of GCA in more patients. Higher halo counts and Halo Scores were associated with a higher risk of ocular ischaemia. They allowed to identify subgroups of patients with low risk (≤5%) and high risk of ocular ischaemia (>30%). CONCLUSIONS: Ultrasound halo scoring allows to quantify the extent of vascular inflammation in GCA. Extensive vascular inflammation on ultrasound may provide strong diagnostic confirmation and associates with ocular ischaemia in GCA.


Assuntos
Oftalmopatias/diagnóstico por imagem , Olho/irrigação sanguínea , Arterite de Células Gigantes/diagnóstico por imagem , Isquemia/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Axilar/diagnóstico por imagem , Biópsia , Oftalmopatias/etiologia , Feminino , Arterite de Células Gigantes/complicações , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Artérias Temporais/diagnóstico por imagem , Ultrassonografia/métodos
2.
Autoimmun Rev ; 19(2): 102446, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31838164

RESUMO

INTRODUCTION: Myelodysplastic syndromes (MDS) and MDS/myeloproliferative neoplasms (MDS/MPN) can be associated with giant cell arteritis (GCA). In this nationwide study by the "French Network of dysimmune disorders associated with hemopathies" (MINHEMON) the objective was to evaluate characteristics, treatment and outcome of GCA MDS-MDS/MPN. PATIENTS AND METHODS: Retrospective analysis of patients that presented a MDS or MDS/MPN associated with GCA. Treatment efficiency, relapse-free and overall survival of GCA MDS-MDS/MPN were compared to GCA alone. RESULTS: Twenty-one patients with GCA MDS-MDS/MPN were included with median age 76 [42-92], M/F ratio 2.5, 8 MDS with multilineage dysplasia (38%), 4 chronic myelomonocytic leukemia (19%), at low or intermediate risk according to IPPS and IPSS-R. The prevalence of headaches, jaw claudication and anterior ischemic optic neuropathy was significantly lower in patients with GCA MDS-MDS/MPN compared to idiopathic GCA (14.3%, 0% and 0% versus 30%, 25%, and 25%, respectively; p < .05). Other clinical and histology findings were similar. All GCA patients received steroid therapy as first-line treatment. Complete or partial response was observed in 14 GCA MDS-MDS/MPN patients (66.7%), of whom 6 (28.6%) received combined immunosuppressive therapies (versus 10% of idiopathic GCA; p = .07). Relapse incidence was similar in the two groups. Steroid dependence was more frequent among GCA MDS-MDS/MPN patients (12 (57%) versus 18 (22.5%); p < .05). Relapse-free and steroid-free survivals were significantly decreased in GCA MDS-MDS/MPN patients (log rank 0.002 and 0.049 respectively), but not overall survival. CONCLUSION: Characteristics of GCA MDS-MDS/MPN seem different than idiopathic GCA, with a distinct clinical phenotype and poorer outcome with a higher risk of steroid dependence and relapse.


Assuntos
Arterite de Células Gigantes/complicações , Síndromes Mielodisplásicas/complicações , Doenças Mieloproliferativas-Mielodisplásicas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/patologia , Doenças Mieloproliferativas-Mielodisplásicas/tratamento farmacológico , Doenças Mieloproliferativas-Mielodisplásicas/patologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
3.
Ann Vasc Surg ; 62: 496.e9-496.e13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394245

RESUMO

Large artery stenosis of the arm or leg arteries or the cervical arteries has been described in giant cell arteritis (GCA); aortic involvement, nevertheless, is less frequent, even if imaging tools such as positron emission tomography (PET) computed tomography have increased the frequency in the observation of aortic involvement. A 56-year-old female with a medical history of GCA presented to our emergency department with an unruptured voluminous thoracoabdominal aortic aneurysm (TAAA). The fluorodeoxyglucose PET demonstrated the presence of high inflammatory activity. The patient underwent endovascular correction using a "sandwich technique." The 3-month control CT scan shows complete aneurysm exclusion. In high risk for surgery patients with GCA, the endovascular treatment with parallel stent graft of TAAA is safe and feasible.


