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Treppo E, Monti S, Delvino P, Marvisi C, Ricordi C, La Rocca G, Moretti M, Italiano N, Di Cianni F, Ferro F, Muratore F, Baldini C, Talarico R, Quartuccio L, Salvarani C. Systemic vasculitis: one year in review 2024. Clin Exp Rheumatol 2024; 42:771-781. [PMID: 38683204 DOI: 10.55563/clinexprheumatol/gkve60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
Systemic vasculitides comprise a collection of rare and heterogeneous disorders capable of impacting any organ and system, posing a considerable burden of mortality and comorbidity. As with previous annual reviews of this series, this review will offer a critical overview of the latest literature on pathogenesis, biomarkers, and treatment options in both small- and large-vessel vasculitis.
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Affiliation(s)
- Elena Treppo
- Clinic of Rheumatology, Department of Medicine, University of Udine, Hospital Santa Maria della Misericordia, Udine, Italy.
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, University of Pavia, and Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Delvino
- School of Medicine, University of Milano Bicocca, Milan, and IRCCS San Gerardo dei Tintori Foundation, Monza, Italy
| | - Chiara Marvisi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, and Università di Modena e Reggio Emilia, Modena, Italy
| | - Caterina Ricordi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, and Università di Modena e Reggio Emilia, Modena, Italy
| | - Gaetano La Rocca
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - Michele Moretti
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - Nazzareno Italiano
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - Federica Di Cianni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, and Università di Modena e Reggio Emilia, Modena, Italy
| | - Chiara Baldini
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, University of Udine, Hospital Santa Maria della Misericordia, Udine, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, and Università di Modena e Reggio Emilia, Modena, Italy
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Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Australia
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Azienda Ospedaliera Universitaria Meyer IRCCS, Firenze, Italy.
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Firenze, Italy.
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3
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Crawshaw H, Janagan S, Austin K, Baker C, Day J, Robson JC. Patient-reported outcomes in vasculitis. Best Pract Res Clin Rheumatol 2023; 37:101829. [PMID: 37277246 DOI: 10.1016/j.berh.2023.101829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 06/07/2023]
Abstract
Systemic vasculitis encompasses a group of multisystem disorders; both the diseases and the treatment strategies can have a significant impact on a patient's health-related quality of life (HRQoL). Using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) to evaluate the patient's view of their condition, treatments, and healthcare journey is essential to the patient-centered care approach. In this paper, we discuss the use of generic, disease-specific, and treatment-specific PROMs and PREMs in systemic vasculitis and future research goals.
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Affiliation(s)
- Helena Crawshaw
- Rheumatology Department Gloucestershire Royal Hospital NHS Trust, Great Western Road, Gloucester, Gloucestershire, GL1 3NN, UK.
| | - Shalini Janagan
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Keziah Austin
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK; Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Combe Park, Bath, BA1 3NG, UK.
| | - Charlotte Baker
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Julia Day
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, UK.
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, Room 5-054, Rheumatology Research B502, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
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4
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Nwannunu CE, Shah R, Limmer AL. Management of Primary Small-Vessel Vasculitis. Skin Therapy Lett 2020; 25:5-8. [PMID: 32510891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Small-vessel vasculitides (SVV) are a group of disorders that occur due to primarily systemic inflammation or as sequelae of an infection, malignancy, or other rheumatic disease. Arising in any organ including the skin, the clinical features of SVV encompass a variety of manifestations. A comprehensive diagnostic assessment should be performed as management protocols widely differ. Although rare, physicians should be familiar with the common types of SVV to ensure prompt management and prevention of severe, life-threatening end-organ damage. Given the variable manifestations and associated etiologies of SVV, the following review aims to discuss the pathogenesis of more prevalent SVVs, highlight distinguishing features to aid in patient evaluation and diagnosis, and examine evidence-based management options for treatment and care.
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Affiliation(s)
- Crystal E Nwannunu
- Department of Dermatology, McGovern Medical School, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Radhika Shah
- Texas A&M University College of Medicine, Dallas, TX, USA
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Felicetti M, Treppo E, Posarelli C, Ferro F, Bond M, Monti S, Elefante E, Trentin F, Delvino P, Talarico R, Baldini C, Quartuccio L. One year in review 2020: vasculitis. Clin Exp Rheumatol 2020; 38 Suppl 124:3-14. [PMID: 32359039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/19/2020] [Indexed: 06/11/2023]
Abstract
Systemic vasculitides are a group of diseases that could potentially affect any organ with heterogeneous clinical manifestations that usually depend on the size of the most involved vessels. These diseases could be associated with a relevant burden of mortality and morbidity if not early recognised and treated. Moreover, even if they are usually rare diseases, their incidence and prevalence seem to be increasing in the last decade, partially because of improved awareness and management of vasculitis from physicians. Like in the previous annual reviews of this series, in this paper we revised the most recent literature on pathogenesis, clinical manifestations and treatment options in small- and large-vessel vasculitis.
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Affiliation(s)
- Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy
| | - Elena Treppo
- Clinic of Rheumatology, Department of Medicine, University of Udine, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Milena Bond
- Rheumatology Unit, S. Chiara Hospital, Trento, Italy
| | - Sara Monti
- Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia; and University of Pavia, PhD in Experimental Medicine, Pavia, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
| | - Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Paolo Delvino
- Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, University of Udine, Italy.
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Monti S, Bond M, Felicetti M, Cavallaro E, Posarelli C, Elefante E, Ferro F, Talarico R, Quartuccio L, Baldini C. One year in review 2019: vasculitis. Clin Exp Rheumatol 2019; 37 Suppl 117:3-19. [PMID: 31162034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
Systemic vasculitis are disabling complex disorders potentially involving any organ and system. Tremendous efforts have been made recently in this field with novel insights into pathogenesis and new therapy in the pipeline. Following the previous annual reviews of this one year in review series, in this paper we provide a critical digest of the most recent literature regarding pathogenesis, clinical manifestations and therapy, with the ultimate aim of addressing whether the existing data may open new avenues for precision medicine in these disorders.
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Affiliation(s)
- Sara Monti
- Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Milena Bond
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Mara Felicetti
- Operative Unit of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Elena Cavallaro
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Emergency, University of Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Syniachenko O, Khaniukov O, Yehudina Y, Taktashov H, Gashynova K. CHARACTERISTICS OF ARTICULAR SYNDROME IN SYSTEMIC VASCULITIS. Georgian Med News 2017:69-75. [PMID: 29328034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of the study - investigation the separate joint lesion in systemic vasculitis, their X-ray sonographic characteristics, the correlation of the articular syndrome severity with extra-articular manifestations of the diseases, as well as aspects of the arthritis pathogenesis in this category of patients. The study included 525 patients in the ratio of the examined with Henoch-Schonlen purpura, microscopic polyangiitis, cryoglobulinemic vasculitis, polyarteritis nodosa, Takayasu's arteritis, Wegener's granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis Churg-Strauss as a 7:4:3:1:1:1:1. Joint's damage in the form of arthritis or arthralgia observed in 32-67% different groups of patients, that depending on the disease duration, the degree of the pathological process's activity, extraarticular signs severity, lung parenchyma involving and hemodynamic status in the pulmonary circulation. The frequency of the certain bone lesions, existence of tenosynovitis and enthesopathies, X-ray sonographic signs of articular syndrome in different kind of vasculitis has its own gender dimorphism. The immune system malfunction, the rheological properties of blood and endothelial function of vessels collaborate in pathogenetic constructions of arthropathy. What is more, the high value of rheumatoid factor in blood associates with severe course of joint damage. Joint syndrome at different variants of systemic vasculitis is progressing in 1/3-2/3 of cases, this syndrome has definite features of clinical course and pathogenesis.
