EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice

Dejaco, Christian; Smolen, Josef S; Duftner, Christina; Besson, Florent L.; Bley, Thorsten Alexander; Blockmans, Daniel Engelbert; Brouwer, Elisabeth; Cimmino, Marco A.; Clark, Eric; Dasgupta, Bhaskar; Diamantopoulos, Andreas P.; Direşkeneli, Haner; Iagnocco, Annamaria; Klink, Thorsten; Neill, Lorna; Ponte, Cristina; Salvarani, Carlo; Slart, Riemer H. J. A.; Whitlock, Madeline; Schmidt, Wolfgang A.

doi:10.1136/annrheumdis-2017-212649

Cited by 836 publications

(1,017 citation statements)

References 45 publications

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“…Temporal arteries are unlikely to be seen with PET . The European League Against Rheumatism (EULAR) recommendations do not advise the use of PET to visualise the cranial vessels . However, newer PET scanners with improved spatial resolution may be able to visualise the temporal arteries better in the future.…”

Section: Diagnosismentioning

confidence: 99%

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Investigation and management of giant cell arteritis

Tracey¹,

S²

2020

Prescriber

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Section: Diagnosismentioning

confidence: 99%

“…EULAR recommends magnetic resonance imaging (MRI) or ultrasound for imaging of cranial vessels . High‐resolution MRI (fat suppression, T1 weighted) allows detailed imaging of the walls and lumen of superficial cranial arteries.…”

Section: Diagnosismentioning

confidence: 99%

Investigation and management of giant cell arteritis

Tracey¹,

S²

2020

Prescriber

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“…In patients with chronic GCA, already receiving a treatment, the ultrasound appearance of inflamed artery walls changes and becomes difficult to detect. (1)(2)(3)(4) IMT measurement may help to identify patients with chronic large-vessel GCA (LV-GCA) by assessing the axillary arteries; however, a cut-off for distinguishing between chronically affected arteries and unaffected ones is not yet available.…”

Section: Use Of Contrast Enhanced Ultrasound Sonography (Ceus) In Larmentioning

confidence: 99%

Fri0272 risk of Potential Glucocorticoid-Related Adverse Events in Patients With Giant Cell Arteritis: Results From a Us-Based Electronic Health Records Database

Best¹,

Kong

Tran

et al. 2019

Poster Presentations

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BackgroundOral glucocorticoids (OGC) have been the mainstay of treatment for giant cell arteritis (GCA). However, OGCs are associated with several adverse events (AEs).ObjectivesTo estimate the risk of potential OGC-related AEs in patients with GCA.MethodsThis retrospective, observational cohort study utilized the 2008-2017 IBM Explorys Electronic Health Records database which includes lab values. Inclusion criteria included age ≥ 50 years with ≥ 2 GCA diagnoses ≥ 7 days apart, 1 OGC prescription within 6 months of the first GCA diagnosis (index date = date of first OGC prescription) followed by a second OGC prescription, no other autoimmune disease requiring high-dose OGCs, no exposure to anti-tumor necrosis factor or anti-interleukin-6 therapies, ≥ 1 C-reactive protein (CRP)/erythrocyte sedimentation rate (ESR) lab test and 12 months of data available pre- and post-index. Potential AEs assessed during the 12 months post-index were descriptively summarized across cohorts of patients based on quartiles (Q) of mean daily dose of OGCs measured over 6 months post-index among this patient sample (Q1: ≥ 1.00 to ≤ 13.75 mg; Q2: > 13.75 to ≤ 25.00 mg; Q3: > 25.00 to ≤ 40.00 mg; Q4: > 40.00 mg). Potential AEs included type 2 diabetes (T2D) diagnosis, hemoglobin A1c (HbA1c), blood glucose level, serious infections, cataracts, gastrointestinal bleeding or ulcer and increases in body mass index (BMI). Actual OGC use by patient could not be confirmed and is a limitation of this study.ResultsMean age of the 785 eligible patients was 76 years (SD 9); 70% were female. Mean Deyo Charlson Comorbidity Index score at baseline was 1.57 (SD 2.01). The most common baseline comorbid conditions were cerebrovascular disease, diabetes, chronic pulmonary disease, and renal disease. Mean daily OGC dose was 28.9 mg during the first 6 months post-index. Mean (SD) CRP and ESR during the 12-month follow-up was 5.1 (13.6) and 26.5 (20.7), respectively. The proportion of patients with newly diagnosed T2D or with HbA1c ≥ 7.5 during the 12-month follow-up ranged from 7.5% to 24.5% from OGC daily dose Q1 to Q4 cohorts. The proportion of patients with glucose ≥ 200 mg/dL ranged from 7.5% to 15.0% from Q1 to Q4. Serious infections ranged from 16.8% to 24.8% from Q1 to Q4 and cataract ranged from 12.0% to 21.7% from Q1 to Q4. The proportions of patients with gastrointestinal bleed/ulcer ranged from 6.0% in Q1 to 11.8% in Q4. An increase in BMI of 5 ranged from 4.1% to 6.4% from Q1 to Q4.ConclusionIn patients with GCA, potential OGC-related AEs increased with increased daily OGC dose. This highlights the need for effective therapies that reduce the exposure and potential risk of OGCs.AcknowledgementThis work was supported by funding from Genentech, IncDisclosure of InterestsJennie H. Best Shareholder of: Genentech, Employee of: Genentech, Amanda M. Kong Employee of: IBM Watson Health, Oth Tran Employee of: IBM Watson Health, Margaret Michalska Employee of: Genentech, Inc.

