Follow-up Of Giant Cell Arteritis Research Articles

Follow-up ultrasound examination in patients with newly diagnosed giant cell arteritis.

Ultrasound is a standard tool to diagnose giant cell arteritis (GCA). Until now, only few studies investigated the role of ultrasound in the follow-up of GCA. The aim of this study was to assess the changes in the intima media thickness (IMT), total number of affected arteries and provisional OMERACT GCA ultrasonography score (OGUS) in a 12-months follow-up period. Patients with newly diagnosed GCA were prospectively enrolled. Ultrasound examinations of facial, temporal, carotid, vertebral and axillary arteries were performed at baseline, after three, six, nine and 12 months. Changes of IMT, total number of affected arteries, and OGUS values were evaluated. In a subgroup of patients, exams were conducted weekly in the first 100 days. Fifty patients were enrolled, 36 completed the follow-up. Significant reductions in IMT, total number of affected arteries and OGUS were observed. Eighteen patients presented to weekly exams. The mean IMT of the axillary artery normalized after seven days, while IMT of the common temporal artery normalized after 50 days. The mean OGUS values were below one after six months. There were no differences in IMT changes between GCA patients with or without PMR or between those with and without additional tocilizumab treatment. A relapse occurred in 4 patients. At relapse, mean IMT and OGUS were higher as compared with the preceding assessment. No predictive values indicating a relapse were identified. Vascular ultrasound is sensitive to change in GCA. The presence of PMR or treatment with tocilizumab did not affect IMT decrease.

Diagnosis, Treatment, and Follow-Up of Giant-Cell Arteritis: A Retrospective Multicenter Study.

Giant-cell arteritis (GCA) is the most common type of vasculitis in the elderly and is associated with high risks of visual loss and recurrence. Owing to its rarity in Asian populations, the current clinical interventions for these patients are not well known. Here we aimed to characterize the current management status of patients with GCA using Korean multicenter data. This retrospective study analyzed medical records of patients with GCA at six Korean university hospitals from February 2009 to November 2022. GCA had originally been diagnosed based on the 1990 American College of Rheumatology (ACR) criteria, and cases were selected for inclusion in this study based on the 2022 ACR/European Alliance of Associations for Rheumatology criteria. We evaluated treatments, follow-up periods, and outcomes (relapse, remission, and adverse drug reactions) in patients with GCA with or without arteritic anterior ischemic optic neuropathy (AAION). This study analyzed 18 patients with a median age of 75.5 years that included 12 females (66.7%). Seven patients (38.8%) had AAION. All patients initially received prednisolone treatment, while four (22.2%) underwent adjuvant treatment with methotrexate and azathioprine during prednisolone tapering. During the median follow-up of 3.5 months (interquartile range: 2.0-23.2 months), 4 patients (22.2%) had prednisolone-related adverse reactions, 2 (11.1%) relapsed, and 13 (72.3%) dropped out. Nine patients (50.0%) experienced remission, with this being sustained in four (36.4%). This study observed high dropout rates and short follow-ups. Adverse effects of prednisolone were common, and relapses occurred in approximately one-tenth of Korean patients with GCA. Thus, optimizing GCA treatment necessitates regular monitoring and long-term follow-up.

Ultrasonography in the diagnosis and follow-up of giant cell arteritis.

Colour Doppler ultrasonography is the first measure to allow objective bedside assessment of GCA. This article discusses the evidence using the OMERACT filter. Consensus definitions for ultrasonographic changes were agreed upon by a Delphi process, with the 'halo' and 'compression' signs being characteristic. The halo is sensitive to change, disappearing within 2-4 weeks of starting glucocorticoids. Ultrasonography has moderate convergent validity with temporal artery biopsy in a pooled analysis of 12 studies including 965 participants [κ = 0.44 (95% CI 0.38, 0.50)]. The interobserver and intra-observer reliabilities are good (κ = 0.6 and κ = 0.76-0.78, respectively) in live exercises and excellent when assessing acquired images and videos (κ = 0.83-0.87 and κ = 0.88, respectively). Discriminant validity has been tested against stroke and diabetes mellitus (κ=-0.16 for diabetes). Machine familiarity and adequate examination time improves performance. Ultrasonography in follow-up is not yet adequately defined. Some patients have persistent changes in the larger arteries but these do not necessarily imply treatment failure or predict relapses.

Apport de l’imagerie (hors Doppler) pour le diagnostic et le suivi de l’artérite à cellules géantes

Since 2000, imaging is frequently used for the diagnosis and follow-up of giant cell arteritis (GCA). At diagnosis, the demonstration on imaging of an involvement of the temporal arteries is useful to guide the temporal artery biopsy, or, sometimes, to replace it. Large-vessel imaging is nowadays currently performed as some studies indicate that 30 to 80% of patients might demonstrate involvement of the aorta and its branches, often silently. Aorta CT angiography, positron emission tomography or magnetic resonance angiography show a high sensibility to detect large-vessel inflammation, and have become in current practice and recent studies a supplementary criteria to classify or diagnose GCA. Many studies indicate a different prognosis in patients with large-vessel inflammation, highlighting the need to diagnose such involvement. Large-vessel imaging is important in the patients' follow-up to analyze how large-vessel inflammation evolves under treatment and to detect morphologic changes (dilations, dissections, or stenoses) that are more frequent in these patients. Recent European recommendations analyze the different imaging procedures available for diagnosis and follow-up of patients with GCA.

Is PET/CT essential in the diagnosis and follow-up of temporal arteritis?

