Cranial giant cell arteritis mimickers: A masquerade to unveil

Evangelatos, Gerasimos; Grivas, Alexandros; Παππά, Μαρία; Kouna, Konstantina; Iliopoulos, Alexios; Fragoulis, G.

doi:10.1016/j.autrev.2022.103083

Cited by 14 publications

(13 citation statements)

References 104 publications

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“…We demonstrated that IMT values may discriminate between GCA and its mimics ( Table 4 ); however, false positive ultrasound results can be found in several diseases ( 23 ). An ultrasonographer should consider not only IMT but also the location of the pathological change ( 11 ), its structure, and echogenicity, as well as the grade of general atherosclerosis that all add to the final diagnosis of LV-GCA.…”

Section: Discussionmentioning

confidence: 84%

Intima-media thickness cut-off values depicting “halo sign” and potential confounder analysis for the best diagnosis of large vessel giant cell arteritis by ultrasonography

2022

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BackgroundVascular ultrasound enables fast-track diagnosis of giant cell arteritis (GCA), but this method remains subjective. We aimed to determine intima-media thickness (IMT) cut-off values for large vessel GCA (LV-GCA) and identify the clinically relevant factors influencing it.MethodsWe included 214 patients referred for ultrasound evaluation within a fast-track clinic due to suspected GCA. IMT was measured in axillary, brachial, subclavian, superficial femoral, and common carotid arteries (CCA), in a place without identifiable atherosclerotic plaques. IMT cut-off values for vasculitis were determined by comparing measurements in arteries classified as vasculitis vs. controls without GCA/polymyalgia rheumatica (PMR).ResultsGiant cell arteritis was diagnosed in 81 individuals, including extracranial LV-GCA in 43 individuals. Isolated PMR was diagnosed in 50 subjects. In 83 remaining patients, another diagnosis was confirmed, and they served as controls. The rounded optimal IMT cut-off values for the diagnosis of axillary vasculitis were 0.8 mm, subclavian-0.7 mm, superficial femoral-0.9 mm, CCA-0.7 mm, and brachial-0.5 mm. The IMT cut-off values providing 100% specificity for vasculitis (although with reduced sensitivity) were obtained with axillary IMT 1.06 mm, subclavian-1.35 mm, superficial femoral-1.55 mm, CCA-1.27 mm, and brachial-0.96 mm. Axillary and subclavian arteritis provided the best AUC for the diagnosis of GCA, while carotid and axillary were most commonly involved (24 and 23 patients, respectively). The presence of calcified atherosclerotic plaques was related to an increase of IMT in both patients and controls, while male sex, age ≥ 68, hypertension, and smoking increased IMT in controls but not in patients with GCA.ConclusionCut-off values for LV-GCA performed best in axillary and subclavian arteritis but expanding examination to the other arteries may add to the sensitivity of GCA diagnosis (another location, e.g., brachial arteritis) and its specificity (identification of calcified atherosclerotic plaques in other arteries such as CCA, which may suggest applying higher IMT cut-off values). We proposed a more linear approach to cut-off values with two values: one for the most accurate and the other for a highly specific diagnosis and also considering some cardiovascular risk factors.

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Section: Discussionmentioning

confidence: 84%

Intima-media thickness cut-off values depicting “halo sign” and potential confounder analysis for the best diagnosis of large vessel giant cell arteritis by ultrasonography

2022

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“…It is widely acknowledged now that negative biopsies may either result from technical irregularities (e.g., insufficient tissue size, skip lesions 13 ) or represent cases of noncranial large-vessel GCA, which is a newly recognized pathologic entity of the GCA spectrum 1 . Aiming to illustrate further the complexity of TAB interpretation, we should mention that despite false-negative results due to corticosteroid treatment exist, false-positive TAB results can also derive from other than GCA conditions 10 . The possible effects of corticosteroids in the biopsy result have been debated for decades.…”

