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Vaiopoulos A, Kanakis M, Vaiopoulos G, Samanidis G, Kaklamanis P. Giant Cell Arteritis: Focusing on Current Aspects From the Clinic to Diagnosis and Treatment. Angiology 2022:33197221130564. [PMID: 36164723 DOI: 10.1177/00033197221130564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Giant cell arteritis (GCA) is a granulomatous arteritis involving large arteries, particularly the aorta and its major proximal branches, including the carotid and temporal arteries. GCA involves individuals over 50 years old. The etiopathogenesis of GCA may involve a genetic background triggered by unknown environmental factors (eg infections), the activation of dendritic cells as well as inflammatory and vascular remodeling. However, its pathogenetic mechanism still remains unclear, although progress has been made in recent years. In the past, inflammatory markers and arterial biopsy were considered as gold standard for the diagnosis of GCA. However, emerging imaging methods have been made more sensitive and specific for the diagnosis of GCA. Treatment includes biological and other modalities including interleukin-6 (IL-6) inhibitors.
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Affiliation(s)
- Aristeidis Vaiopoulos
- 2nd Department of Dermatology and Venereology, 69038Attikon University General Hospital, Athens, Greece
| | - Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Surgery Center, Athens, Greece
| | - George Vaiopoulos
- Department of Physiology, Medical School, 68989National and Kapodistrian University of Athens, Athens, Greece
| | - George Samanidis
- First Department of Adult Cardiac Surgery, 69106Onassis Cardiac Surgery Center, Athens, Greece
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Lacy A, Nelson R, Koyfman A, Long B. High risk and low prevalence diseases: Giant cell arteritis. Am J Emerg Med 2022; 58:135-140. [DOI: 10.1016/j.ajem.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
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Rose EC, Carroll LS, Evans S, Mason A. Giant cell arteritis complicated by tongue necrosis and bilateral cerebellar ischaemic stroke. BMJ Case Rep 2021; 14:e244948. [PMID: 34880035 PMCID: PMC8655573 DOI: 10.1136/bcr-2021-244948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
Giant cell arteritis (GCA) typically presents with headache, scalp tenderness or visual disturbance. Other symptoms include orofacial pain, constitutional symptoms and ischaemic stroke. An 81-year-old woman with a background of type-2 diabetes and hypertension presented with headache, oral pain and right visual loss. Examination showed hypertension, nodular temporal arteries, reduced visual acuity and suspected oral candida. Inflammatory markers were raised and she was diagnosed with GCA and commenced on corticosteroids. During treatment she developed tongue ulceration, then acute vertigo and incoordination with nystagmus and ataxia. Neuroimaging confirmed bilateral, cerebellar ischaemic strokes and temporal artery biopsy was consistent with GCA. With corticosteroids and secondary prevention of stroke measures she is now functionally independent. Oral pain is an uncommon symptom of GCA and delays in recognition may lead to catastrophic consequences. Clinicians should be aware of uncommon presentations and to optimise additional ischaemic stroke risk-factors.
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Affiliation(s)
- Emily Charlotte Rose
- Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Liam Stuart Carroll
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Evans
- Department of Stroke Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alice Mason
- Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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4
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Prieto-Peña D, González-Gay MA. Giant cell arteritis diagnosis. Med Clin (Barc) 2021; 157:285-287. [PMID: 34482969 DOI: 10.1016/j.medcli.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Diana Prieto-Peña
- Servicio de Reumatología, Grupo de Investigación en Epidemiología Genética y Arterioesclerosis de las Enfermedades Sistémicas y en Enfermedades Metabólicas Óseas del Aparato Locomotor, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Miguel A González-Gay
- Servicio de Reumatología, Grupo de Investigación en Epidemiología Genética y Arterioesclerosis de las Enfermedades Sistémicas y en Enfermedades Metabólicas Óseas del Aparato Locomotor, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España; Unidad de Investigación en Genética y Fisiopatología Cardiovascular, Facultad de Fisiología y Ciencias de la Salud, Universidad de Witwatersrand, Johannesburg, Sudáfrica.