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Affiliation(s)
- O Syniachenko
- Donetsk National Medical University of Health Ministry of Ukraine, Lyman; State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Ukraine
| | - O Khaniukov
- Donetsk National Medical University of Health Ministry of Ukraine, Lyman; State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Ukraine
| | - Ye Yehudina
- Donetsk National Medical University of Health Ministry of Ukraine, Lyman; State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Ukraine
| | - H Taktashov
- Donetsk National Medical University of Health Ministry of Ukraine, Lyman; State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Ukraine
| | - K Gashynova
- Donetsk National Medical University of Health Ministry of Ukraine, Lyman; State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Ukraine
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Volc S, Maier JC, Röcken M. [Skin diseases due to systemic vasculitides and vasculopathies]. Hautarzt 2017; 67:948-959. [PMID: 27864582 DOI: 10.1007/s00105-016-3896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vasculitis and vasculopathy are two distinct disease entities. Each entity comprises a large number of heterogeneous diseases, which can occur alone or associated with autoimmune, infectious or neoplastic diseases. The terms vasculitis and vasculopathy are often falsely used synonymously. A vasculitis initially causes inflammation of the vessel walls that may result in a secondary occlusion. In contrast, a vasculopathy is a primary occlusion of the vascular lumen, which is followed by inflammation after ischemia and ulceration. In most patients the distinction can be made based on the clinical presentation. A clear clinical diagnosis is then followed by targeted serological, histological and imaging procedures to confirm the clinical diagnosis. On this basis a well-founded treatment can be initiated. In the presence of vasculitis an anti-inflammatory therapy is indicated, whereas in the case of vasculopathy, removal of the vascular occlusion is the main focus. This article provides an overview of the various diseases and addresses the pathogenetic and clinical characteristics used to differentiate the individual disease entities. It also provides an insight into the therapy options and prophylaxis.
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Affiliation(s)
- S Volc
- Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - J C Maier
- Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - M Röcken
- Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
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Elefante E, Monti S, Bond M, Lepri G, Quartuccio L, Talarico R, Baldini C. One year in review 2017: systemic vasculitis. Clin Exp Rheumatol 2017; 35 Suppl 103:5-26. [PMID: 28375840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
Systemic vasculitis is a group of heterogeneous, disabling disorders. Great interest has recently arisen in pathophysiology, clinical phenotypes and therapy of large- and small-vessel vasculitis. The general work hypothesis has been to promote research focused on disease-related pathogenetic pathways, with the ultimate goal of identifying novel diagnostic and prognostic biomarkers, thus leading towards more effective targeted treatments. Following the previous annual reviews of this series, we will hereby provide a critical digest of the recent literature on small- and large-vessel systemic vasculitis, with a specific focus on novel possible disease-related biomarkers and their impact on current and future therapies.
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Affiliation(s)
- Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Sara Monti
- Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Milena Bond
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Gemma Lepri
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, AOUC, Florence, Italy
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Abstract
The objective of the present study was to characterize the patients presenting with atypical inflammation of the middle ear and consider the currently available methods for their examination. A total of 20 patients at the age from 16 to 66 years were admitted to the Department of Ear Microsurgery during the period from 2008 and 2016 for the treatment of atypical inflammation of the middle ear. Eleven of them (18 ears) were found to have tuberculous lesions (TL) of the middle ear while the remaining 9 patients (11 ears) suffered giant cell vasculitis (GCV). All the patients underwent the general clinical and otorhinolaryngological examination, computed tomography of the temporal bones and the thoracic cavity organs, cytological, bacteriological, pathomorphological, and molecular-genetic studies including PCR diagnostics, rheumatological tests, as well as counseling by a phthisiotherapist and rheumatologist. The primary localization of TL in the middle ear was documented in 6 patients including its association with lung lesions in 5 cases. The clinical picture of the disease in 5 patients was that of smoldering exudative pathology and in 6 ones was accompanied by suppurative perforative otitis media. According to the laboratory analyses, bacteriological diagnostics proved efficient in 9% of the patients, pathomorphological and cytological diagnostics in 18% and 27.3% of the cases respectively while the effectiveness of PCR diagnostics was estimated at 55%. The diagnosis in individual patients was established within the period from 1 month to 1.5 years after they first sought medical advice in connection with complaints of the ear disease. Tuberculosis of the middle ear began to develop as exudative middle otitis that acquired the form of bilateral pathology in 4 patients. Three patients had a concomitant pulmonary disease. In 4 patuents, the diagnois of middle ear tuberculosis was established based on the presence of the specific antibodies and in 5 ones based on the results of the pathomorphological study. All the studies were carried out in duplicate. The period between the beginning of the disease and the establishment of the definitive diagnosis varied from 1 month to 1 year.
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Affiliation(s)
- E V Garov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A I Kryukov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152; N.I .Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - V N Zelenkova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - N G Sidorina
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A S Kaloshina
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
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Elefante E, Tripoli A, Ferro F, Baldini C. One year in review: systemic vasculitis. Clin Exp Rheumatol 2016; 34:S1-S6. [PMID: 27214397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 06/05/2023]
Abstract
Systemic vasculitis are complex and heterogenous disorders. During the past months great efforts have been made aimed at clarifying disease pathogenesis and at improving patient management and treatment. In this review we summarise the most important scientific contributions on vasculitis pathogenesis, diagnostic tools and treatment published in 2015.
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Affiliation(s)
- Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandra Tripoli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Moreno-Ariño M, Ortiz-Santamaria V, Deudero Infante A, Ayats Delgado M, Novell Teixidó F. A classic mimicker of systemic vasculitis. Reumatol Clin 2016; 12:103-106. [PMID: 25935820 DOI: 10.1016/j.reuma.2015.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Embolic and constitutional manifestations of intracavitary cardiac tumors are included within the classic mimickers of systemic vasculitis, especially in those in which there are no cardiac manifestations. We present a case report of atrial myxoma in which the patient only presented systemic symptoms and in whom an initial diagnostic approach of systemic vasculitis was made. We also performed a literature search of the cases described. PATIENT AND METHOD A case report of atrial myxoma with atypical presentation manifested as a systemic disease with no concomitant cardiac symptoms is described. The case report is discussed and 11 cases of atrial myxoma pseudovasculitis described in the literature are reviewed, emphasizing their similarities and differences. DISCUSSION Constitutional symptoms and cutaneous manifestations were the most common. Most of the cases showed partial response to glucococorticosteroid treatment, reinforcing the theory of the inflammatory role in its pathogenesis. Mean delayed time to diagnosis was 12.27 months. CONCLUSION Atrial myxoma is a systemic vasculitis mimicker, this being difficult to diagnose in the absence of cardiac manifestations. This delay in diagnosis entails serious complications.
