Recent advances in our understanding of giant cell arteritis pathogenesis

Samson, Maxime; Corbera-Bellalta, Marc; Audia, Sylvain; Planas‐Rigol, Ester; Martin, Laurent; Cid, María C.; Bonnotte, Bernard

doi:10.1016/j.autrev.2017.05.014

Cited by 168 publications

(148 citation statements)

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“…Predominant Th-1/Th-17 responses were reported in cells/ tissues of GCA patients [37][38][39]. Their distinct cytokines IL-1 beta, IL-17A, TNF-alpha, and IFN-gamma were however found in low levels in sera of the GCA patients tested in the current study (Table 2); therefore, their determination using high-sensitivity assays could provide more information on whether they could be relevant serum analytes to test in the future.…”

Section: Discussionmentioning

confidence: 96%

Utility of serological biomarkers for giant cell arteritis in a large cohort of treatment-naïve patients

et al. 2018

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Early diagnosis and treatment of giant cell arteritis (GCA) is crucial for preventing ischemic complications. Multiple serological markers have been identified; however, there is a distinct lack of predicting markers for GCA relapse and complications. Our main objective was to identify serological parameters in a large cohort of treatment-naïve GCA patients, which could support clinicians in evaluating the course of the disease. Clinical data was gathered, along with analyte detection using Luminex technology, ELISA, and nephelometry, among others. Unsupervised hierarchical clustering and principal component analysis of analyte profiles were performed to determine delineation of GCA patients and healthy blood donors (HBDs). Highest, significantly elevated analytes in GCA patients were SAA (83-fold > HBDs median values), IL-23 (58-fold), and IL-6 (11-fold). Importantly, we show for the first time significantly changed levels of MARCO, alpha-fetoprotein, protein C, resistin, TNC, TNF RI, M-CSF, IL-18, and IL-31 in GCA versus HBDs. Changes in levels of SAA, CRP, haptoglobin, ESR, MMP-1 and MMP-2, and TNF-alpha were found associated with relapse and visual disturbances. aCL IgG was associated with limb artery involvement, even following adjustment for multiple testing. Principal component analysis revealed clear delineation between HBDs Blaž Burja and Julia Feichtinger shared first co-authorship, authors contributed equally to the work. Rheumatology in Slovenia: Clinical practice and translational researchElectronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-018-4240-x) contains supplementary material, which is available to authorized users. and GCA patients. Our study reveals biomarker clusters in a large cohort of patients with GCA and emphasizes the importance of using groups of serological biomarkers, such as acute phase proteins, MMPs, and cytokines (e.g. TNF-alpha) that could provide crucial insight into GCA complications and progression, leading to a more personalized disease management.

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Section: Discussionmentioning

confidence: 96%

Utility of serological biomarkers for giant cell arteritis in a large cohort of treatment-naïve patients

et al. 2018

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“…Hearing loss has been reported with a prevalence ranging from 7% to 100% in several case series of patients with GCA, a multisystemic vasculitis mainly involving large- and medium-sized blood vessels [133]. In a series of 44 patients with GCA, PTA at the time of diagnosis showed auditory dysfunction in all patients [134].…”

Section: Inner Ear Involvement In Autoimmune Diseasesmentioning

confidence: 99%

Audiovestibular Symptoms in Systemic Autoimmune Diseases

Ralli

D’Aguanno

Stadio

et al. 2018

Journal of Immunology Research

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Immune-mediated inner ear disease can be primary, when the autoimmune response is against the inner ear, or secondary. The latter is characterized by the involvement of the ear in the presence of systemic autoimmune conditions. Sensorineural hearing loss is the most common audiovestibular symptom associated with systemic autoimmune diseases, although conductive hearing impairment may also be present. Hearing loss may present in a sudden, slowly, rapidly progressive or fluctuating form, and is mostly bilateral and asymmetric. Hearing loss shows a good response to corticosteroid therapy that may lead to near-complete hearing restoration. Vestibular symptoms, tinnitus, and aural fullness can be found in patients with systemic autoimmune diseases; they often mimic primary inner ear disorders such as Menière's disease and mainly affect both ears simultaneously. Awareness of inner ear involvement in systemic autoimmune diseases is essential for the good response shown to appropriate treatment. However, it is often misdiagnosed due to variable clinical presentation, limited knowledge, sparse evidence, and lack of specific diagnostic tests. The aim of this review is to analyse available evidence, often only reported in the form of case reports due to the rarity of some of these conditions, of the different clinical presentations of audiological and vestibular symptoms in systemic autoimmune diseases.

