Subclavian and axillary involvement in temporal arteritis and polymyalgia rheumatica

Ninet, J.; Bachet, P.; Dumontet, Charles; Colombier, Pascale Bureau Du; Stewart, Morris Doublet; Pasquier, J.

doi:10.1016/0002-9343(90)90121-s

Cited by 61 publications

(5 citation statements)

References 11 publications

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“…Limb claudication is one of the most frequent symptoms, although sometimes remaining poorly symptomatic ( 56 ). Vascular limb manifestations accompany or often reveal general symptoms in ~30–40% of patients ( 56 – 59 ). In half of cases, vascular symptoms appear after treatment initiation ( 56 ).…”

Section: Resultsmentioning

confidence: 99%

“…Vascular limb manifestations accompany or often reveal general symptoms in ~30–40% of patients ( 56 – 59 ). In half of cases, vascular symptoms appear after treatment initiation ( 56 ). Local vascular relapses (stenosis) may occur at the end of the treatment ( 56 ).…”

Section: Resultsmentioning

confidence: 99%

“…In half of cases, vascular symptoms appear after treatment initiation ( 56 ). Local vascular relapses (stenosis) may occur at the end of the treatment ( 56 ). Except in rare cases showing dramatic improvement of stenosis, the resolution of symptoms does not generally accompany arteriographic improvement of stenosis and results from the development of artery collaterals ( 56 , 57 ).…”

Section: Resultsmentioning

confidence: 99%

“…Local vascular relapses (stenosis) may occur at the end of the treatment ( 56 ). Except in rare cases showing dramatic improvement of stenosis, the resolution of symptoms does not generally accompany arteriographic improvement of stenosis and results from the development of artery collaterals ( 56 , 57 ). Unlike other types of vasculitis, gangrene is not a common feature of GCA ( 7 ), which suggests that lesions of the distal bed or emboli are not involved.…”

Section: Resultsmentioning

confidence: 99%

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Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Bonnan,

Debeugny

2023

Front. Neurol.

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Stroke is a rare and severe complication of giant cell arteritis (GCA). Although early diagnosis and treatment initiation are essential, the mechanism of stroke is often related to vasculitis complicated by arterial stenosis and occlusion. Its recurrence is often attributed to early steroid resistance or late GCA relapse, so immunosuppressive treatment is often reinforced. However, many questions concerning the mechanisms of stroke remain elusive, and no review to date has examined the whole data set concerning GCA-related stroke. We therefore undertook this scoping review. GCA-related stroke does not necessarily display general signs and inflammatory parameters are sometimes normal, so clinicians should observe caution. Ischemic lesions often show patterns predating watershed areas and are associated with stenosis or thrombosis of the respective arteries, which are often bilateral. Lesions predominate in the siphon in the internal carotid arteries, whereas all the vertebral arteries may be involved with a predominance in the V3-V4 segments. Ultrasonography of the cervical arteries may reveal edema of the intima (halo sign), which is highly sensitive and specific of GCA, and precedes stenosis. The brain arteries are spared although very proximal arteritis may rarely occur, if the patient has microstructural anatomical variants. Temporal artery biopsy reveals the combination of mechanisms leading to slit-like stenosis, which involves granulomatous inflammation and intimal hyperplasia. The lumen is sometimes occluded by thrombi (<15%), suggesting that embolic lesions may also occur, although imaging studies have not provided strong evidence for this. Moreover, persistence of intimal hyperplasia might explain persisting arterial stenosis, which may account for delayed stroke occurring in watershed areas. Other possible mechanisms of stroke are also discussed. Overall, GCA-related stroke mainly involves hemodynamic mechanisms. Besides early diagnosis and treatment initiation, future studies could seek to establish specific preventive or curative treatments using angioplasty or targeting intimal proliferation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Bonnan,

Debeugny

2023

Front. Neurol.

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“…Известно, что основными жалобами при ГКА являются впервые возникшая головная боль [32], нарушение зрения, боль в челюсти при жевании, реже встречаются перемежающаяся хромота конечностей, отсутствие пульса на периферических артериях [33,34]. До половины пациентов отмечают конституциональные симптомы, такие как лихорадка, недомогание, депрессия, анорексия и потеря веса [35].…”

Section: рис 2 безрецидивная выживаемость (метод каплана -мейера): це...unclassified

Clinical manifestations and prognosis of giant cell arteritis: A retrospective cohort study

Filatova,

Bulanov,

Meshkov

et al. 2023

Naučno-praktičeskaâ revmatologiâ

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The aim of the study was to evaluate the clinical manifestations and survival of patients with giant cell arteritis (GCA).Methods. A retrospective study included 166 patients with newly diagnosed GCA. Clinical, laboratory and instrumental data, three sets of classification criteria were used to confirm the diagnosis: the American College of Rheumatology (ACR) 1990, the revised ACR criteria of 2016 and/or the new ACR and European Alliance of Associations for Rheumatology (EULAR) 2022 criteria. Some of the patients underwent instrumental investigations: temporal artery ultrasound Doppler (n=61), contrast-enhanced computed tomography (CT) (n=5), CT angiography (n=6), magnetic resonance imaging (n=4), magnetic resonance angiography (n=3) and 18F-FDG positron emission tomography/CT (n=47). Overall and recurrence-free survival were analyzed using survival tables, Kaplan – Meier method.Results. The most frequent first manifestations of GCA were headache (81.8%), weakness (64%), fever (63.8%) and symptoms of rheumatic polymyalgia (56.6%). Changes of temporal arteries in color duplex scanning were detected in 44 out of 61 patients. GCs therapy was performed in all patients who agreed to be treated (n=158), methotrexate was used in 49 out of 158 patients, leflunomide – in 9 patients. In 45 (28.5%) out of 158 patients a stable remission was achieved as a result of GCs monotherapy, in 120 (75.9%) patients long-term maintenance therapy with GCs was required to prevent exacerbations, including 71 (44.9%) patients – in combination with methotrexate or other immunosuppressive drugs. The follow-up period of patients with a history of relapses was 21.0 (8.0–54.0) months. Relapses developed in 73 (46.2%) patients. The overall one-year survival rate was 97.1% [95% confidence interval (CI): 94.3; 99.9], and the five-year survival rate of patients was 94.6% [95% CI: 90.2; 99.0]. The one-year relapse-free survival rate was 86.4% [95% CI: 80.5; 92.3], and the five-year relapse-free survival rate was 52.4% [95% CI: 42.0; 62.8]. 12 (7.2%) of 166 patients died. The cause of death was myocardial infarction in two patients, stroke in two patients, and breast cancer in one patient; in the remaining seven cases, the cause of death was not determined.Conclusion. Given the high frequency of disease exacerbation, patients with GCA require long-term follow-up, especially during the first year after diagnosis.

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Giant cell arteritis and cardiovascular risk factors: A multicenter, prospective case-control study

Duhaut

Pinède

Demolombe-Ragué

et al. 1998

Arthritis & Rheumatism

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Subclavian and axillary involvement in temporal arteritis and polymyalgia rheumatica

Cited by 61 publications

References 11 publications

Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Giant-cell arteritis related strokes: scoping review of mechanisms and rethinking treatment strategy?

Clinical manifestations and prognosis of giant cell arteritis: A retrospective cohort study

Giant cell arteritis and cardiovascular risk factors: A multicenter, prospective case-control study

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