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Affiliation(s)
- Marc Moreno-Ariño
- Servicio de Geriatría, Hospital General de Granollers, Granollers, Barcelona, España.
| | - Vera Ortiz-Santamaria
- Unidad de Reumatología, Servicio de Medicina Interna, Hospital General de Granollers, Granollers, Barcelona, España; Departamento de Medicina, Universidad Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - Aída Deudero Infante
- Servicio de Medicina Interna, Hospital General de Granollers, Granollers, Barcelona, España
| | - Montserrat Ayats Delgado
- Unidad de Cardiología, Servicio de Medicina Interna, Hospital General de Granollers, Granollers, España
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Shilkina NP, Panchenko KI. [Clinical and morphological characteristics of systemic vasculitides: contribution of professor N.E. Yarygin into the solution of the problem]. Angiol Sosud Khir 2016; 22:48-52. [PMID: 27626249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The article deals with the role of Professor N.E. Yarygin in studying the clinical and morphological characteristics of systemic vasculitides and is dedicated to the 70th anniversary of the Yaroslavl State Medical University.
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Affiliation(s)
- N P Shilkina
- Yaroslavl State Medical University of the Ministry of Public Health of the Russian Federation, Yaroslavl, Russia
| | - K I Panchenko
- Yaroslavl State Medical University of the Ministry of Public Health of the Russian Federation, Yaroslavl, Russia
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Abstract
Behçet's disease (BD) is a multi-systemic inflammatory disorder of an unknown etiology and shows a chronic recurrent clinical course. When the disease involves the alimentary tract, it is called intestinal BD because of its clinical importance. Intestinal BD is more frequently reported in East Asian countries than in Western or Middle Eastern countries. While any part of the gastrointestinal tract can be involved, the most common location of intestinal BD is the ileocecal area. A few, large, deep ulcerations with discrete border are characteristic endoscopic findings of intestinal BD. Currently, there is no single gold standard test or pathognomonic finding of intestinal BD. However, recently developed novel diagnostic criteria and a disease activity index have helped in assessing intestinal BD. As intestinal BD shares a lot of characteristics with inflammatory bowel disease, including genetic background, clinical manifestations, and therapeutic strategies, distinguishing between the two diseases in clinical practice is quite difficult. However, biologic agents such as anti-tumor necrosis factor α antibody shows a considerable efficacy similar to inflammatory bowel disease cases. It is important to distinguish and treat those two disease entities separately from the standpoint of precise medicine. Clinicians should require comprehensive knowledge regarding the similarities and differences between intestinal BD and inflammatory bowel disease for making an accurate clinical decision.
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Affiliation(s)
- Duk Hwan Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
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Nevler A, Shpitzer SA, Shinhar D, Bilik R. Ileo-Ileal Intussusception caused by an Inverted Meckel's Diverticulum Eliciting a Systemic Vasculitis-Like Response. Isr Med Assoc J 2015; 17:646-647. [PMID: 26665323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Abstract
The systemic vasculitides are a heterogeneous group of disorders characterized by the inflammation of blood vessels. The development and implementation of advanced diagnostic tests and genetic studies have resulted in substantial improvement in our understanding of vasculitis pathogenesis, resulting in the revision of the nomenclature and classification for vasculitis. Multicenter, collaborative studies are currently underway to develop improved diagnostic criteria. In this review, the major nomenclature and classification systems for vasculitides are summarized, with special emphasis on those emerging from the recent 2012 Chapel Hill Consensus Conference (CHCC).
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Affiliation(s)
- Ezgi Deniz Batu
- Division of Paediatric Rheumatology, Department of Paediatrics, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
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Terrier B, Marie I, Lacraz A, Belenotti P, Bonnet F, Chiche L, Graffin B, Hot A, Kahn JE, Michel C, Quemeneur T, de Saint-Martin L, Hermine O, Léger JM, Mariette X, Senet P, Plaisier E, Cacoub P. Non HCV-related infectious cryoglobulinemia vasculitis: Results from the French nationwide CryoVas survey and systematic review of the literature. J Autoimmun 2015; 65:74-81. [PMID: 26320984 DOI: 10.1016/j.jaut.2015.08.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/15/2015] [Accepted: 08/17/2015] [Indexed: 01/16/2023]
Abstract
In patients with infectious cryoglobulinemia vasculitis (CryoVas) in the absence of hepatitis C virus infection, data on presentation, therapeutic management and outcome are lacking. We conducted a nationwide survey that included patients with HCV-negative CryoVas. We describe here the presentation, therapeutic management and outcome of 18 patients with non-HCV infectious CryoVas and 27 additional patients identified form a systematic review of the literature. We included 18 patients, mean age 57.9±13.5 years. Infectious causes were viral infections in 8 patients [hepatitis B virus (HBV) in 4, and cytomegalovirus, Epstein Barr virus, parvovirus B19 and human immunodeficiency virus in one case each], pyogenic bacterial infection in 6 patients, parasitic infection in 2 patients, and leprosy and candidiasis in one case each. Baseline manifestations were purpura (78%), glomerulonephritis (28%), arthralgia (28%), peripheral neuropathy (22%), skin necrosis (22%), cutaneous ulcers (17%), and myalgia (11%). Cryoglobulinemia was type II in 2/3 of cases. Most cases received specific anti-infectious therapy as first-line therapy, sometimes associated with corticosteroids, achieving sustained remission in the majority of cases. Refractory or relapsing patients, frequently related to HBV infection, showed a complete remission after rituximab in addition to antiviral therapy. In contrast, corticosteroids and/or immunosuppressive agents used in the absence of anti-infectious agents were frequently associated with refractory CryoVas. Viral and pyogenic bacterial infections represent the main causes of non-HCV infectious CryoVas. Antimicrobial therapy is commonly associated with sustained remission. Immunosuppressive agents should be considered only as a second-line option in patients with refractory vasculitis.
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Affiliation(s)
- Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Autoimmune Diseases, Hôpital Cochin, Assistance Publique Hôpitaux de Paris (AP-HP), Université Pierre Descartes, Paris 5, Paris, France.
| | | | - Adeline Lacraz
- Department of Nephrology, CH Côte Basque, Bayonne, France
| | | | | | - Laurent Chiche
- Department of Internal Medicine, Hôpital Européen, Marseille, France
| | | | - Arnaud Hot
- Department of Internal Medicine, CHU Edouard Herriot, Lyon, France
| | | | | | | | | | - Olivier Hermine
- Department of Hematology, Hôpital Necker-Enfants Malades, Paris, France
| | - Jean-Marc Léger
- Department of Neurology, Groupe Hospitalier Pitié-Salpetrière, Paris, France
| | - Xavier Mariette
- Department of Rheumatology, AP-HP, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, INSERM U1184, Le Kremlin-Bicêtre, France
| | - Patricia Senet
- Department of Dermatology, Tenon Hospital, AP-HP, Université Paris 6, Paris, France
| | - Emmanuelle Plaisier
- Department of Nephrology and Dialysis, Tenon Hospital, AP-HP, Université Paris 6, Paris, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France; INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France.