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Should Tocilizumab Be Used Routinely in New Patients With a Diagnosis of Giant Cell Arteritis? J Neuroophthalmol 2021; 40:117-121. [PMID: 31834197 DOI: 10.1097/wno.0000000000000869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Frías-Vargas M, Aguado-Castaño AC, Robledo-Orduña C, García-Lerín A, González-Gay MÁ, García-Vallejo O. [Giant Cell Arteritis. Recommendations in Primary Care]. Semergen 2021; 47:256-266. [PMID: 34112594 DOI: 10.1016/j.semerg.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Giant cell arteritis is a systemic vasculitis with significant intra and extracranial involvement that, with early diagnosis and treatment in primary care, can improve its prognosis as it is a medical emergency. Our working group on vascular diseases of the Spanish Society of Primary Care Physicians (SEMERGEN) proposes a series of recommendations based on current scientific evidence for a multidisciplinary approach and follow-up in primary care.
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Prieto-Peña D, Castañeda S, Atienza-Mateo B, Blanco R, González-Gay MÁ. A Review of the Dermatological Complications of Giant Cell Arteritis. Clin Cosmet Investig Dermatol 2021; 14:303-312. [PMID: 33790612 PMCID: PMC8008160 DOI: 10.2147/ccid.s284795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022]
Abstract
Giant cell arteritis (GCA) is characterized by granulomatous inflammation of large and medium-sized vessels. It is the most common vasculitis among elderly people in Europe and North America. GCA usually presents with ischemic cranial manifestations such as headache, scalp tenderness, visual manifestations, and claudication of the tongue and jaw. Thickness and tenderness of temporal arteries are the most recognizable signs of GCA on physical examination. Laboratory tests usually show raised acute phase reactants. Skin manifestations are uncommon in GCA and are rarely found as a presenting symptom of GCA. Necrosis of the scalp and tongue is the most common ischemic cutaneous manifestation of GCA. Although infrequent, when present it reflects severe affection and poor prognosis of GCA. Panniculitis-like lesions have been reported in the setting of GCA, with nodules being the most common finding. Other entities, such as generalized granuloma annulare or basal cell carcinoma have been occasionally described in GCA patients. Prompt recognition and initiation of therapy are crucial to prevent serious complications of GCA. When high suspicion of GCA exists, immediate administration of glucocorticoids is recommended. It is advisable to refer the patient to a specialist GCA team for further multidisciplinary assessment.
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Affiliation(s)
- Diana Prieto-Peña
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Santos Castañeda
- Department of Rheumatology, H. Universitario de La Princesa, IIS-Princesa, Madrid, Spain.,Cátedra UAM-ROCHE, EPID-Future, Universidad Autónoma Madrid (UAM), Madrid, Spain
| | - Belén Atienza-Mateo
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ángel González-Gay
- Department of Rheumatology, Research Group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,School of Medicine, Universidad de Cantabria, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Tocilizumab in refractory giant cell arteritis. Monotherapy versus combined therapy with conventional immunosuppressive drugs. Observational multicenter study of 134 patients. Semin Arthritis Rheum 2021; 51:387-394. [PMID: 33607384 DOI: 10.1016/j.semarthrit.2021.