Гігантоклітинний Артеріїт: Епідеміологія, Діагностика, Прогноз

Нетяженко, В.З.; Puzanova, O.G.

doi:10.22141/2224-1507.9.2.2019.172121

Cited by 3 publications

(10 citation statements)

References 82 publications

(140 reference statements)

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“…In 2018, the FDG-PET/CT(A) use for detection of large vessel vasculitis attending the refractory PMR (either with constitutional or extracranial symptoms predominating in the clinical picture) was launched by Mayo Clinic (USA), along with CT -and MRI-angiography. Koster M. J. et al offered a diagnostic algorithm, which took account of GCA's clinical likelihood and such an option as ultrasonography and/or temporal artery biopsy [46][47]. The 2020 Italian clinical practice guidelines recommended the use of CT-angiography only in conjunction with FDG-PET.…”

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Puzanova¹

2021

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At the beginning of the Healthy Ageing Decade, a number of guidelines were published describing management of the rheumatic diseases of the elderly. The aim of the paper is to characterize and discuss the Italian Society of Rheumatology’s guideline for polymyalgia rheumatica (2020) and the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology’s (2018) recommendation for positron-emission tomography/computed tomography imaging to diagnose the large vessel vasculitis and polymyalgia rheumatica. The following methods were used: original texts of recommedations, their content and methodology behind the development of both guidelines were studied by means of information analysis and compared with the recommendations for the management of polymyalgia rheumatica and giant cell arteritis elaborated in 2018–2020 by the European League Against Rheumatism, American College of Rheumatology; the German, Austrian, Swiss and British rheumatological societies; the European Headache Federation and their references. We’ve established the priority of consensus approach for the development of modern guidelines for polymyalgia rheumatica. The specific feature of the Italian guideline’s development is the search for prototypes restricted to the two evidence-based medicine databases and the grey literature as well as selection of three international guidelines for adaptation, one of them elaborated by the societies for nuclear medicine. The following issues were updated: the patient management in primary care (whose algorithm is proposed), including the conserted clinical decision-making and alertness to the giant cell arteritis. Out of the first-line therapy tools, only the initial doses of glucocorticoids are evidence-based, and their reduction is allowed as an alternating regimen. The ineffectiveness of hydroxichloroquine use is justified, while both azathioprine and alternative medical drugs are not subject to discussion. It is necessary to identify the risk factors for vasculitis and its relapses, longterm glucocorticoid use and their side effects. For the first time, the use of positron-emission tomography/computed tomography is recommended for detecting of vasculitis. The recommendation for adjuvant therapy with methotrexate and abstaining from the biologic agents is found the most evidence-based, strongest and consistent; referral to a rheumatologist being the least agreed-on position. Conclusion. Solving such an urgent healthcare problem as improving the quality of polymyalgia rheumatic management suggests the medical standards being raised on the most clinically important issues, the importance of at-risk patient identification and referral to rheumatologists and ophthalmologists, and consideration of the methotrexate’s benefits.

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Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Puzanova¹

2021

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“…According to Lensen K.D. et al [11], the clinical GCA range includes "classical" cranial, isolated giant vessel and mixed subtypes. In agreement with Dejaco C., Koster M.J. et al [26] offer their own list of clinical differential-diagnostic PMR signs and symptoms and primary GCA subtypes (Table 2).…”

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

“…The GCA aortitis is associated with an elevated risk of aneurysm and acute aortic syndrome's developing due to thoracic aortic rupture or dissection [11][12][13]. The pathogenesis of ascending aorta's dilatation is attributed to the inflammation of its wall [14] and accelerated atherosclerosis developing on the background of glucocorticoid (GC) medication [15], there is also a high probability of Chlamidia pneumonia and anaerobic involvement [16][17].…”