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18
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Flores-Franco RA, Ramos-Martínez E. Vasculitic pleural effusion. Reumatol Clin 2015; 11:186-187. [PMID: 25456239 DOI: 10.1016/j.reuma.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 06/04/2023]
Affiliation(s)
- René Agustín Flores-Franco
- Departamento de Medicina Interna, Hospital General Regional «Dr. Salvador Zubirán Anchondo», Chihuahua, México.
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Sertoglu E, Kayadibi H, Uyanik M. Biochemical view: "red blood cell distribution width as a useful indicator to predict systemic vasculitis in patients with cutaneous vasculitis". Rheumatol Int 2015; 35:765-6. [PMID: 25413844 DOI: 10.1007/s00296-014-3181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Erdim Sertoglu
- Biochemistry Laboratory, Anittepe Dispensary, Ankara Mevki Military Hospital, Ankara, Turkey,
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20
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Musaev RB, Pomogaibo BV, Popov AV, Sergoventsev AA, Borisov AG. [Diagnosties of pulmonary-renal syndrome in young patients with suspected community-acquired pneumonia]. Voen Med Zh 2015; 336:39-43. [PMID: 26454937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In patients of young age atical clinical course of community-acquired pneumonia may mask of interstitial lung disease causing systemic vasculitis. Lung damage occurs in the form of vasculitis with perivascular infiltration, interstitial pneumonia symptoms and various sequential processes up to necrosis of the lung tissue and pleurisy. A distinctive feature of vascular pneumonia is probability of development of plurivisceral damage with simultaneous involvement of heart, kidney, abdominal, skin, joints and hepatolienal syndromes into tfe pathohogical process. At suspicion on development of systemic vasculitis it requires to perform differential diagnosis with the use of immunological tests and X-ray examination of the chest. Lung disease in systemic vasculitis worsens prognosis and necessitates urgent therapeutic measures.
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21
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Smith LA, Gangopadhyay M, Gaya DR. Catastrophic gastrointestinal complication of systemic immunosuppression. World J Gastroenterol 2015; 21:2542-2545. [PMID: 25741165 PMCID: PMC4342934 DOI: 10.3748/wjg.v21.i8.2542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/04/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone. The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis. Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus (HSV) and cytomegalovirus (CMV) respectively. Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens. CMV on the other hand most commonly causes a colitis or less commonly oesophagitis. CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only. Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate. The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.
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22
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Borroni G, Grassi S, Carugno A. Vasculitides with cutaneous expression in children: clinico-pathological correlations. GIORN ITAL DERMAT V 2015; 150:51-71. [PMID: 25516220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The most recent pediatric vasculitis classifications (EULAR/PRINTO/PRES) have proposed the use of an integration of clinical signs and symptoms, laboratory data, imaging and pathologic data. Pediatric vasculitis represent a peculiar clinical-diagnostic model, compared to the corresponding adult pathology chapter, and in particular, dermatopathologic aspects of these diseases identify more specific issues, made contingent by crucial variables such as duration of vasculitis lesion, site of the biopsy, proper biopsy depth, and possibility to correlate histopathological findings with immunopathological results. Possible additional diagnostic difficulties may arise from the fact that, in children, the same systemic disease, such as lupus erythematosus, may present with different clinical manifestations, with histopathological features of a precise type of vasculitis specific for that type of clinical manifestation. Examples are provided by hypocomplementemic urticarial vasculitis, cryoglobulinemic purpura, lymphocytic vasculitis of livedoid lesions. This paper describes the cutaneous histopathological findings of some vasculitis related pediatric diseases, be they pertaining to a systemic vasculitis with corresponding cutaneous vasculitis, to a systemic vasculitis with sporadic cutaneous vasculitic involvement, and to a systemic vasculitis without cutaneous vasculitic involvement. Type and level of histopathological vasculitic involvement, caliber of the vessel, type of vasculitis associated infiltrate, are likewise reliable integration in the complex diagnostic path of vasculitis in childhood. On the basis of these criteria dermatopathologists should be confident in identifying the type of the vasculitis and relate them to a specific pediatric disease.
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Affiliation(s)
- G Borroni
- Department of Clinical-Surgical Diagnostic and Pediatric Science, Unit of Dermatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy -
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Abstract
Although a new classification algorithm for systemic vasculitides was proposed by Watts et al. and the Chapel Hill Consensus Conference (CHCC) was updated in 2012, there are currently no validated diagnostic criteria for systemic vasculitides. The Diagnostic and Classification Criteria for Vasculitis study (DCVAS) is a global study to develop and improve the diagnostic criteria for systemic vasculitides. The epidemiology of systemic vasculitides differs widely among countries. For example, in the case of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, patients with microscopic polyangiitis (MPA) and with positivity for MPO-ANCA are predominant in Asian countries, whereas patients with granulomatosis with polyangiitis (GPA) and with positivity for PR3-ANCA are predominant in northern Europe and the United States. Interstitial lung disease (ILD) occurs more frequently in Asian patients compared with patients in Europe. The incidence and the prevalence of large-vessel vasculitis also differ significantly. Giant cell arteritis (GCA) occurs frequently in northern Europe, unlike Takayasu arteritis (TAK). The ethnic and regional differences in the incidence, prevalence and clinical characteristics of patients with vasculitis should be recognized when we diagnose and treat patients with vasculitis using criteria, and should also be considered when interpreting the results from clinical studies.
