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1.
Medicina (B Aires) ; 79(6): 509-512, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829955

RESUMO

Giant cell arteritis is a systemic vasculitis that affects arteries of medium and large caliber, mainly the aorta artery and its main branches. It is more frequent in women older than 50 years. The most common symptoms are fever, jaw claudication, headache, hyperesthesia of the scalp and loss of vision with anterior ischemic optic nerve disease. But, in a minority of cases, less frequent symptoms are observed that delay and make more difficult the diagnosis. Here, we present the case of a 76-year-old woman who came to our consultation having pain in the oral cavity and presenting tongue and neck edema for 48 hours. She had also suffered from headaches during the previous month. Because the physical examination showed clinical signs of lingual ischemia, a presumptive diagnosis of ischemic involvement due to giant cell arteritis was considered. She started a treatment with systemic corticosteroids and a temporal artery biopsy was performed. We conclude, that giant cell arteritis should be suspected in patients presenting lingual ischemia symptoms in order to start the specific treatment early enough to avoid irreversible complications.


Assuntos
Arterite de Células Gigantes/patologia , Doenças da Língua/patologia , Idoso , Diagnóstico Diferencial , Feminino , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Necrose , Doenças da Língua/diagnóstico , Doenças da Língua/tratamento farmacológico
2.
Ned Tijdschr Tandheelkd ; 126(11): 565-570, 2019 Nov.
Artigo em Holandês | MEDLINE | ID: mdl-31730133

RESUMO

Sometimes it is difficult to diagnose temporal arteritis because the complaints may vary, change in intensity and are not always characteristic. The condition is a cranial form of giant-cell arteritis affecting large and medium-sized arteries. The first manifestation of temporal arteritis can be a sore tongue that does not manifest any abnormalities during a clinical investigation. In a later stage patients sometimes develop ulceration or necrosis of a part of one side of the tongue. Other symptoms can be a recently developed headache, jaw claudication and acute loss of vision. To diagnose temporal arteritis, histological investigation of a biopsy of the temporal artery is carried out. The treatment consists of long-term use of corticosteroids. A patient in your practice with inexplicable pain on one side of the tongue, without clinical abnormalities, or an ulceration of the tongue without an immediately apparent cause may have temporal arteritis.


Assuntos
Arterite de Células Gigantes , Artérias Temporais/patologia , Doenças da Língua , Biópsia , Diagnóstico Diferencial , Arterite de Células Gigantes/diagnóstico , Humanos , Língua/patologia , Doenças da Língua/diagnóstico
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.
Curr Opin Ophthalmol ; 30(6): 407-411, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31503077

RESUMO

PURPOSE OF REVIEW: To summarize recent advances in the diagnosis of giant cell arteritis (GCA). RECENT FINDINGS: Less common manifestations of GCA include corneal edema, proptosis from lacrimal gland ischemia and sensorineuronal hearing loss. Histology studies have suggested that temporal artery biopsies (TAB) with fixed specimen lengths of 15 mm may be adequate to prevent false negative biopsies. In centers with appropriate radiologic expertise, a European rheumatology consensus guideline has proposed Doppler ultrasound as a first-line confirmatory test for GCA in lieu of temporal artery biopsy. Finding extracranial large vessel disease can help to diagnose GCA. Statistical prediction rules can help risk stratify patients with suspected GCA. Age and platelet level when maintained as continuous variables are the strongest predictors for GCA. SUMMARY: GCA can present with diverse ophthalmic and systemic presentations and expedient recognition of same can avoid diagnostic delay and possible vision loss, among other complications. TAB remains the conventional diagnostic standard test for GCA. The use of statistical prediction models and increased expertise in noninvasive imaging techniques such as ultrasound may decrease reliance on TAB, especially in patients determined to be at low risk for GCA.


Assuntos
Arterite de Células Gigantes/diagnóstico , Artérias Temporais/patologia , Biópsia , Diagnóstico Precoce , Humanos , Estudos Retrospectivos , Ultrassonografia Doppler
6.
Drugs Aging ; 36(11): 1015-1026, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31493201

RESUMO

Polymyalgia rheumatica is an inflammatory rheumatic disease of the elderly characterised by pain and stiffness in the neck and pelvic girdle, and is the second most common inflammatory rheumatic condition in this age group, after rheumatoid arthritis. Polymyalgia rheumatica can occur independently or in association with giant cell arteritis, which is the most common form of primary vasculitis. The diagnosis of polymyalgia rheumatica is usually based on clinical presentation and increase of inflammatory markers. There are no pathognomonic findings that can confirm the diagnosis. However, different imaging techniques, especially ultrasonography, can assist in the identification of polymyalgia rheumatica. Glucocorticoids are the cornerstone of the treatment of polymyalgia rheumatica, but they might be associated with different adverse events. A subgroup of patients presents with a refractory disease course and, in these cases, adding methotrexate as a steroid-sparing agent could be useful. In this review, we summarise the latest findings regarding the pathogenesis, diagnosis and management of polymyalgia rheumatica and try to highlight the possible pitfalls, especially in elderly patients.


