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Banerjee S, Quinn KA, Gribbons KB, Rosenblum JS, Civelek AC, Novakovich E, Merkel PA, Ahlman MA, Grayson PC. Effect of Treatment on Imaging, Clinical, and Serologic Assessments of Disease Activity in Large-vessel Vasculitis. J Rheumatol 2019; 47:99-107. [PMID: 30877209 DOI: 10.3899/jrheum.181222] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Disease activity in large-vessel vasculitis (LVV) is traditionally assessed by clinical and serological variables rather than vascular imaging. This study determined the effect of treatment on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) vascular activity in relation to clinical- and serologic-based assessments. METHODS Patients with giant cell arteritis (GCA) or Takayasu arteritis (TA) were prospectively evaluated at 6-month intervals in an observational cohort. Treatment changes were made at least 3 months before the followup visit and categorized as increased, decreased, or unchanged. Imaging (FDG-PET qualitative analysis), clinical, and serologic (erythrocyte sedimentation rate, C-reactive protein) assessments were determined at each visit and compared over interval visits. RESULTS Serial assessments were performed in 52 patients with LVV (GCA = 31; TA = 21) over 156 visits. Increased, decreased, or unchanged therapy was recorded for 36-, 23-, and 32-visit intervals, respectively. When treatment was increased, there was significant reduction in disease activity by imaging, clinical, and inflammatory markers (p ≤ 0.01 for each). When treatment was unchanged, all 3 assessments of disease activity remained similarly unchanged over 6-month intervals. When treatment was reduced, PET activity significantly worsened (p = 0.02) but clinical and serologic activity did not significantly change. Treatment of GCA with tocilizumab and of TA with tumor necrosis factor inhibitors resulted in significant improvement in imaging and clinical assessments of disease activity, but only rarely did the assessments both become normal. CONCLUSION In addition to clinical and serologic assessments, vascular imaging has potential to monitor disease activity in LVV and should be tested as an outcome measure in randomized clinical trials.
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Affiliation(s)
- Shubhasree Banerjee
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Kaitlin A Quinn
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - K Bates Gribbons
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Joel S Rosenblum
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Ali Cahid Civelek
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Elaine Novakovich
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Peter A Merkel
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Mark A Ahlman
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Peter C Grayson
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. .,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS.
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