Assuntos
Aneurisma da Aorta Torácica/etiologia , Arterite de Células Gigantes/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Stents , Resultado do Tratamento
4.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586951

RESUMO

A 72-year-old man presented with a short history of headache, jaw claudication, double vision, amaurosis fugax and distended temporal arteries. A diagnosis of giant cell arteritis (GCA) was confirmed on temporal artery ultrasound and temporal artery biopsy. Despite treatment with high-dose oral glucocorticoid (GC) and multiple pulses of intravenous methylprednisolone, his vision deteriorated to hand movements in one eye. 8 mg/kg intravenous tocilizumab, a humanised, recombinant anti-IL-6 receptor antibody, was administered within 48 hours of vision loss and continued monthly, resulting in marked visual improvement within days, as well as sustained remission of GCA. This case suggests a possible role for tocilizumab as a rescue therapy to prevent or recover visual loss in patients with GCA resistant to GC treatment, termed refractory GCA. Further research is required to elucidate the role of intravenous administration of tocilizumab in this setting.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Células Gigantes/diagnóstico , Artérias Temporais , Administração Intravenosa , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Diagnóstico Diferencial , Diplopia/etiologia , Esquema de Medicação , Resistência a Medicamentos , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides , Cefaleia/etiologia , Humanos , Masculino
5.
Presse Med ; 48(9): 948-955, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31564551

RESUMO

GCA ischemic complications occur generally in patients with a yet undiagnosed or uncontrolled disease. When disease control is fair, ischemic complications may be due mostly to atheromatosis. Ophtalmic complications are most frequent and are dominated by anterior ischemic optic neuropathy. Vasculitic strokes occur essentially in the vertebrobasilar arterial territory. Overt vasculitic coronary disease is exceptional. The diagnosis of upper and lower limbs ischemic complications benefit from advances in echography (halo sign) and positron emission tomography imaging. Treatment relies on corticosteroids (initially 1mg/kg prednisone or more, preceded by intravenous methylprednisolone gigadoses if necessary), the control of cardiovascular risk factors and antiplatelet drugs; heparin may be indicated for threatening limbs ischemia.


Assuntos
Arterite de Células Gigantes/complicações , Isquemia/etiologia , Isquemia Miocárdica/etiologia , Neuropatia Óptica Isquêmica/etiologia , Acidente Vascular Cerebral/etiologia , Doença Aguda , Doenças da Aorta/etiologia , Aterosclerose/complicações , Humanos , Isquemia/terapia , Miocardite/etiologia , Pericardite , Doença Arterial Periférica/etiologia
7.
Postgrad Med ; 131(7): 546-549, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31483199

RESUMO

Objectives: To identify the cognitive and functional deficits in a well-characterized group of patients with vasculitis of the nervous system. Methods: Sixty-seven patients diagnosed with Central Nervous System (CNS) or Peripheral nervous System (PNS) vasculitis over a 14-year period were retrospectively identified. Data on clinical presentation, laboratory, radiographic and tissue biopsy investigations, and treatment were collated. Cognitive, functional and quality of life evaluation assessments were performed in 31 patients who agreed to participate and included Addenbrooke's Cognitive Examination-revised (ACE-R), Nottingham Extended Activities of Daily Living (NEADL) and EQ-5D-3L quality of life questionnaires. Results: CNS vasculitis patients exhibited cognitive impairment, with a mean ACE-R score of 74/100 (standard deviation (SD) 16). NEADL and EQ-5D-3L scores were in the impaired range at 41/66 (SD 21) and 57/81 (SD 22), respectively. Patients with just PNS vasculitis exhibited fewer cognitive deficits with ACE-R and NEADL scores of 87 (SD 8) and 46 (SD 16) respectively. EQ-5D-3L score was in the impaired range of 65 (SD 22). Conclusions: Vasculitis of the nervous system and, in particular, CNS vasculitis causes cognitive impairment and deficits in functional ability. Such patients should be targeted for cognitive rehabilitation.