Assuntos
Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Arterite de Células Gigantes , Glucocorticoides/uso terapêutico , Polimialgia Reumática , Idoso , Diagnóstico Diferencial , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/etiologia , Humanos , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamento farmacológico , Polimialgia Reumática/etiologia
7.
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
8.
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
9.
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
10.
Acta Med Hist Adriat ; 17(1): 19-44, 2019 06.
Artigo em Espanhol | MEDLINE | ID: mdl-31315406

RESUMO

Saint Martin of Leon was a monk who lived in the 12th century. The details of his life are known because they were described by his contemporary, Lucas de Tuy, in the Liber de Miraculis Sancti Isidori. Saint Martin of Leon was a venerable old man who suffered from severe headaches, considerable difficulties in raising or maintaining his arms raised, asthe-nia, and anorexia. In addition, he is represented in his codex Concordia with an unusual hyperpigmentation of the temples suggesting a therapeutic intervention on temporal arteries. These data lead us to think that this could be the first described case of giant cell arteritis with some clinical information. Moreover, he experienced a singular and curious appear-ance of Saint Isidore of Seville, who made him swallow a booklet, which might correspond to a complex visual hallucination or associated Charles Bonnet syndrome. Historical data on the disease are reviewed and discussed, as well as its evolution and treatment before giving steroids.


Assuntos
Síndrome de Charles Bonnet/história , Arterite de Células Gigantes/história , Síndrome de Charles Bonnet/diagnóstico , Arterite de Células Gigantes/diagnóstico , História Medieval , Humanos
11.
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
12.
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
13.
Clin Exp Rheumatol ; 37 Suppl 117(2): 57-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162029

RESUMO

OBJECTIVES: To estimate the frequency of different clinical patterns in giant-cell arteritis (GCA) at onset. METHODS: All GCA patients consecutively followed-up in two referral centers for GCA with a biopsy-proven diagnosis and/or large-vessel vasculitis (LVV) demonstrated on imaging were analysed. RESULTS: We analysed the initial clinical presentation of 693 patients with a median age of 75 [48-94] years and including 486 (70%) women. We identified four different clinical patterns: isolated cranial GCA (in 80%), symptomatic LVV with or without associated cranial signs (9%), isolated fever or inflammatory response (9%), and isolated polymyalgia rheumatica with vasculitis (2%). A silent LVV was found in 110 (45%) out of the 247 patients without large-vessel symptoms who underwent imaging at GCA diagnosis. Symptomatic LVV patients were more frequently GC-dependent compared to other patterns (p=0.03) and showed the longest treatment duration (median: 37 [15-212] months versus <30 months for other clinical phenotypes; p=0.001). CONCLUSIONS: This study suggests that 80% of GCA patients display a typical presentation, whereas the other 20% showed rarer presentations. Patients with symptomatic LVV required longer treatment duration.


Assuntos
Arterite de Células Gigantes , Polimialgia Reumática , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo
15.
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
16.
Autoimmun Rev ; 18(7): 714-720, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31059846

RESUMO

BACKGROUND: Age at onset of large-vessel vasculitis (LVV) is commonly used to distinguish giant cell arteritis (GCA) and Takayasu arteritis (TA). However, LVV between age 50 and 60 years may be difficult to classify. METHODS: We conducted a retrospective study including LVV aged between 50 and 60 years at onset (LVV50-60, cases) and compared them to LVV aged over 60 years (LVV>60, controls). LVV was defined histologically and/or morphologically. Controls fulfilled ACR 1990 criteria for GCA or presented isolated aortitis. RESULTS: We included 183 LVV50-60 and 183 gender-matched LVV>60. LVV50-60 had more frequent peripheral limb manifestations (23 vs. 5%), and less frequent cephalic (73 vs. 90%) and ocular signs (17 vs. 27%) than LVV>60. Compared to LVV>60, CT angiography and PET/CT scan were more frequently abnormal in LVV50-60 (74 vs. 38%, and 90 vs. 72%, respectively), with aorta being more frequently involved (78 vs. 47%). By multivariate analysis, absence of cephalic symptoms, presence of peripheral limb ischemia and aorta involvement, and increased CRP level were significantly associated with LVV50-60 presentation compared to LVV>60. At last follow-up, compared to LVV>60, LVV50-60 received significantly more lines of treatment (2 vs. 1), more frequent biologics (12 vs. 3%), had more surgery (10 vs. 0%), and had higher prednisone dose (8.8 vs. 6.5 mg/d) at last follow-up, CONCLUSION: LVV onset between 50 and 60 years identifies a subset of patients with more frequent aorta and peripheral vascular involvement and more refractory disease compared to patients with LVV onset after 60.


