Spectrum of Aortic Disease in the Giant Cell Arteritis Population

Kebed, Daniel T.; Bois, John P.; Connolly, Heidi M.; Scott, Christopher G.; Bowen, Juan M.; Warrington, Kenneth J.; Makol, Ashima; Greason, Kevin L.; Schaff, Hartzell V.; Anavekar, Nandan S.

doi:10.1016/j.amjcard.2017.11.011

Cited by 31 publications

(11 citation statements)

References 36 publications

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“…On the other hand, MRA, although time-consuming and expensive, is essential for the assessment of intracranial arteries and vessel wall, as well as in the monitoring of the common, and unpredictable, onset of long-term vascular complications (e.g. aneurysms and stenosis) [ 17 ], as mentioned in EULAR recommendations.…”

Section: Discussionmentioning

confidence: 99%

The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis

Conticini

Sota

Falsetti

et al. 2020

Mediators of Inflammation

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Introduction. Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients. Monitoring GCA activity during tocilizumab (TCZ) treatment is an unmet need, since low serum levels of C-reactive protein (CRP) during treatment may underestimate disease activity. To date, few data are available on the role of different imaging techniques in monitoring GCA activity and response to treatment. We report herein a cohort of GCA patients treated with TCZ and followed up with multimodal imaging. Patients and Methods. We collected clinical, laboratory, and imaging data of 11 GCA patients treated with TCZ 162 mg subcutaneously every week. Disease activity was assessed at baseline and within 12 months from the start of treatment using different imaging techniques such as color Doppler ultrasonography (CDUS), magnetic resonance imaging/angiography (MRI/MRA), computed tomography angiography (CTA), and/or positron emission tomography (PET). Results. Four patients were affected by cranial and 7 by LV-GCA. All patients were treated with oral glucocorticoids (GCs) (mean dose 55.68 mg±8.19 of prednisone or equivalent) in combination with TCZ. Treatment was preceded in 5 cases by 3 intravenous boluses of 1000 mg methylprednisolone. A significant decrease of the mean dose of oral GCs was observed between baseline and the last follow-up visit (4.65±3.69 mg) (p=0.003). TCZ treatment significantly decreased erythrocyte sedimentation rate (p<0.01) and CRP levels (p<0.01). At follow-up (mean 8.18±3.63 months), all patients were in clinical and serological remission. Moreover, PET, CDUS, MRI/MRA, and CTA did not show any LVV finding. Conclusions. Our study highlights TCZ efficacy in inducing GCA remission and its steroid-sparing effect. We highlighted a reliability of imaging procedures in the evaluation of disease activity and treatment response. A close disease monitoring with imaging techniques should be taken into account in GCA patients during TCZ treatment.

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Section: Discussionmentioning

confidence: 99%

The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis

Conticini

Sota

Falsetti

et al. 2020

Mediators of Inflammation

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“…Aortic dilation or aneurism occurred habitually on an aorta segment shown to be inflammatory on previous imaging in 94% of patients (29). Also, aortic dissection, which is the most severe clinical condition that involves the aorta, occur in 6 to 24% of patients having an aneurysm (33,(39)(40)(41)(42). Finally, even if aortic complications were shown to be maximal within the first 5 years after diagnosis, it continues to occur over time (35,41,43,44).…”

Section: Discussionmentioning

confidence: 99%

Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years

Delaval

Daumas²,

Samson

et al. 2019

Autoimmunity Reviews

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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.

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“…Different imaging modalities have been used, including ultrasonography, 18 F‐fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F‐FDG PET/CT), CT angiography, and magnetic resonance angiography . Aortic inflammation may eventually lead to the development of aortic aneurysms and dissection in patients with GCA . Little is known about the factors predictive of these late complications in GCA, although a recent study indicated that subclavian artery dilatation at diagnosis is associated with a higher risk of aortic aneurysms in GCA patients .…”

Section: Evidence For Distinct Gca Subsets Based On Clinical Featuresmentioning

confidence: 99%

Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?

Geest

Sandovici

Sleen

et al. 2018

Arthritis & Rheumatology

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Giant cell arteritis (GCA) is an autoimmune vasculitis affecting large and medium‐sized arteries. Ample evidence indicates that GCA is a heterogeneous disease in terms of symptoms, immune pathology, and response to treatment. In the current review, we discuss the evidence for disease subsets in GCA. We describe clinical and immunologic characteristics that may impact the risk of cranial ischemic symptoms, relapse rates, and long‐term glucocorticoid requirements in patients with GCA. In addition, we discuss both proven and putative immunologic targets for therapy in patients with GCA who have an unfavorable prognosis. Finally, we provide recommendations for further research on disease subsets in GCA.

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Spectrum of Aortic Disease in the Giant Cell Arteritis Population

Cited by 31 publications

References 36 publications

The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis

The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis

Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years

Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?

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Spectrum of Aortic Disease in the Giant Cell Arteritis Population

Cited by 31 publications

References 36 publications

The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis

The Role of Multimodality Imaging in Monitoring Disease Activity and Therapeutic Response to Tocilizumab in Giant Cell Arteritis

Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years

Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?

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Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years