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Affiliation(s)
- Takayuki Katsuyama
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken-Ei Sada
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirofumi Makino
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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24
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Yamaguchi M, Izuhara K. New features of systemic vasculitides. Allergol Int 2014; 63:503-4. [PMID: 25574557 DOI: 10.2332/allergolint.14-ed-0832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hernández-Rodríguez J, Tan CD, Rodríguez ER, Hoffman GS. Single-organ gallbladder vasculitis: characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 61 patients. Medicine (Baltimore) 2014; 93:405-413. [PMID: 25500710 PMCID: PMC4602437 DOI: 10.1097/md.0000000000000205] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Systemic vasculitis (SV) involving abdominal structures usually has a poor prognosis. Gallbladder vasculitis (GV) has been reported as part of SV (GB-SV) and focal single-organ vasculitis (GB-SOV). We analyzed clinical and histologic characteristics of patients with GV to identify features that differentiate GB-SOV from the systemic forms of GV. To identify affected patients with GV we used pathology databases from our institution and an English-language PubMed search. Clinical manifestations, laboratory and histologic features, treatment administered, and outcomes were recorded. Patients were divided in 2 groups, GB-SOV and GB-SV. As in previous studies of single-organ vasculitis, GB-SOV was only considered to be a sustainable diagnosis if disease beyond the gallbladder was not apparent after a follow-up period of at least 6 months. Sixty-one well-characterized patients with GV were included (6 from our institution). There was no significant sex bias (32 female patients, 29 male). Median age was 52 years (range, 18-94 yr). GB-SOV was found in 20 (33%) and GB-SV in 41 (67%) patients. No differences were observed in age, sex frequency, or duration of gallbladder symptoms between groups. Past episodes of recurrent right-upper quadrant or abdominal pain and lithiasic cholecystitis were more frequent in GB-SOV patients, whereas acalculous cholecystitis occurred more often in GB-SV. In GB-SV, gallbladder-related symptoms occurred more often concomitantly with or after the systemic features, but they sometimes appeared before SV was fully developed (13.5%). Constitutional and musculoskeletal symptoms were reported only in GB-SV patients. Compared to GB-SOV, GB-SV patients presented more often with fever (62.5% vs 20%; p = 0.003) and exhibited higher erythrocyte sedimentation rate levels (80 ± 28 vs 37 ± 25 mm/h, respectively; p = 0.006). All GB-SV patients required glucocorticoids and 50% of them also received cytotoxic agents. Mortality in GB-SV was higher than in GB-SOV (35.5% vs 10%; p = 0.05). Nongranulomatous inflammation with fibrinoid necrosis of medium-sized vessels occurred equally in both groups (>90%). Forms of SV affecting the gallbladder included polyarteritis nodosa (n = 10), hepatitis B virus-associated vasculitis (n = 8), cryoglobulinemic (essential or hepatitis C virus-associated) vasculitis (n = 6), vasculitis associated with autoimmune diseases (n = 6), microscopic polyangiitis (n = 4), eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (n = 4), IgA vasculitis (Henoch-Schönlein) (n = 2), and giant cell arteritis (n = 1).GV is uncommon. Its histology most often consists of a nongranulomatous necrotizing vasculitis affecting medium-sized vessels. GB-SOV is usually discovered after routine cholecystectomy performed because of the presence of local symptoms, gallstone-associated cholecystitis, and contrary to GB-SV, GB-SOV is usually not associated with systemic symptoms. Acute phase reactants and surrogate markers of autoimmunity are usually normal or negative in GB-SOV. GB-SOV does not require systemic antiinflammatory or immunosuppressive therapy; surgery is adequate to achieve cure. GB-SV always warrants immunosuppressant therapy and is associated with high mortality. The finding of GV may precede the generalized manifestations of SV. Therefore, once GV is discovered, studies to determine disease extent and a vigilant follow-up are mandatory.
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Affiliation(s)
- José Hernández-Rodríguez
- From the Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain (JHR); Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases (GSH); and Department of Anatomic Pathology (CDT, ERR), Cleveland Clinic, Cleveland, Ohio, United States
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26
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Morbelli S, Ghigliotti G, Spinella G, Marini C, Bossert I, Cimmino M, Pane B, Rousas N, Cittadini G, Massollo M, Camellino D, Riondato M, Palombo D, Barisione C, Sambuceti G. Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study. Q J Nucl Med Mol Imaging 2014; 58:299-309. [PMID: 24658166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. METHODS Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. RESULT FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes' count (P<0.02). Carotid metabolism was directly correlated with monocytes' count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). CONCLUSION The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.
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Affiliation(s)
- S Morbelli
- Nuclear Medicine Unit IRCCS San Martino University Hospital, IST Dept of Health Sciences, University of Genoa, Genoa, Italy -
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27
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Lo Gullo A, Bajocchi G, Cassone G, Cavazza A, Zanichelli M, Salvarani C. Granulomatosis with polyangiitis presenting as a renal mass successfully treated with rituximab. Clin Exp Rheumatol 2014; 32:S138. [PMID: 24021545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/07/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Alberto Lo Gullo
- Unit of Rheumatology, Department of Internal Medicine, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
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28
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Della Rossa A, Cioffi E, Elefante E, Ferro F, Parma A, Vagelli R, Talarico R. Systemic vasculitis: an annual critical digest of the most recent literature. Clin Exp Rheumatol 2014; 32:S98-S105. [PMID: 24854379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
Herewith we provide our annual digest of the recent literature on systemic vasculitis in which we reviewed all the articles published during the last 12 months on large-, medium- and small-vessel vasculitis, and selected the most relevant studies regarding the epidemiology, pathogenesis and management of systemic vasculitis. In particular, we focused the attention on giant cell arteritis, ANCA-associated vasculitis and cryoglobulinaemia.
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Affiliation(s)
- Alessandra Della Rossa
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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29
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D'Alessandro M, Buoncompagni A, Minoia F, Coccia MC, Martini A, Picco P. Cytomegalovirus-related necrotising vasculitis mimicking Henoch-Schönlein syndrome. Clin Exp Rheumatol 2014; 32:S73-S75. [PMID: 24854375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/23/2014] [Indexed: 06/03/2023]
Abstract
Viral vasculitides have been previously reported in the literature, the role of infections in their pathogenesis ranging from direct cause to trigger event. Here we report the case of a 3-year-old immunocompetent girl who developed a systemic vasculitis leading to ileal perforation, mimicking a full blown picture of Henoch-Schönlein purpura. High dosage steroid treatment was started, with good response. The anatomopathological examination of the resected gastrointestinal tract showed features of necrotising vasculitis and cytomegalovirus (CMV)-related inclusion bodies in the endothelial cells, with direct correlation to vascular damage. The causative role of viral infection was revealed by the presence of CMV DNA in patient's blood and positive IgG titer against the virus. Steroid therapy was then tapered: the patient achieved clinical remission, which still persists after a six-months follow-up. Our report suggests that CMV vasculitis is probably more frequent than previously thought, even in immunocompetent patients, with a protean clinical presentation, mimicking other types of vasculitides.
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30
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Tejedor A, Solé M, Prieto-González S, Alba MA, Grau JM, Cid MC, Hernández-Rodríguez J. Acute dilated cardiomyopathy in a patient with beriberi and cryoglobulinaemic vasculitis: an unusual potential complication of two rare disorders. Clin Exp Rheumatol 2014; 32:S66-S69. [PMID: 24429381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/12/2013] [Indexed: 06/03/2023]
Abstract
We report the case of a 45-year-old patient who presented with acute dilated cardiomyopathy. During admission the patient was consecutively diagnosed with cryoglobulinaemic vasculitis and beriberi. In both diseases, cardiac involvement may occur as dilated cardiomyopathy. Thiamin deficiency was the final cause for the severe cardiac manifestations (cardiac acute beriberi or Shoshin syndrome), which returned to normal after thiamin supplementation.
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Affiliation(s)
- Ana Tejedor
- Vasculitis Research Unit, Department of Autoimmune Diseases. Hospital Clínic of Barcelona. IDIBAPS. University of Barcelona. Barcelona, Spain.
