Vascular Calcification in Takayasu Arteritis; Relationship with Metabolic Syndrome, Left Ventricular Mass Index and Intima-Media Thickness

INTRODUCTION

; The present study aims to determine the frequency of vascular calcification in Takayasu arteritis (TA) and the risk factors for it and to evaluate its relation with atherosclerotic predictors such as metabolic syndrome (MS), left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT).

METHOD

A cross-sectional study was conducted in patients with TA; MS was defined according to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria. The study included 49 TA patients (22 with MS, 27 without MS) and 31 healthy controls (HCs). Non-contrast computed tomography measured calcification in coronary arteries, aorta, and branches.

RESULTS

Forty-seven patients (95.9%) were female and mean age was 33.45±8.53 years. Total calcification score (mean±SD; 5223.9±18041.1 AU vs 35.87±72.70 AU (p=0.05)), CIMT and LVMI were found to be significantly higher in TA patients than HCs (p<0.05). While there was no significant difference between the total calcification score of MS (+) TA patients and MS (-) TA patients, in both patient groups, the total calcification score was found to be significantly higher than HCs. MS (+) and MS (-) groups were found to have significantly higher CIMT and LVMI values than the control group, in addition, MS (+) patients were found to have significantly higher LVMI and CIMT values than MS (-) group (p<0.05).

CONCLUSION

; Vascular calcification, CIMT, and LVMI are elevated in all TA patients, with greater impact in the presence of MS.

The systemic score may identify life-threatening evolution in Still's disease: data from the GIRRCS AOSD-study group and the AIDA Network Still's Disease Registry

OBJECTIVES

To evaluate the clinical usefulness of the systemic score in the prediction of life-threatening evolution in Still's disease. To assess the clinical relevance of each component of the systemic score in predicting life-threatening evolution and to derive patient subsets accordingly.

METHODS

A multicenter, observational, prospective study was designed including patients included in the GIRRCS (Gruppo Italiano Di Ricerca in Reumatologia Clinica e Sperimentale) AOSD-study group and AIDA (AutoInflammatory Disease Alliance) Network Still's Disease Registry. Patients were assessed if variables to derive the systemic score were available. The life-threatening evolution was defined as mortality, whichever the clinical course, and/or macrophage activation syndrome (MAS), a secondary hemophagocytic lymphohistiocytosis associated with a poor prognosis.

RESULTS

Totally 597 patients with Still's disease were assessed (age 36.6±17.3 years; male 44.4%). The systemic score, assessed as continuous variable, significantly predicted the life-threatening evolution (OR: 1.24, 95%CI:1.07-1.42; p=0.004). A systemic score ≥7 also significantly predicted the likelihood of a patient experiencing life-threatening evolution (OR: 3.36, 95%CI:1.81-6.25; p<0.001). Assessing the clinical relevance of each component of the systemic score, liver involvement (OR: 1.68, 95%CI:1.48-2.67; p=0.031) and lung disease (OR: 2.12, 95%CI:1.14-4.49; p=0.042) both significantly predicted life-threatening evolution. The clinical characteristics of patients with liver involvement and lung disease were derived, highlighting their relevance in multiorgan disease manifestations.

CONCLUSION

The clinical utility of the systemic score was shown in identifying Still's disease at higher risk of life-threatening evolution in a large cohort. Furthermore, the clinical relevance of liver involvement and lung disease was highlighted.

Efficacy of canakinumab in patients with Still's disease across different lines of biologic therapy: real-life data from the International AIDA Network Registry for Still's Disease

Introduction

The effectiveness of canakinumab may change according to the different times it is used after Still's disease onset. This study aimed to investigate whether canakinumab (CAN) shows differences in short- and long-term therapeutic outcomes, according to its use as different lines of biologic treatment.

Methods

Patients included in this study were retrospectively enrolled from the AutoInflammatory Disease Alliance (AIDA) International Registry dedicated to Still's disease. Seventy-seven (51 females and 26 males) patients with Still's disease were included in the present study. In total, 39 (50.6%) patients underwent CAN as a first-line biologic agent, and the remaining 38 (49.4%) patients were treated with CAN as a second-line biologic agent or subsequent biologic agent.

