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1.
Praxis (Bern 1994) ; 110(6): 285-292, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33906446

RESUMO

CME: Giant Cell Arteritis Abstract. Giant cell arteritis (GCA) is the most common vasculitis among patients over the age of 50. Mainly large vessels are targeted. GCA can be differentiated into cranial and extra-cranial types; thus the symptoms can range from headache, blurred vision and jaw claudication to non-specific symptoms like fatigue, polymyalgia and fever. Complications such as an irreversible loss of vision are critical, which is why timeous diagnosis and treatment are essential. There are some recommendations for treatment, but no defined guidelines exist. Steroids have been the standard treatment for the past six decades and remain so, but side effects are common. Tocilizumab represents an alternative and more effective and safer treatment.


Assuntos
Arterite de Células Gigantes , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides , Cefaleia , Humanos , Mialgia , Transtornos da Visão
2.
J Stroke Cerebrovasc Dis ; 30(4): 105601, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33497936

RESUMO

OBJECTIVES: The diagnosis of giant cell arteritis (GCA) is based on the presence of clinical and laboratory features. Color-duplex sonography (CDS) may supplant the limited sensitivity of temporal artery biopsy. The aim of our work was to characterize clinical and laboratory findings in patients with positive CDS for GCA. MATERIALS AND METHODS: Retrospective study of all consecutive patients of our center fulfilling American College of Rheumatology criteria for GCA who performed CDS study between 2009-2019. Data on clinical and laboratory features were compared in two groups: with and without halo sign. RESULTS: Ninety-one patients were included. Temporal halo sign was identified in 46% of patients. Halo sign was more often present in older patients (77 ± 8 vs 73 ± 8 years, p = 0.022), associated with systemic features (58% vs 42%, p = 0.011), higher erythrocyte sedimentation rate (84 ± 26 vs 74 ± 34 mm/hour, p = 0.020), and lower hemoglobin values (10.9 ± 1.5 vs 12.1 ± 1.6 g/dL, p < 0.001). The number of patients under corticosteroids before CDS was higher in the group without halo (62% vs 33%, p = 0.005). Ischemic stroke occurred in 17 patients (19%), 76% in the vertebrobasilar territory, and stroke was associated with vertebral halo sign (p < 0.001). CONCLUSIONS: Halo sign was present in half of our patients. Previous corticosteroids treatment decreased positive CDS findings. Systemic symptoms and laboratory findings are more notorious in halo sign subgroup of patients. Stroke cases in GCA patients disproportionally affected the posterior circulation. Ultrasonography provides information about a more pronounced systemic involvement and a higher risk of major complications.


Assuntos
Arterite de Células Gigantes/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler Transcraniana , Corticosteroides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/patologia , Humanos , /etiologia , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Artérias Temporais/patologia
4.
Z Rheumatol ; 80(2): 176-179, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33351160

RESUMO

The revised S2 guidelines for treatment of giant cell arteritis have recently been published. Glucocorticosteroids remain the standard first line treatment. For severe or relapsing courses of the disease, the IL­6 antagonist tocilizumab, a potent antibody, is now available as a therapeutic option; however, how long this treatment should be continued after having achieved a stable remission remains a matter of discussion. For patients with a complicated course and a high risk of relapse, a continuous treatment would be the safest way; however, with a milder course of disease for approximately half of the patients, treatment without relapse can be discontinued again.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Células Gigantes , Anticorpos Monoclonais Humanizados/efeitos adversos , Quimioterapia Combinada , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/efeitos adversos , Humanos , Resultado do Tratamento
7.
J Neuroophthalmol ; 40(3): 305-314, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32804456