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of TCZ in monotherapy (TCZMONO) vs. combined with conventional immunosuppressive drugs (TCZCOMBO) in Giant Cell Arteritis (GCA) in a clinical practice scenario. METHODS Multicenter study of 134 patients with refractory GCA. Patients on TCZMONO (n = 82) were compared with those on TCZCOMBO (n = 52). Drugs were methotrexate (MTX) (n = 48), azathioprine (n = 3), and leflunomide (n = 1). The main outcomes were: prolonged remission (normalization of clinical and laboratory parameters for at least 6 months) and the number of relapses. RESULTS Patients on TCZCOMBO were younger (68.8 ± 8.0 vs 71.2 ± 9.0 years; p = 0.04), with a trend to a longer GCA duration (median [IQR],18.5 [6.25-34.0] vs. 13.0 [7.75-33.5] months; p = 0.333), higher C-reactive protein (CRP) levels (2.1[1-4.7] vs 1.2 [0.2-2.4] mg/dL; p = 0.003), and more prevalence of extra-cranial large-vessel vasculitis (LVV) (57% vs. 34.1%; p = 0.007). In both groups, rapid and sustained improvement was observed. Despite the longer GCA duration, and the higher CRP levels and prevalence of LVV in the TCZCOMBO, the improvement was similar in both groups at 12 months. Moreover, in the TCZCOMBO group, prolonged remission was significantly higher at 12-month. Relapses and serious adverse events were similar in both groups. CONCLUSION In clinical practice, TCZ in monotherapy or combined with conventional immunosuppressive agents is effective and safe in patients with GCA. Nevertheless, the addition of immunosuppressive drugs, usually MTX, seems to allow a higher rate of prolonged remission, even in patients with a longer GCA duration, more extra-cranial LVV involvement, and higher acute-phase reactants.
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Harrington R, Al Nokhatha SA, Conway R. Biologic Therapies for Giant Cell Arteritis. Biologics 2021; 15:17-29. [PMID: 33442231 PMCID: PMC7797292 DOI: 10.2147/btt.s229662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/12/2020] [Indexed: 01/31/2023]
Abstract
Glucocorticoids have been the mainstay of treatment in giant cell arteritis (GCA) for the past 70 years. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) have largely failed to show significant clinical efficacy or reduction of the glucocorticoid burden in GCA. Tocilizumab is the first biologic to make a substantial impact in GCA treatment. With the current understanding of GCA pathogenesis implicating multiple cytokines, notably interleukin (IL) 6, IL-12, IL-23, IL-1β, and the role of janus kinases (JAKs) and the signal transducer and activator of transcription (STAT) pathway in these cytokines, many biologics are currently being investigated in GCA. This review article looks at the existing evidence for biologic agents in GCA. In addition to tocilizumab, the potential role of ustekinumab, abatacept, JAK inhibitors and other promising biologics in GCA are discussed in detail. A treatment algorithm based on the best evidence to date is also presented.
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Affiliation(s)
| | | | - Richard Conway
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
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González-Gay MÁ, Pina T, Prieto-Peña D, Calderon-Goercke M, Gualillo O, Castañeda S. Treatment of giant cell arteritis. Biochem Pharmacol 2019; 165:230-239. [DOI: 10.1016/j.bcp.2019.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022]
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Del Giorno R, Iodice A, Mangas C, Gabutti L. New-onset cutaneous sarcoidosis under tocilizumab treatment for giant cell arteritis: a quasi-paradoxical adverse drug reaction. Case report and literature review. Ther Adv Musculoskelet Dis 2019; 11:1759720X19841796. [PMID: 31019572 PMCID: PMC6463335 DOI: 10.1177/1759720x19841796] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background New-onset sarcoidosis has been previously described in three case reports in patients affected by rheumatoid arthritis treated with tocilizumab (TCZ). The existence of a cause-effect mechanism between the biological treatment and the onset of the illness is still being debated. Patient concerns A 74-year-old woman was diagnosed with giant cell arteritis (GCA). The first-line treatment with glucocorticoids; and the second-line with methotrexate and low-dose glucocorticoids were stopped due to multiple pathological vertebral fractures and insufficient biological and clinical response. The cytotoxic