Assuntos
Arterite de Células Gigantes/epidemiologia , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Biochem Pharmacol ; 165: 230-239, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31034796

RESUMO

Giant cell arteritis (GCA) is the most common form of vasculitis in adults. Cranial manifestations are typical clinical features of this vasculitis. Sometimes the presenting symptoms are nonspecific and, in some cases, large-vessel involvement may prevail. Polymyalgia rheumatica is a frequent manifestation that in some cases may be the presenting symptom of GCA. Visual complications, in particular the risk of blindness, constitute the most feared manifestations of GCA. Prompt recognition of this vasculitis is required to avoid irreversible complications. Prednisone/prednisolone at a dose of 40-60 mg/day is the cornerstone therapy in GCA. Glucocorticoids lead to rapid improvement of symptoms and may reduce the risk of irreversible visual loss. However, relapses are common when the prednisone dose is tapered. Therefore, additional therapies are required in relapsing GCA or when a rapid reduction of glucocorticoids is needed. The most widely used conventional immunosuppressive drug is methotrexate Adjunctive treatment with methotrexate may decrease the risk of relapses and reduce glucocorticoid exposure. However, comprehensive reviews indicate that the efficacy of methotrexate in GCA is modest. The experience with other conventional immunosuppressive drugs in GCA patients is scarce. In some cases, the new biologic agents are required. Among them, the most frequently used is the recombinant humanized anti-IL-6 receptor antibody tocilizumab. It improves clinical symptoms, reduce the cumulative prednisone dose and the frequency of relapses in GCA patients. However, anti-tumor necrosis factor-α therapy is not useful in GCA. Promising results on other biologic agents, such as abatacept, ustekinumab or anakinra, require further confirmatory studies.


Assuntos
Fatores Biológicos/administração & dosagem , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Animais , Anticorpos Monoclonais Humanizados/administração & dosagem , Arterite de Células Gigantes/metabolismo , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/administração & dosagem , Metotrexato/administração & dosagem , Resultado do Tratamento
18.
Dtsch Med Wochenschr ; 144(9): 587-594, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-31026867

RESUMO

In Giant Cell Arteritis (GCA), a timely diagnosis is required to avoid severe complications such as blindness or structural vascular damage. The heterogeneous symptoms are mainly due to local and systemic inflammatory processes. Diagnostics are based on increased inflammation parameters in the laboratory, imaging, in which color-coded duplex sonography (FKDS), high-resolution magnetic resonance imaging (MRI), computer tomography (CT) or CT angiography (CTA) and 18F fluorodeoxyglucose-positron emission tomography with CT (FDG-PET-CT) have become established, as well as histopathological findings in temporal artery biopsy.


Assuntos
Arterite de Células Gigantes/diagnóstico , Idoso , Feminino , Arterite de Células Gigantes/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
19.
Neurol Clin ; 37(2): 335-344, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952412

RESUMO

"Giant cell arteritis (GCA) is a chronic, idiopathic, granulomatous vasculitis of medium and large arteries comprising overlapping phenotypes of cranial arteritis and extracranial GCA. Vascular complications are generally due to delay in diagnosis and initiation of effective treatment. Advancements in MRI and MR angiography, computed tomography angiography, 18fluoro-deoxyglucose/PET, and color duplex ultrasonography have led to improved diagnosis. Corticosteroids are the mainstay of therapy in GCA; however, their use is associated with predictable and occasionally serious side effects. Biological agents are effective and safe corticosteroid-sparing agents in treating GCA. This article reviews the epidemiologic, clinicopathologic features, diagnosis, and treatment of GCA."


Assuntos
Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/patologia , Arterite de Células Gigantes/terapia , Humanos
20.
BMJ Case Rep ; 12(3)2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30846454

RESUMO

Giant cell arteritis (GCA) is the most common vasculitis in adults and blindness is a common complication if left untreated. Oral glucocorticoids are the mainstay of treatment and if started promptly, loss of vision can usually be prevented. We present the case of a 77-year-old man who developed irreversible bilateral blindness after a confirmed diagnosis of GCA and oral steroid treatment. The roles of diagnostic delay, steroid dosing, significance of visual symptoms at diagnosis and after commencing oral glucocorticoids, and interpretation of ophthalmological signs are reviewed.


Assuntos
Cegueira/etiologia , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Idoso , Cegueira/diagnóstico , Cegueira/prevenção & controle , Diagnóstico Tardio/efeitos adversos , Arterite de Células Gigantes/diagnóstico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Oftalmoscópios , Resultado do Tratamento
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