RESUMO

The initiation and continuation of immune-based therapies to treat and prevent complications of inflammatory neuro-ophthalmologic disorders during the 2019 novel coronavirus (COVID-19) pandemic is the subject of considerable debate. In each case, a treatment decision must be reached based on best clinical practices for the disorder, patient comorbidities, the current state of knowledge about the pathogenesis and infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the utilization of hospital and community resources. Unfortunately, the evidence needed to standardize the decision-making process for each neuro-ophthalmologic disorder is currently absent and is likely to require months or years to develop based on the accrual of robust international data sets. In this article, we review the current understanding of SARS-CoV-2 and COVID-19 complications to provide a framework for approaching the treatment of inflammatory neuro-ophthalmic disorders during the COVID-19 viral pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Oftalmopatias/tratamento farmacológico , Inflamação/tratamento farmacológico , Doenças do Sistema Nervoso/tratamento farmacológico , Pandemias , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/imunologia , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Imunomodulação , Imunossupressores/uso terapêutico , Miastenia Gravis/tratamento farmacológico , Neurite Óptica/tratamento farmacológico , Pneumonia Viral/imunologia
8.
FP Essent ; 494: 25-29, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32640151

RESUMO

Polymyalgia rheumatica (PMR) is a chronic systemic inflammatory disease that is common in individuals older than 70 years. Classic symptoms of PMR include pain in the neck, pelvic girdle, and shoulders. Morning stiffness that lasts at least 30 minutes is typical. Glucocorticoids are the mainstay of PMR management, and prednisone 12.5 to 25 mg/day or equivalent is recommended. Giant cell arteritis is a comorbidity of PMR. Dermatomyositis is a rare, idiopathic inflammatory myopathy characterized by erythematous skin lesions and inflammation of skeletal muscles. Dermatomyositis manifests as proximal muscle weakness and fatigue that occurs when patients rise from a seated position, walk, climb stairs, or lift objects. It is a systemic condition and also may affect joints, the esophagus, and lungs. Prednisone is started at a dose of 60 mg/day and then tapered slowly, based on response, to prevent recurrence. Dermatomyositis may be associated with malignancy.


Assuntos
Dermatomiosite , Arterite de Células Gigantes , Polimialgia Reumática , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Diagnóstico Diferencial , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides , Humanos , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamento farmacológico , Prednisona
9.
Int J Clin Pharmacol Ther ; 58(9): 504-510, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32567545

RESUMO

OBJECTIVE: This study assessed the efficacy and safety of biological agents in patients with giant cell arteritis (GCA). MATERIALS AND METHODS: A meta-analysis of 6 randomized clinical trials (RCTs) (260 patients and 193 controls) to examine the efficacy and safety of tocilizumab, tumor necrosis factor (TNF) inhibitors, and abatacept relative to that of placebo in GCA patients was performed. RESULTS: The remission rate was significantly higher for tocilizumab-treated patients than that for placebo-treated controls (odds ratio (OR) 7.009, 95% confidence interval (CI) 3.854 - 12.75, p < 0.001). In addition, the relapse rate was significantly lower for the tocilizumab group than that for the placebo group (OR 0.222, 95% CI 0.129 - 0.381, p < 0.001). Further, no significant difference in remission and relapse was observed between groups treated with TNF inhibitors, abatacept, and placebo. The number of serious adverse events (SAEs) was significantly lower in tocilizumab-treated patients than that in placebo-treated controls (OR 0.539, 95% CI 0.296 - 0.982, p = 0.044). However, there was no significant difference in SAEs among patients treated with TNF inhibitors, abatacept, and placebo. The infection rate was significantly higher in TNF inhibitor-treated patients than in those treated with placebo (OR 2.407, 95% CI 1.168 - 4.960, p = 0.017), while there was no significant difference in infection rate between individuals treated with tocilizumab, abatacept, and placebo. CONCLUSION: Tocilizumab was found to be more effective than placebo in GCA patients, but TNF inhibitors and abatacept were not. Further, TNF inhibitors were associated with a higher risk of infection.