agent, cyclophosphamide, was then introduced and in turn stopped, because of gastrointestinal side effects. Thereafter a treatment with TCZ was begun. The patient experienced good clinical response; however, 8 months later she developed painful hyper-pigmented reddish cutaneous micronodular lesions localized to the abdomen and thorax. A cutaneous biopsy was performed, and histological analysis showed noncaseating epithelioid granulomas in the hypodermis. The diagnosis of cutaneous sarcoidosis was made. Interventions Topical corticosteroids were administered and, as requested by the patient, TCZ was discontinued with slow but complete resolution of the skin lesions. After TCZ discontinuation however, the GCA flared and the patient's symptoms and biological abnormalities reappeared. Thus, after a 6-month suspension, TCZ was re-administered. At 2 months later the skin lesions compatible with cutaneous sarcoidosis reappeared. Topical corticosteroids were once again prescribed and as suggested by the patient the TCZ posology was reduced. The patient's symptoms disappeared, and the cutaneous lesions resolved. Lessons The time elapsed from TCZ treatment start and the onset of cutaneous sarcoidosis, as well as its recurrence after TCZ suspension and rechallenge supported the diagnosis of a drug-induced reaction. To the best of our knowledge, this case report represents the first instance of cutaneous sarcoidosis most likely induced by TCZ in patients affected by GCA. In addition, our case emphasizes that although TCZ in monotherapy confirms to be an effective treatment for GCA, further immunological disorders could be unmasked, and the discussed side effect of the drug could be dose-dependent.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Alfonso Iodice
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Cristina Mangas
- Unit of Dermatology, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Luca Gabutti
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
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Calderón-Goercke M, Loricera J, Aldasoro V, Castañeda S, Villa I, Humbría A, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, Palmou-Fontana N, Calvo-Río V, Prieto-Peña D, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 2019; 49:126-135. [PMID: 30655091 DOI: 10.1016/j.semarthrit.2019.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tocilizumab (TCZ) has shown efficacy in clinical trials on giant cell arteritis (GCA). Real-world data are scarce. Our objective was to assess efficacy and safety of TCZ in unselected patients with GCA in clinical practice Methods: Observational, open-label multicenter study from 40 national referral centers of GCA patients treated with TCZ due to inefficacy or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants, glucocorticoid-sparing effect, prolonged remission and relapses. A comparative study was performed: (a) TCZ route (SC vs. IV); (b) GCA duration (≤6 vs. >6 months); (c) serious infections (with or without); (d) ≤15 vs. >15 mg/day at TCZ onset. RESULTS 134 patients; mean age, 73.0 ± 8.8 years. TCZ was started after a median [IQR] time from GCA diagnosis of 13.5 [5.0-33.5] months. Ninety-eight (73.1%) patients had received immunosuppressive agents. After 1 month of TCZ 93.9% experienced clinical improvement. Reduction of CRP from 1.7 [0.4-3.2] to 0.11 [0.05-0.5] mg/dL (p < 0.0001), ESR from 33 [14.5-61] to 6 [2-12] mm/1st hour (p < 0.0001) and decrease in patients with anemia from 16.4% to 3.8% (p < 0.0001) were observed. Regardless of administration route or disease duration, clinical improvement leading to remission at 6, 12, 18, 24 months was observed in 55.5%, 70.4%, 69.2% and 90% of patients. Most relevant adverse side-effect was serious infections (10.6/100 patients-year), associated with higher doses of prednisone during the first three months of therapy. CONCLUSION In clinical practice, TCZ yields a rapid and maintained improvement of refractory GCA. Serious infections appear to be higher than in clinical trials.
