Management of difficult polymyalgia rheumatica and giant cell arteritis: Updates for clinical practice

Lally, Lindsay; Spiera, Robert

doi:10.1016/j.berh.2019.04.006

Cited by 4 publications

(14 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Few patients receiving TCZ does not seem a representative sampling of the population and renders the study promising but largely inconclusive. In a study by Lally et al (2016), a similar weakness was found in nine participants, all of whom were able to discontinue GCs within four months and maintain GC-free remission. However, reliability of this study was increased by the length of time participants were followed, i.e., 15 months (Lally et al, 2016).…”

Section: Discussionmentioning

confidence: 57%

“…In a study by Lally et al (2016), a similar weakness was found in nine participants, all of whom were able to discontinue GCs within four months and maintain GC-free remission. However, reliability of this study was increased by the length of time participants were followed, i.e., 15 months (Lally et al, 2016). Some researchers, however, found TCZ monotherapy to be more efficacious or at least as effective as TCZ adjuvant therapy (Alegria et al, 2017;Camellino, Matteson et al, 2020;Chino et al, 2019;Devauchelle-Pensec et al, 2016;Huwart et al, 2018).…”

Section: Discussionmentioning

confidence: 57%

“…Four studies identified the combination of TCZ plus GCs as an effective PMR treatment strategy (Akiyama et al, 2020; Camellino, Matteson et al, 2020; Izumi et al, 2021; Lally et al, 2016). TCZ can have a dramatic steroid-sparing effect in PMR therapy.…”

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica

Walz

Elliott

Pearson

2022

J Am Assoc Nurse Pract

View full text Add to dashboard Cite

Background: Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with necessary treatment duration typically one year or longer. This duration of GC use is often associated with significant morbidity. Numerous studies have been and are being conducted that focus on alternative treatment modalities.Objectives: This literature review explores alternatives to glucocorticoid monotherapy in the treatment of PMR.Data Sources: An integrative literature review was conducted to evaluate peer-reviewed literature on the topic. An electronic literature search was performed in the Cochrane Database of Systematic Reviews, and an EBSCO search identified relevant articles in the following databases: MEDLINE Complete, Academic Search Premier, Cumulative Index of Nursing and Allied Health (CINAHL) Plus, PsycInfo, Education Source, SocINDEX, the CDC, and PubMed.Conclusions: Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted.Implications for Practice: Because PMR is commonly diagnosed and managed in primary care, providers should keep abreast of the most current recommendations concerning optimal treatment options and carefully weigh the risks versus benefits of long-term GC use. This expanding area of research may assist primary care providers to better treat and manage PMR as well as reduce long-term treatment risk by minimizing corticosteroid use when possible.

show abstract

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 57%

See 1 more Smart Citation

Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica

Walz

Elliott

Pearson

2022

J Am Assoc Nurse Pract

View full text Add to dashboard Cite

show abstract

“…Imaging techniques such as temporal artery ultrasound (TAUS), which also include axillary arteries and color doppler imaging, have become first-line diagnostic tests instead of TAB in the 2018 European League Against Rheumatism (EULAR) recommendations (67). Positive ultrasounds in GCA present with a "halo sign" of dark hypoechoic area around the area of mural edema in the vascular wall (75).…”

Section: Diagnostic Workupmentioning

confidence: 99%

“…Rheumatologists generally manage the long-term steroid dosing or steroid-sparing agents. The effectiveness of corticosteroid therapy is often monitored by measuring ESR and CRP over time (44), but these inflammatory markers may not consistently reflect disease activity (75). Patients usually require at least 2 years of corticosteroid therapy, and most are able to taper off by 5 years after diagnosis, but relapse of GCA is common when glucocorticoids are tapered (92).…”

Section: Treatmentmentioning

confidence: 99%

Giant Cell Arteritis: Updates and Controversies

Yu¹,

Chang²

2022

Front. Ophthalmol.

View full text Add to dashboard Cite

Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting the medium and large-size arteries, and may present with a range of ophthalmic findings. This review will cover GCA epidemiology, pathophysiology, clinical presentation, diagnostic workup, and treatment.Epidemiology and PathophysiologyGCA is commonly found in elderly patients and individuals of Scandinavian descent. Recent publications suggest it may be more common in African Americans and Hispanics than previously thought. It is very rare in Asian and Middle-Eastern populations, and there is little data regarding African populations. Genetic studies have identified increased risk associated with HLA-DRB1*04. Rather than a response to a specific antigen such as varicella zoster virus, current immunology research suggests that GCA results from changes associated with the aging immune system.Clinical presentation to OphthalmologyArteritic anterior ischemic optic neuropathy is the most common ophthalmic manifestation of GCA, but central or branch retinal artery occlusion, ophthalmic artery occlusion, cranial neuropathies causing diplopia, and more rarely anterior segment ischemia and anisocoria may also occur. Clinical testing including visual field testing, OCT, OCT-A, ICG and fluorescein angiography can be helpful in suggesting a diagnosis in addition to the clinical exam.Diagnostic WorkupGCA is ultimately a clinical diagnosis, but it is usually supported with lab results, pathology, and/or imaging. Temporal artery biopsy (TAB) remains the gold standard diagnostic test although its sensitivity is debated and practice patterns still vary with respect to sample length and whether unilateral or simultaneous bilateral biopsies are performed. Some studies have reported higher sensitivity of ultrasounds over TAB, with added benefits of time efficiency and cost effectiveness, promoting the diagnostic use of ultrasounds. MRI and even PET CT protocols offer additional options for less invasive diagnostic testing.TreatmentVision-threatening GCA is treated acutely with emergent admission for intravenous methylprednisolone, and long-term high dose oral corticosteroids remain the standard of care, despite common and sometimes serious side effects. The use of steroid-sparing alternatives such as tocilizumab is becoming more common and additional agents are being investigated.

show abstract

Oral or pulse glucocorticoid use at the onset of giant cell arteritis and its influence on the risk of relapse: a retrospective study

et al. 2023

View full text Add to dashboard Cite

Management of difficult polymyalgia rheumatica and giant cell arteritis: Updates for clinical practice

Cited by 4 publications

References 35 publications

Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica

Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica

Giant Cell Arteritis: Updates and Controversies

Oral or pulse glucocorticoid use at the onset of giant cell arteritis and its influence on the risk of relapse: a retrospective study

Contact Info

Product

Resources

About