Assuntos
Arterite de Células Gigantes , Abatacepte/efeitos adversos , Antirreumáticos/uso terapêutico , Fatores Biológicos/uso terapêutico , Terapia Biológica , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Z Rheumatol ; 79(6): 516-522, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32399619

RESUMO

Glucocorticoids (GC) represent the standard treatment in remission induction and maintenance in the treatment of giant cell arteritis (GCA). Additive immunosuppressants are currently only recommended in special situations, such as refractory or relapsing disease or in cases of glucocorticoid-induced side effects. Methotrexate has been the standard steroid-sparing agent for many years. Meanwhile, tocilizumab is the first choice for steroid reduction, which was the first biological to be licensed for the treatment of GCA; however, long-term data over more than 3 years are lacking. A number of promising bDMARD and tsDMARD are currently being investigated in randomized controlled trials (RCT), which could contribute to additional effective steroid-sparing options in the treatment of GCA and help to establish an additive GC-sparing medication as the standard treatment in the future. This article gives an overview on current treatment studies for GCA.


Assuntos
Arterite de Células Gigantes/tratamento farmacológico , Imunossupressores/uso terapêutico , Indução de Remissão , Anticorpos Monoclonais Humanizados/uso terapêutico , Glucocorticoides , Humanos , Metotrexato , Resultado do Tratamento
12.
Praxis (Bern 1994) ; 109(5): 347-354, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32233763

RESUMO

Polymyalgia rheumatica and Giant Cell Arteritis - Update on Diagnosis and Therapy Abstract. Polymyalgia rheumatica (PMR) is an inflammatory syndrome which often co-incides with giant cell arteritis (GCA). Due to unspecific symptoms and a plethora of possible alternative diagnoses, PMR often represents a diagnostic challenge. The use of ultrasound, but also other imaging methods has improved and accelerated the time to diagnosis in PMR and GCA, so that complications such as blindness can be reduced. Glucocorticoids are still the main initial therapy for both diseases. Although further research is needed concerning prevention of and screening for long term complications for GCA, the efficacy of biologicals, namely tocilizumab, has markedly increased therapeutic options for GCA and allows for a reduction of side effects.


Assuntos
Produtos Biológicos , Arterite de Células Gigantes , Polimialgia Reumática , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides , Humanos , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/tratamento farmacológico , Síndrome
13.
Rev Med Suisse ; 16(685): 487-491, 2020 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-32167250

RESUMO

Targeted therapies are nowadays commonly used in connective tissue diseases and vasculitis. Experts recommend the use of belimumab and rituximab in refractory and/or severe cases of lupus. Rituximab can be also considered in difficult to treat cases of Sjögren's disease or myositis. Nintedanib seems a very promising weapon in the management of systemic sclerosis-associated pulmonary fibrosis. Regarding vasculitis, rituximab has become the preferred treatment for granulomatosis with polyangiitis and microscopic polyangiitis. Finally, tocilizumab is recommended as a steroid-sparing agent in giant cell arteritis. Further clinical trials are warranted to study the efficacy of other targeted therapies in connective tissue diseases and vasculitis.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Doenças do Tecido Conjuntivo/tratamento farmacológico , Rituximab/uso terapêutico , Vasculite/tratamento farmacológico , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Miosite/tratamento farmacológico , Síndrome de Sjogren/tratamento farmacológico
14.
J Headache Pain ; 21(1): 28, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183689

RESUMO

BACKGROUND AND AIM: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. METHODS: The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience. RESULTS: Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA. CONCLUSION: The present article will outline recent advances made in the diagnosis and management of GCA.