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31
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Liu JY, Zhang RS, Zhou CK. A case of primary systemic necrotizing vasculitis presenting primarily with neurologic involvement. Kobe J Med Sci 2014; 59:E157-E160. [PMID: 24854993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Systemic necrotizing vasculitis (SNV) is a type of vasculitis that presents with necrosis, predominantly involving large, medium-sized and small arteries. Peripheral neuropathy is a major clinical feature of the primary and secondary systemic vasculitides, and is often observed during the early phases of the disease, causing axonal neuropathy. The prevalence of central nervous system (CNS) involvement ranges from 4% to 45%. Encephalopathy, focal neurological deficits, and seizures are the most common manifestations and usually occur late during the course of SNV. In this report, we describe a 61-year-old woman with SNV who had both CNS and peripheral nervous system vasculitic involvement. We also discuss the pathophysiology of nervous system involvement in patients with SNV.
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Affiliation(s)
- Jing-Yao Liu
- Department of Neurology, Jilin University First Hospital, Changchun 130031, China
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32
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Beketova TV. [The current classification of systemic vasculitides]. TERAPEVT ARKH 2014; 86:94-98. [PMID: 25026809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Systemic vasculitides (SV) are severe multiorgan diseases whose early diagnosis and treatment can significantly improve prognosis. Improving the classification of SV may lead to a significant reduction in the likelihood of diagnostic errors. The presented paper deals with the results of the International Consensus Conference on the Nomenclature of SV (Chappel Hill, USA) in 2012. The nomenclature and definitions of the major forms of SV were revised and additional categories of vasculitis were included into the classification, by relying on the current trends in the practical use of terms, on the current ideas on the specific features of manifestations of diseases, and on achievements in studying the pathogenesis.
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33
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Shilkina NP. [Academician V.A. Nasonova's role in the study of systemic vasculitides]. Angiol Sosud Khir 2014; 20:24-26. [PMID: 25076510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Article is dedicated to academician V.A.Nasonova contribution to the development of clinic, diagnostics and treatment of systemic vasculitides].
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34
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Fain O, Mekinian A. [Systemic vasculitis]. Rev Prat 2014; 64:113-126. [PMID: 24649563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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35
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Brătucu E, Lazar A, Marincaş M, Daha C, Zurac S. Aseptic mesenteric lymph node abscesses. In search of an answer. A new entity? Chirurgia (Bucur) 2013; 108:152-160. [PMID: 23618562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
Mesenteric lymphadenitis constitutes a frequent cause for abdominal pain and may manifest acute abdominal symptoms. Very often, it is difficult to achieve a differential diagnosis as there are many diseases that can generate mesenteric lymphadenopathy. Many times, it is impossible to determine the diagnosis of the disease that has triggered mesenteric lymphadenopathy even after surgical intervention with biopsy. The failure in determining the precise cause of the mesenteric lymphadenoapathy, as well as its unresponsiveness to conservative treatments increases the difficulty in the management of this disease very much. In this paper we have reviewed the diseases that can trigger mesenteric lymphadenitis in detail, with reference to our experience. To the best of our knowledge, this is the most extensive review on this theme in current specific literature. The case reported by us, with a history of mesenteric adenitis, splenic and ganglionic abscesses, vasculitis skin nodules, pseudotumoral ileal stenosis and remission-recurrence pattern over 25 years, has raised extremely difficult problems of differential diagnosis. Its enlistment as a Crohn's disease, vasculitis or aseptic abscess syndrome seems unsatisfactory. The analysis of the data in this case can raise the legitimacy of the question: should we recognize and define a new entity?
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Affiliation(s)
- E Brătucu
- University of Medicine and Pharmacy "Carol Davila", Department of Surgery I, Bucharest Oncology Institute "Al. Trestioreanu", Bucharest, Romania
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36
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Talarico R, Baldini C, Della Rossa A, Carli L, Tani C, Bombardieri S. Systemic vasculitis: a critical digest of the recent literature. Clin Exp Rheumatol 2013; 31:S84-S88. [PMID: 23663686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 06/02/2023]
Abstract
Herewith we provide a critical digest of the recent literature on systemic vasculitis. In this manuscript, we reviewed all the articles published during the last 12 months on large-, medium- and small-vessel vasculitis and selected the most relevant studies regarding the epidemiology, pathogenesis and management of systemic vasculitis. In particular we focused the attention on giant cell arteritis, ANCA-associated vasculitis and cryoglobulinemia.
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Affiliation(s)
- R Talarico
- Rheumatology Unit, University of Pisa, Pisa, Italy.
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Ryba M, Konieczny A, Sroka M, Agnieszka H, Zbigniew H. [Rapid progressive glomerulonephritis (RPGN) and skin involvement as a clinical manifestation of vasculitis: a case report]. Przegl Lek 2013; 70:173-175. [PMID: 24003675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Systemic vasculitis is a heterogeneous group of diseases characterized by infiltrates consisting of neutrophils infiltrated the walls of blood vessels of various caliber. The most common clinical manifestation is renal involvement, nervous system, lungs and skin. These disorders may be manifested by changes in the image of urine in the form of a nephritic syndrome, deterioration of renal function, haemoptysis and ulceration of the skin. Characteristic for systemic vasculitis is the presence of neutrophil cytoplasmic antibodies (ANCA), which binds to the specific antigens generate immune complexes, which then activates a cascade of inflammatory reactions and lead to damage of vascular walls. The treatment includes steroids and cyclophosphamide and therapeutic plasma exchange treatments, and after reaching remission therapy is continued by low-dose steroids and azathioprine. A case of a man with systemic vasculitis is presented, in whom symptoms were present in the form of nephritic syndrome and RPGN, and has developed sores on the skin of abdomen and lower limbs. After the use of prednisone at a dose of 1 mg/kg and pulses of cyclophosphamide, remission has been achieved, patient restored normal kidney function, and the massive skin lesions have healed.
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Affiliation(s)
- Monika Ryba
- Wrovasc--Zintegrowane Centrum Medycyny, Sercowo-Naczyniowej, Wojewódzki Szpital Specjalistyczny we Wrocławiu, Ośrodek Badawczo-Rozwojowy.
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Shilkina NP, Driazhenkova IV. [Systemic vasculitides: diagnostic stages]. TERAPEVT ARKH 2013; 85:39-42. [PMID: 23808290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM To present systemic vasculitis (SV) diagnostic stages. SUBJECTS AND METHODS Immunological and hemostatic parameters were determined, vascular scanning, histological and immunomorphological studies were performed in 360 patients. RESULTS The main diagnostic searching stages were presented, which could reveal the key clinical signs of vasculitis and systemacy of the process, differentiate primary and secondary vasculitides, conduct clinical and instrumental studies, detect specific markers of vascular wall injury, perform a morphological study of biopsy specimens, identify the major pathogenic components of vascular bed lesion, define the possible etiology and form of vasculitis, and make a nosological diagnosis. CONCLUSION The proposed diagnostic steps will be able to specify the nosological form of SV and the activity of the process and to define approaches to pathogenetic therapy.
