Update on the management of giant cell arteritis

Roberts, Janet; Clifford, Alison

doi:10.1177/2040622317700089

Cited by 17 publications

(13 citation statements)

References 82 publications

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“…Abatacept, a cytotoxic T lymphocyte-associated protein 4 fusion protein, has shown a significant increase in relapse-free survival at 12 months [11]. Ustekinumab, an anti-IL-12 and -23 monoclonal antibody, functions by inhibiting both the Th1 and Th17 pathways simultaneously, and has shown promising results in some studies [12,13].…”

Section: Discussionmentioning

confidence: 99%

High-Sensitivity C-Reactive Protein and Magnetic Resonance Imaging in Occult Giant Cell Arteritis

Mears

Feinsilber

2020

Cureus

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Giant cell arteritis (GCA) can be an elusive diagnosis and is particularly challenging to monitor during the course of treatment when traditional acute phase reactants are all normal, leaving no empirical means of monitoring. Our study aims to explore the use of more sensitive acute phase reactants and imaging in the initial evaluation and monitoring of GCA. We report the case of an 84-year-old in whom the traditional acute phase reactants were normal but who had perineuritis on imaging and whose high-sensitivity C-reactive protein (CRP) levels were elevated. In cases where the traditional measure of inflammatory activity is normal, it may be necessary to consider additional markers.

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Section: Discussionmentioning

confidence: 99%

High-Sensitivity C-Reactive Protein and Magnetic Resonance Imaging in Occult Giant Cell Arteritis

Mears

Feinsilber

2020

Cureus

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“…Determining treatment duration and rate of steroid tapering for individual patients remains a therapeutic challenge given a variable disease course, risk of relapse, the absence of valid biomarkers to evaluate response and the need to balance the risk of both disease and treatment-related adverse events 6. With a lack of consensus relating to the efficacy and safety of steroid-sparing options, it is hoped that further research will help determine efficacious and safer alternative therapies in this condition 6 7…”

Section: Discussionmentioning

confidence: 99%

Scalp ulceration: a rare manifestation of giant cell arteritis

2019

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An 81-year-old woman presented with an enlarging, tender ulcer on her scalp over an 8-week period, attributing it to a prior graze with garden shears. C-reactive protein and erythrocyte sedimentation rate were elevated at 87.7 mg/L and 112 mm/hour, respectively. Incisional biopsies demonstrated ulceration and full thickness necrosis with no evidence of malignancy. Vasculitis was suggested as a likely cause of such extensive necrosis and subsequent temporal artery biopsy findings were consistent with giant cell arteritis. The patient was initially treated with high-dose oral prednisolone and achieved complete healing of the scalp necrosis within 12 months, with a gradual down-titration of steroid therapy thereafter. Scalp necrosis is a rare, potentially life-threatening complication of giant cell arteritis. This case highlights the importance of considering scalp necrosis as a manifestation of giant cell arteritis when assessing scalp ulceration. Prompt diagnosis and treatment can prevent significant morbidity and potential mortality.

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“…Unlike in other autoimmune diseases, most steroid-sparing agents and the use of adjunct agents in GCA [MB1] are not associated with a significant improvement in outcome [ 46 , 47 ]. Tocilizumab, a humanized monoclonal antibody directed against the IL-6 receptor, has been found to improve both induction and maintenance of remission in patients with GCA for up to 12 months [ 48 ]. However, there is a large side effect profile from Tocilizumab.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal expression profiling of CD4+ and CD8+ cells in patients with active to quiescent giant cell arteritis

et al. 2018

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BackgroundGiant cell arteritis (GCA) is the most common form of vasculitis affecting elderly people. It is one of the few true ophthalmic emergencies but symptoms and signs are variable thereby making it a challenging disease to diagnose. A temporal artery biopsy is the gold standard to confirm GCA, but there are currently no specific biochemical markers to aid diagnosis. We aimed to identify a less invasive method to confirm the diagnosis of GCA, as well as to ascertain clinically relevant predictive biomarkers by studying the transcriptome of purified peripheral CD4+ and CD8+ T lymphocytes in patients with GCA.MethodsWe recruited 16 patients with histological evidence of GCA at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, and aimed to collect blood samples at six time points: acute phase, 2–3 weeks, 6–8 weeks, 3 months, 6 months and 12 months after clinical diagnosis. CD4+ and CD8+ T-cells were positively selected at each time point through magnetic-assisted cell sorting. RNA was extracted from all 195 collected samples for subsequent RNA sequencing. The expression profiles of patients were compared to those of 16 age-matched controls.ResultsOver the 12-month study period, polynomial modelling analyses identified 179 and 4 statistically significant transcripts with altered expression profiles (FDR < 0.05) between cases and controls in CD4+ and CD8+ populations, respectively. In CD8+ cells, two transcripts remained differentially expressed after 12 months; SGTB, associated with neuronal apoptosis, and FCGR3A, associatied with Takayasu arteritis. We detected genes that correlate with both symptoms and biochemical markers used for predicting long-term prognosis. 15 genes were shared across 3 phenotypes in CD4 and 16 across CD8 cells. In CD8, IL32 was common to 5 phenotypes including Polymyalgia Rheumatica, bilateral blindness and death within 12 months.ConclusionsThis is the first longitudinal gene expression study undertaken to identify robust transcriptomic biomarkers of GCA. Our results show cell type-specific transcript expression profiles, novel gene-phenotype associations, and uncover important biological pathways for this disease. In the acute phase, the gene-phenotype relationships we have identified could provide insight to potential disease severity and as such guide in initiating appropriate patient management.Electronic supplementary materialThe online version of this article (10.1186/s12920-018-0376-4) contains supplementary material, which is available to authorized users.

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Update on the management of giant cell arteritis

Cited by 17 publications

References 82 publications

High-Sensitivity C-Reactive Protein and Magnetic Resonance Imaging in Occult Giant Cell Arteritis

High-Sensitivity C-Reactive Protein and Magnetic Resonance Imaging in Occult Giant Cell Arteritis

Scalp ulceration: a rare manifestation of giant cell arteritis

Longitudinal expression profiling of CD4+ and CD8+ cells in patients with active to quiescent giant cell arteritis

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