Giant cell arteritis: beyond temporal artery biopsy and steroids

Ninan, Jem; Lester, Susan; Hill, Catherine

doi:10.1111/imj.13483

Cited by 23 publications

(12 citation statements)

References 92 publications

(175 reference statements)

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“…In every patient older than 50 years presenting with head or facial pain, the diagnosis of giant cell arteritis (GCA) should be considered. GCA is a vasculitis of the medium and large arteries, involving the aorta and its branches with a predisposition for the cranial branches of the external carotid and ophthalmic branches of the internal carotid artery [94]. GCA occurs mostly in the elderly Caucasian population, with a north-south gradient and a higher prevalence in women [95].…”

Section: Giant Cell Arteritismentioning

confidence: 99%

Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

et al. 2020

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Background: Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. Objective: The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. Methods: An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should "think outside their own box" and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life-or organthreatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.

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Section: Giant Cell Arteritismentioning

confidence: 99%

Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

et al. 2020

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“…High levels of IL-6 have also been shown in the serum of patients with GCA and there is emerging high-quality evidence to support the use of tocilizumab in GCA 1. Several case series have demonstrated some serious adverse events (none of the overwhelming bacterial meningoencephalitis) and further research is underway with larger trials to determine long-term efficacy and safety 2…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas meningoencephalitis masquerading as a stroke in a patient on tocilizumab

2019

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A previously high-functioning woman presents with clinical and CT features of a subacute ischaemic stroke. Her medical history is relevant for refractory giant cell arteritis on long-term high-dose prednisolone and recent commencement of tocilizumab (interleukin-6 monoclonal antibody). The potential for stroke mimic is considered and a magnetic resonance brain scan is requested. She rapidly deteriorates within 24 hours of admission and unexpectantly dies. An autopsy reveals that she has bilateral pulmonary emboli with lower limb deep vein thrombosis and Pseudomonas meningoencephalitis with frank pus on the brain. We discuss the potential risks of immunosuppression and the role of imaging in the diagnosis of stroke.

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“…Interleukin-6 (IL-6) is a pleiotropic cytokine with both pro-inflammatory and anti-inflammatory properties [ 111 , 112 , 113 ]. Increased levels of pro-inflammatory IL-6 are associated with atherosclerosis [ 93 ], vasculitis [ 114 ], MI [ 94 ] and HF [ 115 ]. Despite the apparent connection between IL-6 and CVD, the IL-6 receptor is only expressed on hepatocytes and in certain leukocytes [ 116 ].…”

Section: Inflammation and Il-6 Signalingmentioning

confidence: 99%

Cyclic Nucleotide-Directed Protein Kinases in Cardiovascular Inflammation and Growth

Holland

Francisco

Johnson

et al. 2018

JCDD

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Cardiovascular disease (CVD), including myocardial infarction (MI) and peripheral or coronary artery disease (PAD, CAD), remains the number one killer of individuals in the United States and worldwide, accounting for nearly 18 million (>30%) global deaths annually. Despite considerable basic science and clinical investigation aimed at identifying key etiologic components of and potential therapeutic targets for CVD, the number of individuals afflicted with these dreaded diseases continues to rise. Of the many biochemical, molecular, and cellular elements and processes characterized to date that have potential to control foundational facets of CVD, the multifaceted cyclic nucleotide pathways continue to be of primary basic science and clinical interest. Cyclic adenosine monophosphate (cyclic AMP) and cyclic guanosine monophosphate (cyclic GMP) and their plethora of downstream protein kinase effectors serve ubiquitous roles not only in cardiovascular homeostasis but also in the pathogenesis of CVD. Already a major target for clinical pharmacotherapy for CVD as well as other pathologies, novel and potentially clinically appealing actions of cyclic nucleotides and their downstream targets are still being discovered. With this in mind, this review article focuses on our current state of knowledge of the cyclic nucleotide-driven serine (Ser)/threonine (Thr) protein kinases in CVD with particular emphasis on cyclic AMP-dependent protein kinase (PKA) and cyclic GMP-dependent protein kinase (PKG). Attention is given to the regulatory interactions of these kinases with inflammatory components including interleukin 6 signals, with G protein-coupled receptor and growth factor signals, and with growth and synthetic transcriptional platforms underlying CVD pathogenesis. This article concludes with a brief discussion of potential future directions and highlights the importance for continued basic science and clinical study of cyclic nucleotide-directed protein kinases as emerging and crucial controllers of cardiac and vascular disease pathologies.

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Giant cell arteritis: beyond temporal artery biopsy and steroids

Cited by 23 publications

References 92 publications

Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

Pseudomonas meningoencephalitis masquerading as a stroke in a patient on tocilizumab

Cyclic Nucleotide-Directed Protein Kinases in Cardiovascular Inflammation and Growth

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