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“…Согласно современным рекомендациям подтверж-дающими визуализирующими методами при неспеци-фическом аортоартериите является МРТ, а как альтер-натива -КТ с контрастированием сосудов и ПЭТ-КТ [21]. ПЭТ-КТ в рассмотренном клиническом примере сыграла ключевую роль в доказательстве наличия ак-тивного сосудистого воспаления и решении вопроса о назначении иммуносупрессивного лечения.…”

Section: клиническое наблюдениеunclassified

Systemic Vasculitis With Lesion of Large Vessels as a Cause of Art Erial Hypert Ension in a Patient of Young Age

et al. 2018

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Objective:to analyze and present a clinical case of late diagnosis of Takayasu’s arteritis in a young female patient with long-term arterial hypertension.Materials and methods.The female patient G., born in 1989, had noted elevated arterial pressure (AP) of 150/90 mm Hg since she was 14. At 21 the following diagnosis was stated: Fibro-muscular dysplasia, stenosis of the left renal artery. Stenosis of the celiac trunk. Aneurisms of the branches of the superior mesenteric artery; prosthesis of the left renal artery was performed. Since the beginning of 2016, the patient has noted elevated AP of 200/110 mm Hg despite continuing hypotensive therapy. Diagnosis of Nonspecific aortoarteritis was proposed in May of 2017. Methylprednisolone therapy was administered: 250 mg No. 2 intravenously, Prednisolone: 25 mg a day orally. Due to signs of decreased blood flow to the left kidney, in August of 2017 extracorporeal repeat prosthesis of the left renal artery, bypass of the right middle renal artery with reversed autovein were performed.Results.During examination in October of 2017, the patient complained of weakness, frequent elevated AP of 200/110 mm Hg. In blood test: hemoglobin 106 g/l, erythrocyte sedimentation rate 38 mm/h, C-reactive protein 25 mg/l. A heterozygous mutation in the methylenetetrahydropholate reductase, a heterozygous mutation in the factor V gene (G1691A) were identified. Homocysteine level was normal, infection and oncological pathology were excluded. The following diagnosis was made: Takayasu»s arteritis type IV affecting the aorta and its branches, moderate activity. Occlusion of the celiac trunk. Aneurisms of the branches of the superior mesenteric artery. Critical stenosis of the left renal artery. Thrombosis of the aorto-renal prosthesis. Hypoplasia of the left kidney. Prednisolone 50 mg a day, metoprolol 50 mg a day, valsartan 160 mg a day, acetylsalicylic acid 100 mg a day were prescribed.Conclusion.The presented clinical observation shows the importance of comprehensive examination of young patients complaining of elevated AP for many years. Due to untimely diagnosis and absence of pathogenetic therapy, the patient suffered negative consequences of surgical treatment.

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EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice

Cited by 836 publications

References 45 publications

Investigation and management of giant cell arteritis

Investigation and management of giant cell arteritis

Fri0272 risk of Potential Glucocorticoid-Related Adverse Events in Patients With Giant Cell Arteritis: Results From a Us-Based Electronic Health Records Database

Systemic Vasculitis With Lesion of Large Vessels as a Cause of Art Erial Hypert Ension in a Patient of Young Age

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