Abstract
Introduction Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients. Monitoring GCA activity during tocilizumab (TCZ) treatment is an unmet need, since low serum levels of C-reactive protein (CRP) during treatment may underestimate disease activity. To date, few data are available on the role of different imaging techniques in monitoring GCA activity and response to treatment. We report herein a cohort of GCA patients treated with TCZ and followed up with multimodal imaging. Patients and Methods. We collected clinical, laboratory, and imaging data of 11 GCA patients treated with TCZ 162 mg subcutaneously every week. Disease activity was assessed at baseline and within 12 months from the start of treatment using different imaging techniques such as color Doppler ultrasonography (CDUS), magnetic resonance imaging/angiography (MRI/MRA), computed tomography angiography (CTA), and/or positron emission tomography (PET). Results Four patients were affected by cranial and 7 by LV-GCA. All patients were treated with oral glucocorticoids (GCs) (mean dose 55.68 mg ± 8.19 of prednisone or equivalent) in combination with TCZ. Treatment was preceded in 5 cases by 3 intravenous boluses of 1000 mg methylprednisolone. A significant decrease of the mean dose of oral GCs was observed between baseline and the last follow-up visit (4.65 ± 3.69 mg) (p = 0.003). TCZ treatment significantly decreased erythrocyte sedimentation rate (p < 0.01) and CRP levels (p < 0.01). At follow-up (mean 8.18 ± 3.63 months), all patients were in clinical and serological remission. Moreover, PET, CDUS, MRI/MRA, and CTA did not show any LVV finding. Conclusions Our study highlights TCZ efficacy in inducing GCA remission and its steroid-sparing effect. We highlighted a reliability of imaging procedures in the evaluation of disease activity and treatment response. A close disease monitoring with imaging techniques should be taken into account in GCA patients during TCZ treatment.
Highlights
Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients
GCA is classically associated with polymyalgia rheumatica (PMR), a common disorder among patients older than 65 which can precede the presentation of GCA even of several years [2]
Patient underwent color Doppler ultrasonography (CDUS) and/or magnetic resonance imaging/angiography (MRI/MRA) and/or computed tomography angiography (CTA) and/or 18F-fluorodeoxyglucosepositron emission tomography (FDG-PET) at the time of diagnosis, and the same procedure was repeated within 12 months from the start of treatment
Summary
Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients. Few data are available on the role of different imaging techniques in monitoring GCA activity and response to treatment. Laboratory, and imaging data of 11 GCA patients treated with TCZ 162 mg subcutaneously every week. A close disease monitoring with imaging techniques should be taken into account in GCA patients during TCZ treatment. Large vessel vasculitis (LVV) is defined as an inflammatory involvement of large arteries, of which giant cell arteritis (GCA) and Takayasu arteritis represent the two main forms [1]. Despite recent advances in imaging techniques, diagnostic process as well as disease monitoring represents unmet needs, especially in case of extracranial involvement and a nonspecific clinical spectrum [3]
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