Section: Introductionmentioning

confidence: 99%

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

Puzanova¹,

Лызиков²

2021

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The issue of improved diagnosis of both rheumatic diseases of the elderly and aortic diseases does not lose its relevance. In terms of aortic aneurysms, dissection and ruptures and their attended pathogenesis, both inflammation and structural wall damages may be detected with imaging methods whose role is vital. A number of international guidelines deal with the management of polymyalgia rheumatica, giant cell arteritis, or aortic aneurysms. Aortitis is associated with up to 40 % of polymyalgia rheumatica’s cases. The clinical suspicion of aortitis is based on the detection of blood pressure and pulse asymmetry, aortic regurgitation murmur, vascular bruits, as well as persistent polymyalgia rheumatica or inflammatory dorsalgia, pelvis or leg pain. In 2020, the positron emission tomography/computed tomography’s use is approved by the Italian Society for Rheumatology for the diagnosis of vasculitis attended by polymyalgia rheumatica at the secondary healthcare level and by the European Headache Federation for the diagnosis of large vessel giant cell arteritis in the neurological practice. A review of the guideline by the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology (2018) was performed in terms of positron emission tomography with fluorodesoxyglucose combined with computed tomography (angiography) imaging in large vessel vasculitis and polymyalgia rheumatica. It is further compared with the clinical guidelines, other guidelines by the societies of nuclear medicine and new scientific data. Both procedure and patient’s preparation for examination are decribed. The criteria for assessing vasculitis proposed for either clinical practice or clinical studies are considered, as well as the factors influencing the test results and their interpretation (such as atherosclerosis, diabetes, age, body mass index, glucemia’s and acute phase markers’ levels). The guideline substantiates the benefit of both positron emission tomography’s use and its combination with computed tomography to detect extracranial vasculitis, as well as the value of performing computed tomography-angiography at different stages of the disease. There is a need to strengthen evidence on both standard time of fluorodesoxyglucose exposure and the benefit of combining positron emission tomography with computed tomography-angiography, in particular for detection of vasculitis relapses. Finding a consensus for early test’s performing is needed, as well as its score standardization, ensuring reimbursement and implementation of new imaging techniques for the cranial vessels. In the future, the evidence-based approach to managing vasculitis will be supplemented by teranostics.

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“…Early diagnosis and treatment of GCA are especially important with regard to possible prevention of irreversible blindness, life-threatening aortic complications (such as aortic aneurysm dissecans or its rupture) [12], and stroke as well [13].…”

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confidence: 99%

“…Speaking of the doctrine of early recognition of GCA, let's note that the 1990 American College of Rheumatology's (ACR) classification criteria are used first of all in clinical trials and remain a basis for diagnosis of this vasculitis in clinical practice, however, a number of new diagnostic approaches and tools have been proposed (among them the «classification tree» by the ACR, the concept of «three whales» by D. Lariviere et al, the diagnostic algorithm used in the Mayo Clinic, etc.) [12]. So, the new criteria for early diagnosis of GCA are developed by I. Salehi-Abari (2016) -for using «during the initial presentation of the disease when by clinical/laboratory judgement of an expert rheumatologist, early diagnosis of GCA can be established».…”

mentioning

confidence: 99%

Гигантоклеточный Артериит: Доказанные И Дискуссионные Аспекты Лечения

Lyzikov¹,

Puzanova²,

Лызиков³

2021

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Giant cell arteritis is the most common systemic vasculitis in adults and especially in older people. Its development and treatment is often associated with comorbidities, relapses and va rious complications. The paper represents an analytical review, systema tic generalization and discussion of evidence on modern strategies, main risks, medicines and outcomes of the treatment of patients with giant cell arteritis. We studied specialized literature data published in English, Russian and German, found by electronic and manual search, checked for indexing in the main computer databa ses of evidence-based medicine (Cochrane Library and Medline) and selected without time limiting. Special attention is paid to prevention of early and severe complications and adverse effects of therapy -eye, cardiovascular, cerebrovascular and infectious diseases, diabetes, osteoporosis, fractures and malignancies. Best practice and the results of the introduction of an accelerated approach to management of a patient with suspected giant cell arteritis in primary healthcare setting are described, as well as current evidence base and prospects for early diagnosis and use of glucocorticoids and adjuvant immunosuppressive and biologic therapy with a focus on methotrexate and tocilizumab. Main principles, recommendations and evidence base of the 2020 British Society for Rheumatology guidelines on diagnosis and treatment of this vasculitis are represented and discussed.

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Гігантоклітинний Артеріїт: Епідеміологія, Діагностика, Прогноз

Cited by 3 publications

References 82 publications

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

Гигантоклеточный Артериит: Доказанные И Дискуссионные Аспекты Лечения

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