Assuntos
Disfunção Cognitiva/psicologia , Doenças do Sistema Nervoso Periférico/psicologia , Vasculite do Sistema Nervoso Central/psicologia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/fisiopatologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/psicologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Estudos de Coortes , Estudos Transversais , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/fisiopatologia , Arterite de Células Gigantes/psicologia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/fisiopatologia , Granulomatose com Poliangiite/psicologia , Nível de Saúde , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Qualidade de Vida , Estudos Retrospectivos , Vasculite/complicações , Vasculite/tratamento farmacológico , Vasculite/fisiopatologia , Vasculite/psicologia , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/tratamento farmacológico , Vasculite do Sistema Nervoso Central/fisiopatologia , Adulto Jovem
8.
Arch. Soc. Esp. Oftalmol ; 94(9): 426-429, sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186220

RESUMO

Introducción: La arteritis de células gigantes (ACG) es una enfermedad inflamatoria con afectación visual considerable, en cuyo diagnóstico la biopsia de arteria temporal (BAT) es muy importante. Material y métodos: Se trata de un estudio retrospectivo en el cual se recogen los casos con un diagnóstico de ACG desde 2010 hasta 2016 (60 casos), todos ellos con BAT realizada, y se analizan las características de la visión de estos pacientes, así como la necesidad/predictibilidad de la biopsia. Resultados: La incidencia media de ACG fue de 34,3 casos por 100.000 habitantes año mayores de 50 años. La edad media fue de 76,9 años con predilección por sexo femenino (1,9:1). La BAT fue solicitada en el 100% de los casos y resultó positiva en el 18,3%. Usando los criterios de ACG de la Sociedad Americana de Reumatología o la calculadora de predictibilidad para el resultado de la BAT, hubiésemos ahorrado la mayoría de las biopsias (90%). Conclusiones: La incidencia media de ACG en nuestro estudio en mayores de 50 años es de 34,3 casos por 100.000 habitantes año. La calculadora de predictibilidad descrita por González-López resulta útil en nuestro medio para la toma de decisiones sobre el diagnóstico de ACG y la indicación de BAT, de forma que nos permite reducir la realización de biopsias y recurrir a ellas solo en casos dudosos


Introduction: Giant cell arteritis (GCA) is an inflammatory disease with serious visual sequelae, in which the diagnosis with the temporal artery biopsy (TAB) is very important. Material and methods: All cases of GCA were collected from 2010 to 2016 (60) in a retrospective study with temporal artery biopsy performed. The vision aspects of these patients were also analysed, along with the need / predictability of the biopsy. Results: The average incidence of GCA was 34.3 cases per 100,000 inhabitants/year in those older than 50 years. The mean age was 79.9 with a predilection for females (1.9: 1). TAB was requested in 100% of cases, with 18.3% with positive results. The AAR criteria and / or TAB calculator could have avoided most (90%) of the biopsies.Conclusions: In the present study, the mean incidence of GCA was 34.3 cases per 100,000 inhabitants/year older than 50 years. The predictability calculator described by González-López is useful in this environment for decision making on the diagnosis of GCA and the indication of a TAB, in such a way that it can help to reduce the performing of biopsies only in doubtful cases


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Arterite de Células Gigantes/patologia , Artérias Temporais/patologia , Corticosteroides/uso terapêutico , Biópsia , Infarto Cerebral/etiologia , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/epidemiologia , Incidência , Oftalmoplegia/etiologia , Neuropatia Óptica Isquêmica/etiologia , Estudos Retrospectivos , Distribuição por Sexo , Transtornos da Visão/etiologia
9.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2279-2284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418104

