Lumpers and Splitters: Ongoing Issues in the Classification of Large Vessel Vasculitis

Grayson, Peter C.

doi:10.3899/jrheum.141376

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…The high prevalence of large-vessel involvement in GCA has led to speculation that TAK and GCA may exist on a single disease spectrum (5)(6)(7). Previous studies using hierarchical agglomerative partitioning have shown that large-vessel involvement within an individual patient is similar for TAK and GCA, because arterial disease in both diseases tends to be contiguous in the aorta and symmetric in paired arteries (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis

Gribbons

Ponte

Carette

et al. 2020

Arthritis Care & Research

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Objective. To identify and validate, using computer-driven methods, patterns of arterial disease in Takayasu arteritis (TAK) and giant cell arteritis (GCA). Methods. Patients with TAK or GCA were studied from the Diagnostic and Classification Criteria for Vasculitis (DCVAS) cohort and a combined North American cohort. Case inclusion required evidence of large-vessel involvement, defined as stenosis, occlusion, or aneurysm by angiography/ultrasonography, or increased 18 F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) in at least 1 of 11 specified arterial territories. K-means cluster analysis identified groups of patients based on the pattern of arterial involvement. Cluster groups were identified in the DCVAS cohort and independently validated in the North American cohort. Results. A total of 1,068 patients were included (DCVAS cohort: TAK = 461, GCA = 217; North American cohort: TAK = 225, GCA = 165). Six distinct clusters of patients were identified in DCVAS and validated in the North American cohort. Patients with TAK were more likely to have disease in the abdominal vasculature, bilateral disease of the subclavian and carotid arteries, or focal disease limited to the left subclavian artery than GCA (P < 0.01). Patients with GCA were more likely to have diffuse disease, involvement of bilateral axillary/subclavian arteries, or minimal disease without a definable pattern than TAK (P < 0.01). Patients with TAK were more likely to have damage by angiography, and patients with GCA were more likely to have arterial FDG uptake by PET without associated vascular damage. Conclusion. Arterial patterns of disease highlight both shared and divergent vascular patterns between TAK and GCA and should be incorporated into classification criteria for large-vessel vasculitis.

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Section: Introductionmentioning

confidence: 99%

Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis

Gribbons

Ponte

Carette

et al. 2020

Arthritis Care & Research

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“…The incidence of large-artery involvement in GCA varies based on timing of imaging acquisition relative to disease onset and initiation of treatment. Incidence also varies depending upon the imaging modality used to screen for disease (angiography 20-30%, positron emission tomography 30-80%, ultrasound 30%) [29]. Despite these estimates, there are no current guidelines regarding the need for screening for large-artery disease in GCA, and reliance on the vascular physical examination to screen for large artery involvement will miss a significant burden of arteriographic disease [30].…”

Section: Suspected Tak or Gca With Predominantly Large-artery Involvementmentioning

confidence: 99%

The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis

Quinn

Grayson

2019

Curr Treat Options in Rheum

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Purpose of the Review: The two main forms of large-vessel vasculitis (LVV) are giant cell arteritis (GCA) and Takayasu's arteritis (TAK). Vascular imaging can characterize disease activity and disease extent in LVV. This review critically analyzes the clinical utility of vascular imaging in LVV and highlights how imaging may be incorporated into the management and study of these conditions.Recent Findings: There are multiple imaging modalities available to assess LVV including ultrasonography, CT angiography (CTA), magnetic resonance angiography (MRA), and 18 Ffluorodeoxyglucose (FDG) positron emission tomography (PET). As these techniques are refined, imaging may be increasingly useful to evaluate the cranial arteries and the aorta and its primary branches. In addition, vascular imaging may be useful to monitor disease activity and may have prognostic value to predict future clinical events.Summary: There are strengths and weaknesses associated with vascular imaging that should be considered when evaluating patients with LVV. Vascular imaging will likely play an increasingly important role in the clinical management of patients and the conduct of research in LVV and may ultimately be incorporated as outcome measures in clinical trials in these conditions.

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“…Thus, depending on how these diseases are classified, they can be conceptualized as either two distinct vasculitides which have a predilection for different age groups or as variations of the same disease, i.e., large vessel vasculitis. [ 9 24 ]…”

Section: Introductionmentioning

confidence: 99%

Giant cell arteritis versus Takayasu's Arteritis

Mortensen,

Raviskanthan,

Chévez-Barrios

et al. 2021

Saudi Journal of Ophthalmology

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There are multiple vasculitides which are distinguished based on multiple criteria, including size of affected vessels, distribution of vessels affected, histopathologic differences, genetic factors, and age at presentation. Takayasu's arteritis (TkA) and giant cell arteritis (GCA) are the two main medium to large vessel vasculitides. These vasculitides are associated with different racial predilections, vascular distributions, age groups, diagnostic criteria, and treatments. Nevertheless, the many shared histopathologic features, genetic factors, and overlap in presentation of these two diseases suggest that they may actually be variable presentations of the same disease process, i.e., large vessel vasculitis. This article will review the genetics, histopathology, disease mechanisms, and diagnostic criteria for both TkA and GCA. Overall, despite major advances our understanding of these two diseases, it is still debated whether these two large vessel vasculitides represent two distinct diseases processes or simply variations of the same disease.

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Lumpers and Splitters: Ongoing Issues in the Classification of Large Vessel Vasculitis

Cited by 8 publications

References 22 publications

Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis

Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis

The Role of Vascular Imaging to Advance Clinical Care and Research in Large-Vessel Vasculitis

Giant cell arteritis versus Takayasu's Arteritis

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