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Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain
| | - Alicia Humbría
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Natalia Palmou-Fontana
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vanesa Calvo-Río
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
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González-Gay MA, Pina T, Prieto-Peña D, Calderon-Goercke M, Blanco R, Castañeda S. The role of biologics in the treatment of giant cell arteritis. Expert Opin Biol Ther 2018; 19:65-72. [DOI: 10.1080/14712598.2019.1556256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Miguel A. González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander,
Spain
- Department of Medicine, University of Cantabria, Santander,
Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa
| | - Trinitario Pina
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander,
Spain
| | - Diana Prieto-Peña
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander,
Spain
| | - Mónica Calderon-Goercke
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander,
Spain
| | - Ricardo Blanco
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander,
Spain
| | - Santos Castañeda
- Rheumatology Division, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM),
Madrid, Spain
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15
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Burja B, Feichtinger J, Lakota K, Thallinger GG, Sodin-Semrl S, Kuret T, Rotar Ž, Ješe R, Žigon P, Čučnik S, Mali P, Praprotnik S, Tomšič M, Hočevar A. Utility of serological biomarkers for giant cell arteritis in a large cohort of treatment-naïve patients. Clin Rheumatol 2018; 38:317-329. [PMID: 30143961 DOI: 10.1007/s10067-018-4240-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
Early diagnosis and treatment of giant cell arteritis (GCA) is crucial for preventing ischemic complications. Multiple serological markers have been identified; however, there is a distinct lack of predicting markers for GCA relapse and complications. Our main objective was to identify serological parameters in a large cohort of treatment-naïve GCA patients, which could support clinicians in evaluating the course of the disease. Clinical data was gathered, along with analyte detection using Luminex technology, ELISA, and nephelometry, among others. Unsupervised hierarchical clustering and principal component analysis of analyte profiles were performed to determine delineation of GCA patients and healthy blood donors (HBDs). Highest, significantly elevated analytes in GCA patients were SAA (83-fold > HBDs median values), IL-23 (58-fold), and IL-6 (11-fold). Importantly, we show for the first time significantly changed levels of MARCO, alpha-fetoprotein, protein C, resistin, TNC, TNF RI, M-CSF, IL-18, and IL-31 in GCA versus HBDs. Changes in levels of SAA, CRP, haptoglobin, ESR, MMP-1 and MMP-2, and TNF-alpha were found associated with relapse and visual disturbances. aCL IgG was associated with limb artery involvement, even following adjustment for multiple testing. Principal component analysis revealed clear delineation between HBDs and GCA patients. Our study reveals biomarker clusters in a large cohort of patients with GCA and emphasizes the importance of using groups of serological biomarkers, such as acute phase proteins, MMPs, and cytokines (e.g. TNF-alpha) that could provide crucial insight into GCA complications and progression, leading to a more personalized disease management.
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Affiliation(s)
- Blaž Burja
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia
| | - Julia Feichtinger
- Institute of Computational Biotechnology, Graz University of Technology, Petersgasse 14, 8010, Graz, Austria.,OMICS Center Graz, BioTechMed Graz, Stiftingtalstraße 24, 8010, Graz, Austria
| | - Katja Lakota
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia.,Faculty of Mathematics, Natural Science and Information Technologies, University of Primorska, Glagoljaška ulica 8, SI-6000, Koper, Slovenia
| | - Gerhard G Thallinger
- Institute of Computational Biotechnology, Graz University of Technology, Petersgasse 14, 8010, Graz, Austria.,OMICS Center Graz, BioTechMed Graz, Stiftingtalstraße 24, 8010, Graz, Austria
| | - Snezna Sodin-Semrl
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia. .,Faculty of Mathematics, Natural Science and Information Technologies, University of Primorska, Glagoljaška ulica 8, SI-6000, Koper, Slovenia.
| | - Tadeja Kuret
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia
| | - Žiga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia
| | - Rok Ješe
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia
| | - Polona Žigon
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Aškerčeva cesta 7, SI-1000, Ljubljana, Slovenia
| | - Polonca Mali
- Blood Transfusion Center of Slovenia, Šlajmerjeva ulica 6, SI-1000, Ljubljana, Slovenia
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova ulica 2, SI-1000, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova ulica 2, SI-1000, Ljubljana, Slovenia
| | - Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, SI-1000, Ljubljana, Slovenia
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