RESUMO

PURPOSE: To investigate the impact of ocular symptom, non-ocular symptom, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and temporal artery ultrasound (TAU) findings on the predictive value of a positive temporal artery biopsy (TAB) in patients with clinically suspected giant cell arteritis (GCA). METHODS: In a retrospective, interventional study, data from 68 patients with clinically suspected GCA who underwent TAB between 2015 and 2017 were analysed. Analysis included five parameters: ocular symptom, non-ocular symptom, ESR, CRP level and TAU findings. Using a contingency table, each parameter was separately analysed for the predictive value of a positive TAB, and a discriminant analysis was applied to check for the predictive value of a positive TAB under consideration of all five parameters and of the three strongest predictive parameters. RESULTS: A positive TAB was significantly associated with a positive TAU in 15 of 15 patients (p < 0.001), an increased ESR in 37 of 53 patients (p < 0.001), an increased CRP level in 35 of 56 patients (p = 0.004) and non-ocular symptoms in 27 of 40 patients (p = 0.01). A positive TAB was not significantly associated with the presence of ocular symptoms (25 of 46 patients, p = 0.988). Using a discriminant analysis, the combined parameters TAU, ESR and CRP were able to predict a positive TAB in 97.3% of all patients. The positive predictive value was 78.3%, and the negative predictive value was 95.4%. CONCLUSION: Temporal artery biopsy to confirm the diagnosis of GCA may not be mandatory in patients who show an elevated ESR and CRP level and a positive TAU.


Assuntos
Biópsia/métodos , Oftalmopatias/etiologia , Arterite de Células Gigantes/diagnóstico , Artérias Temporais/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Oftalmopatias/diagnóstico , Feminino , Seguimentos , Arterite de Células Gigantes/sangue , Arterite de Células Gigantes/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
10.
Immunol Med ; 42(2): 94-98, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31469613

RESUMO

Giant cell arteritis (GCA) is a type of large vessel vasculitis, and it involves the aorta, large vessels and terminal branches of the external carotid artery, especially the temporal artery. Temporal artery biopsy is a simple tool for the diagnosis of vasculitis, however, the histopathological findings do not always differentiate between the small-vessel vasculitis and GCA. We report the case of 72-year-old male who initially had a clinical diagnosis of GCA, then in the course of treatment, diagnostic histopathological approach revealed the necrotizing vasculitis with bronchocentric granulomatosis in the inflammatory nodule of the lung. The manifestations of patients with systemic vasculitis represent the disorders of multiple organ systems thus are diverse and may vary through the course of the disease. Presentation of unexpected features such as insufficient response to antibiotics, sinusitis, runny nose, discomfort of frontal region or pachymeningitis which anticipates re-evaluation of systemic vasculitis that may lead us to an appropriate diagnosis and the treatment.


Assuntos
Arterite de Células Gigantes/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/patologia , Arterite de Células Gigantes/terapia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/patologia , Granulomatose com Poliangiite/terapia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Radiografia Torácica , Rinite/etiologia , Sinusite/etiologia , Artérias Temporais/patologia , Tomografia Computadorizada por Raios X
11.
Medicine (Baltimore) ; 98(32): e16737, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393385

RESUMO

RATIONALE: Giant cell arteritis (GCA) is known to present with typical manifestations like temporal headache and visual abnormalities. However, several cases with atypical manifestations were reported. Stroke occurs in 3% to 7% of patients with GCA. PATIENT CONCERNS: A 67-year-old male patient with known hypertension presented with somnolence, disorientation and mild bilateral limb ataxia. The magnetic resonance imaging showed multiple acute infarctions in the territory of the vertebrobasilar system with occlusion of the left vertebral artery. DIAGNOSIS: Ten months later, during a routine neurovascular follow-up, recanalization of the left vertebral artery was observed and a hypoechoic concentric "halo" sign around both vertebral arteries, mainly on the left side was evident. On further examination of the superficial temporal artery, a hypoechoic concentric "halo" sign was also found, which-along with increased inflammatory markers-raised suspicion about GCA. Classical GCA features like headache, temporal tenderness or amaurosis fugax were not present. Repeated in-depth diagnostic work-up including 48 hours Holter-ECG did not reveal another stroke etiology. INTERVENTIONS: Intravenous Methylprednisolone 250 mg/d was immediately started and after 6 days the dose was tapered to 80 mg/d. The patient was discharged on a tapering scheme with the recommendation to start azathioprine. Additionally, we placed the patient on acetylsalicylic acid 100 mg/d and clopidogrel 75 mg/d. However, the patient was not compliant to treatment; he stopped prednisolone early and did not start azathioprine. OUTCOMES: The inflammatory markers were markedly reduced at the beginning of the treatment. After stopping the immunosuppressive medications, the inflammatory markers were once again increased. Three months later, the patient developed bilateral middle cerebral artery and right occipital lobe infarctions. LESSONS: In patients with cryptogenic vertebrobasilar strokes, GCA may be considered in the differential diagnosis, especially if the inflammatory markers are increased.