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Flores-Suárez LF. Vasculitis: report from Mexico. Clin Exp Nephrol 2012; 17:715-717. [PMID: 23229651 DOI: 10.1007/s10157-012-0748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 11/21/2012] [Indexed: 11/26/2022]
Abstract
Although primary systemic vasculitides (PSV) are infrequent diseases, basic and clinical research have increased the knowledge of these autoimmune conditions substantially. Some PSV seem to be more frequent in certain countries. Here we present a brief history of the modest, but important contributions made in Mexico in this area of research.
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Affiliation(s)
- Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502. Col. Sección XVI. Tlalpan, C.P.14080, Mexico, Mexico.
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Wolf J, Schmitt V, Palm F, Grau AJ, Bergner R. Peripheral neuropathy as initial manifestation of primary systemic vasculitides. J Neurol 2012; 260:1061-70. [PMID: 23212754 DOI: 10.1007/s00415-012-6760-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/06/2012] [Accepted: 11/12/2012] [Indexed: 01/24/2023]
Abstract
Peripheral neuropathies are well-known complications of primary systemic vasculitides. In rare cases, peripheral neuropathies are among the first symptoms of these diseases. In this prospective study, 89 consecutive adult patients with newly diagnosed primary systemic vasculitis were screened, of whom 22 patients (25 %, 12 men, ten women, mean age, 59 years, range, 26-82 years) suffered from peripheral neuropathy due to systemic vasculitis at initial presentation. Peripheral neuropathy was most frequent in newly diagnosed patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome, 12 out of 20 patients, 60 %) and polyarteritis nodosa (three out of six patients, 50 %), and less common in patients with granulomatosis with polyangiitis (six out of 47 patients, 13 %) and microscopic polyangiitis (one out of 16 patients, 6 %). Multiplex mononeuropathy was more frequent (n = 13, 59 %) than symmetric polyneuropathy (n = 9, 41 %). The nerves commonly affected were the peroneal nerve, followed by the sural, posterior tibial, and median nerves. Treatment options were chosen according to current guidelines of the national neurological and rheumatologic societies, with initial corticosteroid monotherapy for patients with a mild disease form and a combination of corticosteroids and intravenously pulsed cyclophosphamide for patients with a more extended organ involvement. During follow-up (mean, 34 months, range, 12-112 months), new neurological complications were rare (9 %): One patient suffered from a cerebral infarct while another patient sustained epileptic seizures. Two patients (9 %) died from sepsis (after 60 months) or severe gastrointestinal bleeding (after 13 months). The degree of neurological disability measured by the functional disability score (described by Prineas) improved in 20 of 22 patients after 12 months of therapy.
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Affiliation(s)
- Joachim Wolf
- Department of Neurology, Klinikum der Stadt Ludwigshafen, Bremserstraße 79, 67063 Ludwigshafen, Germany.
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Hernández-Rodríguez J, Tan CD, Koening CL, Khasnis A, Rodríguez ER, Hoffman GS. Testicular vasculitis: findings differentiating isolated disease from systemic disease in 72 patients. Medicine (Baltimore) 2012; 91:75-85. [PMID: 22391469 DOI: 10.1097/md.0b013e31824156a7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Testicular vasculitis (TV) may be part of systemic (testicular) vasculitis (STV) or may exist as single-organ/isolated (testicular) vasculitis (ITV). In the current study we sought to identify clinical and histologic features that distinguish STV from ITV. The distinction was deemed important because it is already well established that in other forms of single organ vasculitis, surgical therapy alone may be curative. We identified patients with biopsy-proven TV from pathology databases from our institution and from an English-language PubMed search. Patients were included if data were available to determine TV extent confidently. Data recorded included clinical, laboratory, and histologic features; treatment; and clinical follow-up. The study included 72 patients with TV (mean age, 42 yr; range, 4-78 yr) (7 from our institution). About 74% of patients presented with painful testicular swelling/mass, 10% with a painless testicular swelling/mass, and 4% with epididymal swelling/mass. Eleven percent had no testicular complaints and vasculitis was discovered at autopsy or in other surgical interventions. Vasculitis involved the testicle in 80.3% of cases, the epididymis in 44.6%, and the spermatic cord in 30.6%. Thirty-seven (51%) patients had ITV and 35 (49%) had STV. No differences between ITV and STV patients were found in regards to age, presenting testicular features, duration of testicular symptoms, and time of follow-up. Compared to ITV patients, STV patients presented more often with constitutional/musculoskeletal symptoms (74.3% vs. 8.3%, respectively; p = 0.0001), elevated erythrocyte sedimentation rate (94.7% vs. 16%; p = 0.0001), and anemia (50% vs. 0%; p = 0.0001). Neoplasm was more frequently suspected in ITV than in STV (74.2% vs. 31.6%; p = 0.001), but only occurred in 2 ITV patients. Long-term glucocorticoid therapy was given only to STV patients, and 59.1% of them also received cytotoxic agents. ITV was diagnosed more often by orchiectomy (81.1% vs. 42.9%; p = 0.001) and less frequently by testicular biopsy (2.7% vs. 28.6%; p = 0.003) than STV. Nongranulomatous inflammation affecting medium-sized vessels occurred in most patients with both ITV and STV. Among STV, polyarteritis nodosa was the most frequently diagnosed (63%), followed by Wegener granulomatosis (17%).In summary, TV occurs as ITV in men usually presenting with a testicular mass in the absence of systemic symptoms and normal laboratory results. In most ITV patients, a testicular neoplasm is initially suspected, and TV is an unexpected finding. After surgical removal, ITV does not require systemic therapy. Polyarteritis nodosa is the systemic vasculitis most frequently associated with testicular involvement.