Section: Discussionmentioning

confidence: 98%

“…1 Aiming to illustrate further the complexity of TAB interpretation, we should mention that despite false-negative results due to corticosteroid treatment exist, false-positive TAB results can also derive from other than GCA conditions. 10 The possible effects of corticosteroids in the biopsy result have been debated for decades. Reviewing past literature, the hypothesis that corticosteroids influence the biopsy result had been shaped (Table 3).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Corticosteroids on Temporal Artery Biopsy Positivity in Giant Cell Arteritis

et al. 2023

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Objective: Temporal artery biopsy (TAB) remains the standard criterion for the diagnosis of giant cell arteritis (GCA). Temporal artery biopsy is suggested to be performed within 2 weeks from the initiation of corticosteroids. However, the effects of TAB timing on the sensitivity of its findings still warrant further investigation. Methods:We reviewed the medical records of patients with GCA from a tertiary medical center in Germany over an 8-year period. Results:We analyzed data from 109 patients with a median age of 76 years and a median time from glucocorticoid treatment to TAB of 4 days. Approximately 60% of biopsies were positive. Our analysis yielded a nonsignificant trend toward shorter duration of corticosteroid treatment in the TAB(+) group ( p = 0.06). A more than 7 days' duration of steroid treatment was independently linked with lower rates of positive TAB (adjusted odds ratio, 0.33; 95% confidence interval, 0.11-1.00). Conclusion:We conclude that the duration of corticosteroid treatment seems to affect the positivity of TAB in patients with suspected GCA. Further larger studies are required to confirm the generalizability of our findings.

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“…This vasculitis, the histological appearance of which is very similar to GCA, affects large and medium arteries and can lead to stenosis, occlusion, thrombosis or dissection [ 58 , 59 ]. VZV vasculitis can also affect the temporal arteries and cause GCA-like symptoms [ 60 ]. In contrast to earlier research [ 56 , 61 , 62 , 63 , 64 , 65 , 66 ], a recent study suggested that VZV may be the triggering agent of GCA because the presence of VZV was detected in 73% of positive and 64% of negative TAB from patients with GCA, compared to only 22% of negative TAB from controls [ 67 ].…”

Section: Potential Role Of Infections In the Initiation Of Gcamentioning

confidence: 99%

New Insights into the Pathogenesis of Giant Cell Arteritis: Mechanisms Involved in Maintaining Vascular Inflammation

Greigert

Genet

Bonnotte

et al. 2022

JCM

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The giant cell arteritis (GCA) pathophysiology is complex and multifactorial, involving a predisposing genetic background, the role of immune aging and the activation of vascular dendritic cells by an unknown trigger. Once activated, dendritic cells recruit CD4 T cells and induce their activation, proliferation and polarization into Th1 and Th17, which produce interferon-gamma (IFN-γ) and interleukin-17 (IL-17), respectively. IFN-γ triggers the production of chemokines by vascular smooth muscle cells, which leads to the recruitment of additional CD4 and CD8 T cells and also monocytes that differentiate into macrophages. Recent data have shown that IL-17, IFN-γ and GM-CSF induce the differentiation of macrophage subpopulations, which play a role in the destruction of the arterial wall, in neoangiogenesis or intimal hyperplasia. Under the influence of different mediators, mainly endothelin-1 and PDGF, vascular smooth muscle cells migrate to the intima, proliferate and change their phenotype to become myofibroblasts that further proliferate and produce extracellular matrix proteins, increasing the vascular stenosis. In addition, several defects in the immune regulatory mechanisms probably contribute to chronic vascular inflammation in GCA: a defect in the PD-1/PD-L1 pathway, a quantitative and qualitative Treg deficiency, the implication of resident cells, the role of GM-CSF and IL-6, the implication of the NOTCH pathway and the role of mucosal‑associated invariant T cells and tissue‑resident memory T cells.

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Cranial giant cell arteritis mimickers: A masquerade to unveil

Cited by 14 publications

References 104 publications

Intima-media thickness cut-off values depicting “halo sign” and potential confounder analysis for the best diagnosis of large vessel giant cell arteritis by ultrasonography

Intima-media thickness cut-off values depicting “halo sign” and potential confounder analysis for the best diagnosis of large vessel giant cell arteritis by ultrasonography

The Effect of Corticosteroids on Temporal Artery Biopsy Positivity in Giant Cell Arteritis

New Insights into the Pathogenesis of Giant Cell Arteritis: Mechanisms Involved in Maintaining Vascular Inflammation

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