Assuntos
Arterite de Células Gigantes/complicações , Acidente Vascular Cerebral/complicações , Artéria Vertebral/patologia , Idoso , Biomarcadores , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Mediadores da Inflamação/metabolismo , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico
12.
Braz J Cardiovasc Surg ; 34(4): 472-479, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454202

RESUMO

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.


Assuntos
Aneurisma da Aorta Torácica/terapia , Arterite de Células Gigantes/terapia , Arterite de Takayasu/terapia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/cirurgia , Humanos , Complicações Pós-Operatórias , Arterite de Takayasu/complicações , Arterite de Takayasu/cirurgia
13.
Presse Med ; 48(9): 956-967, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31327542

RESUMO

Aortitis, defined by aortic parietal thickening, is noted in about 50% of patients with giant cell arteritis (GCA). Aortic structural lesions, ectasia or aneurism, may occur with or without inflammatory aspect of the aorta, sometimes since the diagnosis of GCA, but more frequently during follow-up. Assessment of aortic involvement, which has to be searched in each patient at the diagnosis of GCA, can be assessed using aortic imaging, angio-CT, angio-MRI or PET-CT. Prognosis of aortitis and its complications remains poorly known, but mortality due to serious events like aneurism rupture or aortic dissection, could be potentially reduced with precocious diagnosis and regular monitoring. Treatment of GCA-related aortitis is based on high-dose glucosteroids, with an initial prednisone dose at 0.7 mg/kg/d, as recommended by the French Study Group for large vessel vasculitis (GEFA). Aortic ectasia and aneurisms have to be monitored, in order to propose aortic surgery in the best conditions as possible.


Assuntos
Aortite/diagnóstico por imagem , Arterite de Células Gigantes/diagnóstico por imagem , Corticosteroides/administração & dosagem , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/cirurgia , Aortite/complicações , Aortite/tratamento farmacológico , Aortite/patologia , Angiografia por Tomografia Computadorizada , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/patologia , Fidelidade a Diretrizes , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prednisona/administração & dosagem , Prognóstico , Ultrassonografia Doppler
14.
Presse Med ; 48(9): 968-979, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31324351

RESUMO

Glucocorticoids (GC) remain the gold standard of the treatment of giant cell arteritis provided objectives of GC-tapering are accurately followed: 15 to 20mg/day at 3 months, 10mg/day at 6 months, 5mg/day at 9-12 months and withdrawal between 12 and 18 months. In case of corticodependance at ≥7.5 mg/day of prednisone or intolerance to GC, a GCsparing therapy has to be introduced, mainly methotrexate or tocilizumab. Individual characteristics of each patient, data about the efficacy of the treatment, its cost and how easy the follow-up under this treatment is are important factors to consider for choosing the right GC-sparing therapy. For all these reasons, except particular situations, we prefer using methotrexate before tocilizumab. Prevention of cardiovascular events is an important aspect of the treatment of GCA. We recommend using aspirin (75-100mg/day) during the first month of treatment or longer in case of occurrence of an ischemic complication. Each patient treated for GCA should receive a prevention of osteoporosis with respect of usual recommendations.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Metotrexato/uso terapêutico , Prednisona/uso terapêutico , Abatacepte/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Azatioprina/uso terapêutico , Esquema de Medicação , Arterite de Células Gigantes/complicações , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/uso terapêutico , Leflunomida/uso terapêutico , Ustekinumab/uso terapêutico
15.
Neurologist ; 24(4): 139-141, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31246724