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“…Only limited data on hospitalization rates among patients with PMR exists (1). Ultrasound (US) may be useful in differentiating PMR from non-inflammatory conditions and can also be used for the diagnosis of concomitant Giant Cell Arteritis (GCA) GCA Fast Track Clinics (FT) using US as the main diagnostic tool have shown both improvement in patient outcomes and decrease in the cost of care (2) Objectives: To investigate the admission rates of patients diagnosed with PMR and the impact of the FT on these rates. Methods: A FT clinic for patients suspected to have PMR was established at rheumatological outpatient clinic of South-West Jutland Hospital (serving 250.000inhabitants) in January 2018.…”

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confidence: 99%

“…REFERENCES:[1] Gran JT,Myklebust G. The incidence of PMR and temporal arteritis in the county of Aust Agder, South Norway: a prospective study 1987-94. J Rheumatol 1997 [2]. Diamantopoulos AP et.al.…”

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confidence: 99%

Fri0267 diagnosing Polymyalgia Rheumatica: The Impact of Fast-Track Clinic at Hospitalization Rates

Chrysidis

Giannoutsou

Lage-Hansen

et al. 2019

Poster Presentations

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BackgroundPolymyalgia Rheumatica (PMR) is a common inflammatory autoimmune rheumatic disease, with the highest incidence rates seen in Scandinavia.One of the challenges in the diagnosis of PMR is the lack of diagnostic tests specific for the disease. The diagnosis may require exclusion of other conditions that can present with polymyalgia symptoms and may lead to hospitalization. Only limited data on hospitalization rates among patients with PMR exists (1).Ultrasound (US) may be useful in differentiating PMR from non-inflammatory conditions and can also be used for the diagnosis of concomitant Giant Cell Arteritis (GCA)GCA Fast Track Clinics (FT) using US as the main diagnostic tool have shown both improvement in patient outcomes and decrease in the cost of care(2)ObjectivesTo investigate the admission rates of patients diagnosed with PMR and the impact of the FT on these rates.MethodsA FT clinic for patients suspected to have PMR was established at rheumatological outpatient clinic of South-West Jutland Hospital (serving 250.000inhabitants) in January 2018. Collaboration with the Emergency Medical department was established and patients with PMR symptoms referred to the hospital were examined at FT within 0-1 days, thereby avoiding hospitalization. Similarly, patients referred with PMR symptoms to the outpatient clinic by a GP, were examined at FT within 1-2 days. At FT a thorough history and clinical examination were performed including musculoskeletal and vascular US. Retrospectively data from patients diagnosed with PMR from 2013-2018 was analyzed.ResultsIn a 6 years’ period, 336 patients were diagnosed with PMR. 54 patients were diagnosed during hospitalization. Hospitalized patients were older (mean values ± standart deviaton-sd) 73,61±8,96 vs 70,94±7,97 years, p=0,024, with significantly higher initial C-reactive protein(CRP, mg/l) levels 99±58,8 vs 43,9±37,p<0,0001 and a shorter duration of symptoms(6,92±5,5 vs 13,6±13,7 weeks, p=0,0018). No differences were found regarding gender, PMR related symptoms, initial prednisolone dose and response to treatment. An equal annual distribution of the number of new diagnosed cases and hospitalizations rates during the first 5 years was found. After the implementation of the FT at January 2018 a significant decrease in hospitalization rates (19,4% vs 3,5% p=0,001) and inpatient days of care (4,15±3,1 vs 1±0, p<0,0001) was observed. The time from symptoms debut to diagnosis was also significantly decreased from 13, 74 to 6, 79 weeks (Table)Diagnosed at2013-2017N 268Diagnosed at2018N 56P valuesAge (years) mean ± sd71,3 ± 8,571,79 ± 6,6n.s*Gender (female)58,2%48,2%n.sDuration of symptoms (weeks) mean± sd13,74± 13,746,79 ± 4,720,001Bilateral shoulder pain95,9%98,2%n.sAbnormal CRP and/or SR at debut91,8%100%0,03CRP (mg/lt) mean± sd52,82 ± 48,3 56,5 ± 37,2n.sMorning stiffness90,3%92,7%n.sHip pain or limited range of motion71,4%61,8%n.sRF and aCCP negative95,1%100%n.sAbsence of other joint involvement72%75%n.sInitial prednisolone dose (mg) mean± sd18,44 ± 8,4119,2 ± 9,25n.sH...

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Recent advances in our understanding of giant cell arteritis pathogenesis

Cited by 168 publications

References 150 publications

Utility of serological biomarkers for giant cell arteritis in a large cohort of treatment-naïve patients

Utility of serological biomarkers for giant cell arteritis in a large cohort of treatment-naïve patients

Audiovestibular Symptoms in Systemic Autoimmune Diseases

Fri0267 diagnosing Polymyalgia Rheumatica: The Impact of Fast-Track Clinic at Hospitalization Rates

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