Results

No statistically significant differences were found between patients treated with CAN as a first-line biologic agent and those previously treated with other biologic agents in terms of the frequency of complete response (p =0.62), partial response (p =0.61), treatment failure (p >0.99), and frequency of patients discontinuing CAN due to lack or loss of efficacy (p =0.2). Of all the patients, 18 (23.4%) patients experienced disease relapse during canakinumab treatment, 9 patients were treated with canakinumab as a first-line biologic agent, and nine patients were treated with a second-line or subsequent biologic agent. No differences were found in the frequency of glucocorticoid use (p =0.34), daily glucocorticoid dosage (p =0.47), or concomitant methotrexate dosage (p =0.43) at the last assessment during CAN treatment.

Conclusion

Canakinumab has proved to be effective in patients with Still's disease, regardless of its line of biologic treatment.

Diffuse generalized venulitis as the primary pathology of Behçet's disease: A comprehensive magnetic resonance venography study

OBJECTIVE

Behçet's Disease (BD) is a chronic multisystem vasculitis that manifests with destructive inflammation affecting the eyes, central nervous system, and blood vessels. The pathology of vein involvement in BD is poorly characterized. Magnetic resonance (MR) venography gives more comprehensive information about deep veins and adjacent tissues. In this study, we aimed to characterize vein involvement and evaluate the diagnostic utility of MR venography in BD.

METHODS

Sixty-five BD patients who fulfilled the International Study Group (ISG) criteria and 20 healthy control subjects were enrolled. Inferior vena cava (IVC), common iliac veins (CIV), external (EIV) and internal iliac veins (IVV), common femoral veins (CFV), femoral veins (FV), and greater saphenous veins (GSV) of BD patients and healthy controls were evaluated with MR venography and ultrasonography for the presence pathologic features, luminal thrombi, vessel wall changes, and perivascular abnormalities.

RESULTS

33 vascular and 32 non-vascular BD patients (mean age 39.3 ± 11.3 years and 48 [73.8%] male) were enrolled. MR venography revealed diffuse concentric thickening of the walls of IVC, CIV, EIV, IIV, CFV, FV, and GSV in BD (healthy controls vs. BD p<0.05 for all vein segments). MR venography provided additional information about veins and perivascular tissues like contrast enhancement, enlarged lymph nodes, and seminal vesicle vascularization, which were remarkably more frequent in vascular BD than non-vascular BD and healthy controls.

CONCLUSION

The results of our study suggest that the involvement of the venous system is diffuse and generalized in BD, and demonstration of venulitis might help diagnose the disease.

Predictors of mortality in rheumatoid arthritis-associated lung disease: A retrospective study on ten years

OBJECTIVES

Rheumatoid arthritis (RA)-associated lung involvement is a cause of mortality. This study aimed to evaluate mortality rate and mortality-associated factors in RA patients with high-resolution computed tomography (HRCT)-proven lung involvement.

METHODS

Patients followed-up for RA between 2010 and 2018 were evaluated regarding HRCT-proven lung involvement. The present study was designed as a single-centre, retrospective and descriptive study. The HRCT reports of patients were re-evaluated for three major patterns: UIP, nonspecific interstitial pneumonia (NSIP), and isolated airway disease (AD). Mortality rates and its associated factors (demographic characteristics, RA-related factors and lung-involvement-related factors) were determined.

RESULTS

The study included 156 patients (females, 68.3%) with radiologically confirmed RA-associated lung disease. The mean age was 55.5 (12.1) years at RA diagnosis and 62.7 (9.7) years at the diagnosis of lung involvement. The patterns of lung involvement on HRCT were UIP in 89 (57.0%) patients, NSIP in 51 (32.7%) patients, and isolated AD in 16 (10.3%) patients. The RA patients were followed-up for a mean of 10.2 (7.4) years and they were followed-up for a mean of 4.5 (3.7) years after interstitial lung disease (ILD) diagnosis. Overall, 40 (25.6%) patients died. The 5-year survival rate was 78%. Multivariate analysis revealed UIP pattern (log-rank test, P<0.01), pleural effusion (log-rank test, P<0.05), and a shorter time interval (<3 years) between the diagnoses of RA and RA-ILD (log-rank test, P<0.01) to be independent predictors of mortality.

CONCLUSIONS

In addition to the UIP, a known risk factor, pleural effusion and the short time between the diagnoses of RA and ILD were also found to be associated with mortality.