Large vessel involvement in biopsy-proven giant cell arteritis: incidence, distribution, and predictors

Naderi, Nazanin; Mohammad, AJ; Turesson, Carl

doi:10.1080/03009742.2016.1190984

Cited by 25 publications

(11 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…ESR and CRP are typically elevated in GCA, and it is highly infrequent (<3%) that both are normal 36 37. While several other serological biomarkers have been evaluated, none is sufficiently sensitive and specific for detection and assessment of disease activity or prediction of prognosis to recommend its use in clinical practice.…”

Section: Resultsmentioning

confidence: 99%

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

et al. 2019

View full text Add to dashboard Cite

BackgroundSince the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations.MethodsUsing EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations.ResultsThree overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40–60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons.ConclusionsWe have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.

show abstract

Section: Resultsmentioning

confidence: 99%

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Analyses of the association between the presence of giant cells and different clinical manifestations have generated con icting results. We have previously investigated the predictive value of different histopathologic features of TAB for LVI, and found a negative association with the presence of giant cells in the histopathological reports [22]. To our knowledge, this was the rst study to examine this relationship in patients with biopsy-proven GCA.…”

Section: Introductionmentioning

confidence: 87%

“…Patients with positive TABs performed between 1997 and 2010 who were diagnosed with GCA (N = 840) were identi ed, as previously described [39]. Among these, patients from two de ned areas of the county that had previously been included in two clinical studies [22,40] were pooled for the present analysis ( Fig. 1).…”

Section: Patientsmentioning

confidence: 99%

“…Although different subsets show different clinical course and prognosis [5,[10][11][12][13][14][15], there are still no established predictors for LVI. Results are divergent on the relation between LVI and presence of cranial symptoms [5,7,11,[16][17][18][19][20][21], PMR at the time of diagnosis [5,10,11,13,16,18,21,22], level of systemic in ammatory markers and leucocyte count [5,7,10,11,13,18,19,[22][23][24][25] and tobacco usage [16,18].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Giant cells in temporal artery biopsies are associated with a reduced risk of large vessel involvement in patients with giant cell arteritis : a retrospective cohort study

Naderi¹,

Mohammad²,

Wadström³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Giant cell arteritis (GCA) is a systemic disease with extensive vascular involvement. There is limited and conflicting information on the relation between patient characteristics at diagnosis and future disease phenotypes. We aimed to investigate predictors of time dependent large vessel involvement (LVI) in a population-based cohort of patients with GCA. Methods: GCA patients with positive temporal artery biopsies (TAB) between 1997and 2010 were identified through a regional pathology register. A structured review of histopathology reports and relevant imaging studies was performed. Cases with LVI through July 2016 were identified. Patients were followed to first LVI, death, migration from the area or July 29, 2016. Event free survival by clinical and histopathologic features was estimated using the Kaplan-Meier method. Potential predictors of LVI were examined using Cox regression models.Results: A total of 274 patients were included. The mean age at GCA diagnosis was 75.7 years. Fifty-one patients (19 %) had documented LVI during the follow-up, corresponding to an incidence rate of 2.4/100 person-years. The median time from GCA diagnosis to the diagnosis of LVI was 4.5 years (interquartile range 0.6-7.4). Thirty-four patients had aortic involvement (67% of those with LVI; 12% of all GCA cases). Survival free of LVI was longer in patients with giant cells in the TAB (75th percentile 14.0 vs 6.7 years; p=0.014). In age-adjusted analysis, the presence of giant cells in the TAB was associated with reduced risk of LVI (hazard ratio 0.48; 95 % confidence interval 0.27-0.86). Conclusions: The negative association with giant cells in the TAB suggests that patients with LVI constitute a subset of GCA with particular disease mechanisms. This underlines the heterogeneity of GCA, which should be further explored in prospective studies.

show abstract

“…A recent study comparing patients with GCA and TA concluded that despite similar distribution of vascular lesions, the angiographic picture of a short segment, tight stenosis of the subclavian artery in TA, as opposed to a long, tapering stenosis in GCA, may help distinguish such patients . Whereas large vessel involvement in GCA is recognized in about 15% of patients, large vessel dilatation is less recognized. A recent study compared patients with GCA with subclavian artery stenosis and subclavian artery dilatation in GCA, and found that those with LV dilation were more likely male, smokers, with associated coronary artery disease, and had a greater propensity to develop aortic aneurysms …”

Section: Giant Cell Arteritismentioning

confidence: 99%

Vasculitis research: Current trends and future perspectives

et al. 2018

View full text Add to dashboard Cite

We discuss recent and prospective research in small and large vessel vasculitis. Large cohorts of Takayasu arteritis (TA) have been recently published from across the world, clarifying our understanding of this uncommon disease. Novel open-ended approaches like large-scale genotyping, proteomics and metabolomics have helped gain novel insights into TA, giant cell arteritis (GCA) and anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Recent advances in the imaging of TA and GCA offer promise for earlier diagnosis and better monitoring of response to therapy. Although two randomized controlled trials of abatacept and tocilizumab failed to meet their primary end-points, successful large-scale studies of abatacept and tocilizumab in GCA hold promise for better disease control. While cyclophosphamide has revolutionized the management of AAV, increasing use of rituximab as an alternative induction regimen, as well as use of novel approaches involving reduced or no corticosteroid use for AAV and alternative agents such as avacopan (a complement 5a receptor antagonist) hold promise for lesser toxic induction regimens in the future. Increasingly, the risk of cardiovascular events and comorbidities such as osteoporosis are being recognized as factors affecting long-term prospects of patients with vasculitis. There is a shift in emphasis to utilize patient-reported outcomes to more accurately gauge the impact of vasculitides and their treatment.

show abstract

Large vessel involvement in biopsy-proven giant cell arteritis: incidence, distribution, and predictors

Cited by 25 publications

References 34 publications

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

Giant cells in temporal artery biopsies are associated with a reduced risk of large vessel involvement in patients with giant cell arteritis : a retrospective cohort study

Vasculitis research: Current trends and future perspectives

Contact Info

Product

Resources

About