The increasing availability and improvement of imaging techniques are deeply influencing diagnosis and work-up of patients affected with vasculitis, particularly those with large vessel vasculitis (LVV). Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), especially when integrated with computed tomography (CT), is taking hold as a useful diagnostic technique to examine the aorta and the other large vessels in giant cell arteritis (GCA) with concomitant large vessel involvement (LV-GCA). In this paper we examined the progresses performed in this field in the last twenty years and the evidence available so far according to two different points of view ('pros' and 'cons'), in order to give a comprehensive answer to a still open question about the role of PET/CT in the diagnosis and follow-up of GCA.

Imaging in Giant Cell Arteritis

Much progress has been made in the use of imaging as a diagnostic tool in giant cell arteritis (GCA), which assists in the management of patients where the initial diagnosis is unclear. This includes patients with atypical cranial symptoms, or with predominantly systemic, constitutional or limb symptoms. Ultrasound and magnetic resonance imaging are capable of visualising both the cranial and extracranial large vessel circulation, with vessel wall thickening and stenotic lesions being visualised. Computed tomographic angiography is helpful in visualising the aorta for aneurysm complicating GCA but can also detect vessel wall thickening in established large vessel vasculitis. PET-CT is a very sensitive test for early vascular inflammation in extracranial large vessel vasculitis, before aneurysmal or stenotic lesions have developed, of use in the patient with unexplained constitutional symptoms. The place of imaging in the follow-up of GCA is being investigated, and repeated imaging may be useful in select cases. Generally, vascular abnormalities become less defined once glucocorticoid treatment has been started, and therefore, imaging studies must be conducted early as part of a GCA fast-track assessment.

Magnetic resonance imaging in the diagnosis and follow-up of giant cell arteritis: case report and review of literature.

A female patient with giant cell vasculitis of the abdominal aorta and its branches and strongly suspected of having extrapulmonary tuberculosis is presented. The diagnoses were based on the clinical picture, laboratory findings, and magnetic resonance imaging (MRI) findings. MRI is highly useful in cases where echosonography and/or vascular biopsy for histopathological analyses are not possible. A combination of giant cell vasculitis and extrapulmonary tuberculosis is extremely rare, and therefore, choosing the right treatment presents a considerable challenge. MRI performed after 6-month antituberculous therapy and 1-year glucocorticoid plus methotrexate therapy showed normal wall of the aorta and its branches, which was consistent with clinical and laboratory remission. Patients with large vessel vasculitis require regular follow-up by MRI.

SP0003 The Role of Imaging Modalities in the Diagnosis and Followup of GIANT Cell Arteritis

iant cell arteritis (GCA) is a primary systemic vasculitis involving the large- and medium-sized arteries, particularly the temporal arteries. Imaging studies have proved useful to detect inflammatory changes in the...

Artérite à cellules géantes et maladie de Takayasu : aspects épidémiologiques, diagnostiques et thérapeutiques

Giant-cell arteritis (GCA) and Takayasu arteritis (TAK) are primary systemic granulomatous large-vessel vasculitides. Whether both entities represent distinct phenotypic expressions of a shared etiopathogenic process remains hypothetical. GCA more commonly affects subjects of northern European background while the clinical observation that TAK might be more common in populations of Asian or African ancestry needs to be confirmed by epidemiological studies. Distinct human leukocyte antigen class II associations were identified as genetic risk factors of GCA and TAK. The increasing incidence of GCA also suggests an environmental cause. Temporal artery biopsy is the main diagnostic test for GCA, although MRI and Doppler ultrasonography of the temporal or occipital arteries may also reveal vessel wall inflammation. MRI, CT and positron emission tomography with 18F fluodeoxyglucose have progressively replaced conventional invasive imaging modalities for study of large-vessel disease. The diagnostic accuracy of these 3 imaging modalities seems equivalent, but their value in the follow-up of GCA and TAK is less clear. According to studies based on modern imaging techniques, 70-80% of patients with newly diagnosed GCA show an involvement of the aorta and/or the major branches of the aorta. Glucocorticoids are the reference therapy for GCA. Adjunctive therapy, notably with methotrexate, appears to enhance disease control and reduce glucocorticoid exposure. IL-6 blockade has hope as a new treatment option for GCA. Principles of therapy for TAK are similar to those of GCA, except that TNFα blockers, particularly infliximab, seem to show good results in TAK and revascularization procedures are an important part of the TAK therapy.

Influence of corticosteroid treatment on MRI findings in giant cell arteritis

Giant cell arteritis (GCA) remains a diagnostic challenge. With the use of a high-resolution MRI protocol, visualization of the superficial cranial arteries is feasible and mural inflammation can be assessed noninvasively. Until today, it is not known how soon inflammatory signals in diagnostic MR imaging vanish after initiation of treatment. Here, we report sequential MR imaging findings during the initial weeks of corticosteroid treatment in a 79-year-old female patient with histologically proven GCA. Mural inflammatory changes decreased within the first 2 weeks and have almost entirely vanished after 2 1/2 months of continued treatment. Moreover, MR angiography revealed sequential stenoses of the subclavian artery, which improved in variable extent with some residuals despite high dose steroid medication. This report underlines the value of high-resolution MRI in diagnosis and follow-up of GCA and illustrates the potential of MRI to detect and monitor intra- and extra-cranial involvement patterns of GCA in high detail.

Supraclavicular pulsatile mass as presenting sign of brachiocephalic trunk aneurysm in the long-term followup of giant cell arteritis

Supraclavicular pulsatile mass as presenting sign of brachiocephalic trunk aneurysm in the long-term followup of giant cell arteritis

Étude des variations des lymphokines dans la maladie de Horton. Résultats préliminaires

The authors present the results of a preliminary study of IL 1, IL 6 and TNF in giant-cell arteritis. IL 1 α and TNF seemed to be uninteresting. IL 6 was well correlated with inflammatory parameters levels and could be useful in the follow-up of giant-cell arteritis.