Assuntos
Arterite de Células Gigantes/tratamento farmacológico , Neurologistas , Anticorpos Monoclonais Humanizados/uso terapêutico , Diagnóstico Tardio , Europa (Continente) , Glucocorticoides/uso terapêutico , Cefaleia/tratamento farmacológico , Humanos , Polimialgia Reumática , Guias de Prática Clínica como Assunto
15.
Z Rheumatol ; 79(2): 175-185, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32078029

RESUMO

Patients with untreated active giant cell arteritis (GCA) are at high risk of permanent vision loss. Therefore, treatment with glucocorticoids should be immediately initiated at an initial dose of 40-60 mg prednisolone equivalent dose per day. Once remission is achieved, the prednisolone dose should be reduced to 15-20 mg within 2-3 months and then to ≤5 mg per day within 1 year. Glucocorticoid-sparing treatment with tocilizumab or alternatively methotrexate should be initiated in patients with an increased risk or pre-existing complications of glucocorticoid treatment and patients with relapse. In polymyalgia rheumatica, prednisolone dosages of 15-25 mg/day are sufficient. After achieving remission, the dose should then be reduced to 10 mg within 4-8 weeks and then to 1 mg per month thereafter. Glucocorticoid-sparing treatment with methotrexate should be initiated in patients with an increased risk or existing complications of glucocorticoid treatment, relapse or increased glucocorticoid requirements.


Assuntos
Arterite de Células Gigantes , Glucocorticoides/uso terapêutico , Polimialgia Reumática , Esquema de Medicação , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Metotrexato , Polimialgia Reumática/tratamento farmacológico
16.
Rev Med Suisse ; 16(676-7): 12-15, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961075

RESUMO

Giant cell arteritis (GCA) is the most common vasculitis in adults over 50 years, which requires an urgent treatment with corticosteroids to reduce ischemic complications. Because of their side-effects, a valid diagnosis is necessary. Histological confirmation remains the gold-standard but non-invasive imaging along specific clinical criteria can nowadays diagnose GCA, particularly temporal artery ultrasound. Alternatives to corticosteroids are being studied and recently, the addition of tocilizumab to corticosteroids has been validated by international institutions and is approved by Swissmedic. Similarly to tocilizumab, methotrexate has been shown to decrease the total dose of corticosteroids and the number of relapses. We will also discuss newer potential therapies (abatacept and ustekinumab).


Assuntos
Arterite de Células Gigantes , Abatacepte/uso terapêutico , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Metotrexato/uso terapêutico , Ultrassonografia
18.
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
19.
Clin Exp Rheumatol ; 38(3): 436-441, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31858957

RESUMO

OBJECTIVES: To investigate clinical and laboratory prognostic factors of remission after one year of follow-up in patients with polymyalgia rheumatica (PMR) treated with low-dose prednisone. METHODS: In this observational study, in a monocentric Italian Rheumatology Unit, we enrolled eighty-one consecutive PMR patients. Clinical and laboratory tests were performed every 3 months. Clinical remission was defined as the lack of symptoms, while laboratory remission was defined as erythrocyte sedimentation rate ≤40 mm/h and C-reactive protein (CRP) ≤0.5 mg/dl. RESULTS: Thirty-eight patients reached complete (clinical and laboratory) remission after 12 months of follow-up. A significant lower percentage of complete remission was seen in female gender compared to male (33.9 % vs. 78.2%, p=0.0001) at univariate analysis. No significant differences were found at baseline according to response to therapy during follow-up, while CRP values at the sixth month were significantly lower in patients who reached complete remission after one year (median: 0.4 mg/dl vs. 1 mg/dl, p=0.017). CRP<0.5 mg/dl at 6 months was independently associated with complete remission at 12 months in the multivariate analysis. CONCLUSIONS: The sixth month of therapy is a target for the management of PMR because it can help to identify patients at greater risk of exacerbations, who may benefit from a tighter follow-up and more aggressive therapeutic strategy. Higher CRP values at 6 months appear to be associated with a higher risk of longer steroid therapy.


Assuntos
Arterite de Células Gigantes/diagnóstico , Polimialgia Reumática/diagnóstico , Sedimentação Sanguínea , Proteína C-Reativa/análise , Feminino , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Masculino , Polimialgia Reumática/tratamento farmacológico , Prednisona/uso terapêutico , Prognóstico , Indução de Remissão
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