RESUMO

OBJECTIVE: To describe rare but important cerebrovascular complications of giant cell arteritis (GCA). CASE REPORT: We report a 59-year-old man who initially presented with vasculitis of the lower extremities. While on steroids, he developed strokes in multiple vascular territories. The conventional angiogram showed stenosis of bilateral carotid and vertebral vessels as they entered the dura. Temporal artery biopsy confirmed GCA. He began cyclophosphamide treatment, which stabilized his clinical course; however, this was switched to tocilizumab by an outside rheumatologist. Two months later, the patient had progression of vessel stenosis and suffered additional strokes. Despite interventions to augment cerebral perfusion, the infarctions continued to expand and the patient passed away. CONCLUSIONS: This case highlights several important features of strokes in GCA: the predilection for the dural entry point of cerebral blood vessels, the progression of disease despite steroids, and the need to quickly escalate treatment in these cases. As seen in our patient, however, this disease carries high morbidity and mortality and patients often have poor outcomes despite aggressive immunosuppression.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Ciclofosfamida/uso terapêutico , Arterite de Células Gigantes/tratamento farmacológico , Imunossupressores/uso terapêutico , Acidente Vascular Cerebral/etiologia , Progressão da Doença , Arterite de Células Gigantes/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva
16.
Clin Exp Rheumatol ; 37 Suppl 117(2): 61-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162028

RESUMO

OBJECTIVES: To identify independent risk factors for permanent visual loss (PVL) in patients with giant cell arteritis (GCA), with a special focus on sonographic findings of the temporal, carotid and subclavian/axillary arteries, and on established scoring systems of ischaemia risk assessment. METHODS: Consecutive patients with a diagnosis of GCA between 2002 and 2013 were retrospectively identified from a prospectively maintained database. Data on clinical characteristics including ophthalmological findings, laboratory values, and sonographic findings of the temporal, carotid an axillary arteries were extracted. CHADS2- and CHA2DS2-VASc-score were calculated. Clinical, laboratory and sonographic characteristics of patients with and without PVL were compared. Multiple logistic regression models were calculated to identify variables independently associated with PVL. RESULTS: One-hundred-fifty-two patients were included in the analysis. PVL occurred in 30.2% of patients, with anterior ischaemic optic neuropathy as predominant underlying cause (91.3%). The frequency of PVL was strongly dependent on the age at diagnosis, with a significant increase after the age of 70 years. In multivariate analysis, axillary artery vasculitis with an odds ratio (OR) of 0.3 and constitutional symptoms with an OR of 0.1 were negatively associated with PVL. A CHADS2-score of 1 (OR 10.7) or ≥2 (OR 25) was associated with a significantly increased risk of PVL. CONCLUSIONS: The risk of PVL secondary to GCA increases with age but is lower in patients presenting with constitutional symptoms and/or exhibiting axillary artery involvement. The CHADS2-score may help to discriminate patients with low vs. high risk of PVL.


Assuntos
Arterite de Células Gigantes , Neuropatia Óptica Isquêmica , Transtornos da Visão/etiologia , Idade de Início , Idoso , Feminino , Arterite de Células Gigantes/complicações , Humanos , Masculino , Razão de Chances , Neuropatia Óptica Isquêmica/complicações , Neuropatia Óptica Isquêmica/diagnóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Transtornos da Visão/diagnóstico
18.
Arch Soc Esp Oftalmol ; 94(9): 426-429, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31147092

RESUMO

INTRODUCTION: Giant cell arteritis (GCA) is an inflammatory disease with serious visual sequelae, in which the diagnosis with the temporal artery biopsy (TAB) is very important. MATERIAL AND METHODS: All cases of GCA were collected from 2010 to 2016 (60) in a retrospective study with temporal artery biopsy performed. The vision aspects of these patients were also analysed, along with the need / predictability of the biopsy. RESULTS: The average incidence of GCA was 34.3 cases per 100,000 inhabitants/year in those older than 50 years. The mean age was 79.9 with a predilection for females (1.9: 1). TAB was requested in 100% of cases, with 18.3% with positive results. The AAR criteria and / or TAB calculator could have avoided most (90%) of the biopsies. CONCLUSIONS: In the present study, the mean incidence of GCA was 34.3 cases per 100,000 inhabitants/year older than 50 years. The predictability calculator described by González-López is useful in this environment for decision making on the diagnosis of GCA and the indication of a TAB, in such a way that it can help to reduce the performing of biopsies only in doubtful cases.


Assuntos
Arterite de Células Gigantes/patologia , Artérias Temporais/patologia , Corticosteroides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Biópsia , Infarto Cerebral/etiologia , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Oftalmoplegia/etiologia , Neuropatia Óptica Isquêmica/etiologia , Estudos Retrospectivos , Distribuição por Sexo , Transtornos da Visão/etiologia
19.
Int J Rheum Dis ; 22(9): 1782-1786, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31245915

RESUMO

OBJECTIVE: To identify risk factors associated with disease relapse in giant cell arteritis (GCA). METHODS: We reviewed data from 30 consecutive, newly diagnosed patients with GCA. The patients were divided according to relapse or non-relapse status, and their baseline characteristics were compared. RESULTS: Among the 30 patients, 8 relapsed at a median of 28 weeks from GCA diagnosis. Patients with relapse were male-dominant (male: 88% vs female: 41%, P = 0.02) and showed a higher body mass index (BMI, 23 kg/m2 vs 19 kg/m2 , P < 0.01) than non-relapse patients. Patients with BMI ≥ 21 kg/m2 showed a significantly higher relapse rate than those with BMI < 21 kg/m2 during the 100-week follow-up (46% vs 0%, log-rank test, P < 0.01). CONCLUSION: Higher BMI may be associated with relapse in patients with GCA.


Assuntos
Índice de Massa Corporal , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Sobrepeso/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Humanos , Masculino , Sobrepeso/diagnóstico , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
20.
Intern Med ; 58(17): 2451-2458, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31118402

RESUMO

Objectives To investigate the sensitivity and specificity of a temporal artery biopsy (TAB) in the diagnosis of giant cell arteritis (GCA) in a single-center retrospective cohort in Japan. Methods A retrospective chart review was performed on consecutive patients who visited our hospital between April 2009 and October 2018 and underwent a TAB. The sensitivity and specificity were calculated for the three pathological standards for a TAB, predetermined according to the pathological criterion of the 1990 American College of Rheumatology (ACR) criteria: A) vasculitis characterized by predominant mononuclear cell infiltration; B) vasculitis with granulomatous inflammation; and C) vasculitis with multinucleated giant cells. We also analyzed the clinical parameters predicting the diagnosis of GCA and the impact of a diagnostic delay of ≥3 months on cardiovascular complications of GCA. Results Our study population was 16 cases in the GCA group and 13 in the non-GCA group. The sensitivity and specificity for Standard A of a TAB were 81% and 85%, respectively, while those for stricter Standards B or C were identical, at 75% and 100%, respectively. These pathological standards, but not any other parameters, significantly predicted the diagnosis. A diagnostic delay tended to cause cardiovascular complications (p=0.057). Conclusion The sensitivity and specificity of the pathological standards of a TAB were favorable in our cohort and were the only predictors for the diagnosis of GCA. Considering the possible impact of a diagnostic delay on cardiovascular complications, the early recognition and prompt initiation of glucocorticoid therapy is needed, even in Japan, where GCA is uncommon.


Assuntos
Doenças Cardiovasculares/etiologia , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Artérias Temporais/patologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Doenças Cardiovasculares/patologia , Estudos de Coortes , Diagnóstico Tardio/efeitos adversos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Vasculite/patologia
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