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Affiliation(s)
- José Hernández-Rodríguez
- From the Department of Autoimmune and Systemic Diseases, Hospital Clínic, Barcelona, Spain (JHR); Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases (AK, GSH) and Department of Anatomic Pathology (CDT, ERR), Cleveland Clinic, Cleveland, Ohio; and Division of Rheumatology (CLK), University of Utah, Salt Lake City, Utah
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Quartuccio L, Isola M, Corazza L, Maset M, Monti G, Gabrielli A, Tzioufas AG, Ferri C, Ferraccioli G, Ramos-Casals M, Voulgarelis M, Lenzi M, Mascia MT, Sansonno D, Cacoub P, Tomsic M, Tavoni A, Pietrogrande M, Zignego AL, Scarpato S, Pioltelli P, Steinfeld S, Lamprecht P, Galli M, Bombardieri S, De Vita S. Performance of the preliminary classification criteria for cryoglobulinaemic vasculitis and clinical manifestations in hepatitis C virus-unrelated cryoglobulinaemic vasculitis. Clin Exp Rheumatol 2012; 30:S48-S52. [PMID: 22410397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 01/24/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cryoglobulinaemic vasculitis (CV) is often related to hepatitis C virus (HCV) infection, but it can develop in other diseases (e.g. other infections, connective tissue diseases, malignancies) in the absence of HCV infection. A comparison of the performance of the recently published classification criteria for the CV was made between HCV-positive and HCV negative patients with serum cryoglobulins. METHODS 500 patients with serum cryoglobulins were studied. Their mean age was 60.77±13.75 years, they were 356 females (71.2%) and 144 males (28.8%). CV was diagnosed in 272 patients (54.4%), while other diseases associated with serum cryoglobulins without CV (CwV) were diagnosed in 228 patients (45.6%). RESULTS 117 HCV negative patients were collected (23.4%) and they were 42/272 (15.4%) among the CV group, while they were 75/228 (32.9%) among the CwV. In HCV negative patients the sensitivity and specificity of the classification criteria of CV were 89.5% CI 95% [79.5-99.5] and 90.3% CI 95% [82.8-97.8], respectively, while in HCV positive patients they were 88.3% CI 95% [83.6%-93.1%] and 96.1% CI 95% [91.8-100], respectively. The most frequent disease recognised among the HCV negative patients was Sjögren's syndrome (SS) (55/117, 47.0%), and the sensitivity and the specificity of the CV classification criteria were 88.9% CI 95% [76.5-100] and 91.3% CI 95% [79.2-100], respectively. CONCLUSIONS The classification criteria for CV showed a good performance even in HCV-unrelated patients. A slightly lower specificity was observed for the classification of HCV-unrelated CV, since some clinical manifestations included in the clinical item for the classification criteria occurred more frequently in HCV-negative rather than HCV-positive controls with CWV.
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Affiliation(s)
- Luca Quartuccio
- Clinic of Rheumatology, DSMB, University Hospital "Santa Maria della Misericordia", Udine, Italy.
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Lamprecht P. Cryoglobulinaemic vasculitis: new aspects. Clin Exp Rheumatol 2012; 30:S3-S5. [PMID: 22510483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 02/08/2012] [Indexed: 05/31/2023]
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Bejerano C, Blanco R, González-Vela C, Pérez-Martín I, Martinez-Rodriguez I, Jimenez-Bonilla J, González-Gay MA. Polymyalgia rheumatica as presenting manifestation of vasculitis involving the lower extremities in a patient with ulcerative colitis. Clin Exp Rheumatol 2012; 30:S110-S113. [PMID: 22640654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 02/28/2012] [Indexed: 06/01/2023]
Abstract
Extraintestinal features may be observed in patients with ulcerative colitis (UC). We describe a 69-year-old woman who was initially diagnosed as having polymyalgia rheumatica (PMR). Prednisone was progressively tapered to complete discontinuation a year and a half after PMR diagnosis. However, at that time, she started to complain of asthenia, abdominal cramping and pain on the left side, weight loss and bloody diarrhoea. A colonoscopy confirmed a diagnosis of left-sided UC. She experienced several flares of the disease that required admission and treatment with high-dose corticosteroids and azathioprine. Colectomy was performed as the disease became refractory to these therapies. Four months after surgery, when the patient was not receiving any corticosteroid therapy, she started to feel dull and achy pain in the thighs along with claudication of the lower limbs. An 18F-fluorodeoxyglucosepositron emission tomography with CT (FDG PET/CT) disclosed an inflammatory process with mild-moderate diffuse increased metabolism in the thoracic aorta and markedly increased FDG uptake in the in the femoral and posterior tibial arteries on both sides. Treatment with the anti-TNF-alpha monoclonal antibody-adalimumab (40 mg every 2 weeks subcutaneously) along with prednisone (initial dose 15 mg/day) yielded rapid improvement of symptoms. Also, a new FDG PET/CT performed 4 months later disclosed marked decrease of FDG uptake in the involved arteries.This report emphasises the importance of suspecting the presence of large- and medium-vessel vasculitis in a patient with UC presenting with musculoskeletal features. It also highlights the beneficial effect of TNF-antagonists in vasculitis associated to UC.
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Affiliation(s)
- Carmen Bejerano
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain.
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Ding YL, Zhu H, Yao WZ, Zhao MW. [Clinical analysis of diffusive interstitial lung diseases with positive anti-neutrophil cytoplasmic antibody]. Beijing Da Xue Xue Bao Yi Xue Ban 2011; 43:222-227. [PMID: 21503116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore the features of pulmonary interstitial pathological changes in diffuse interstitial lung disease (DILD) patients with positive anti-neutrophil cytoplasmic antibody (ANCA), and the similarities as well as differences between ANCA positive patients with non-primary vasculitis and primary systematic vasculitis. METHODS Clinical data of 122 patients with DILD having ANCA examined from October 1995 to September 2008, were reviewed. Among the ANCA positive patients with non-primary vasculitis (Group A), those with primary systematic vasculitis (Group B), and the ANCA negative patients (Group C), the results of syndromes, signs, radiological manifestations, pulmonary function tests, bronchoscope examinations, bronchoalveolar lavage fluid (BALF) cytology and other laboratory examinations were compared. RESULTS In the 122 DILD patients with ANCA results, 36 patients' ANCA (29.51%) were positive. The numbers of patients in Groups A, B, and C were 7, 29, and 86. Total lung capacity (TLC) decreased less and pleural pathological changes were more seen in Groups A and B than in Group C. Oliguria, haematuria, proteinuria, anaemia, and renal inadequacy in Group A, which were similar in Group C, appeared less than in Group B. Results of bronchoscope examination, BALF cytology, anti-nuclear antibody (ANA), and etc. were not significantly different among the three groups. CONCLUSION In DILD patients, pulmonary interstitial changes of those with positive ANCA accompany with more pleural pathological changes and TLC decreased less than those with negative ANCA. In patients with positive ANCA, non-primary vasculitis had some similar clinical manifestations as primary systematic vasculitis, however, anaemia and renal damages were less seen in the non-primary vasculitis patients.
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Affiliation(s)
- Yan-ling Ding
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
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Sharma P, Sharma S, Baltaro R, Hurley J. Systemic vasculitis. Am Fam Physician 2011; 83:556-565. [PMID: 21391523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The systemic vasculitides are characterized by inflammation of blood vessel walls. Vessels of any type, in any organ can be affected, resulting in a broad spectrum of signs and symptoms. The heterogenous nature of vasculitides presents a diagnostic challenge. The American College of Rheumatology classification criteria and the Chapel Hill Consensus Conference nomenclature are the most widely used to distinguish different forms of vasculitis. The Chapel Hill Consensus Conference nomenclature defines 10 primary vasculitides based on vessel size (large, medium, and small). The diagnosis relies on the recognition of a compatible clinical presentation supported by specific laboratory or imaging tests and confirmatory histology. Antineutrophilic cytoplasmic antibody testing has been of particular benefit in defining a subgroup of small vessel vasculitides. Treatment is based on clinical presentation and the pattern of organ involvement. Glucocorticoids are the primary treatment for many forms of vasculitis. Additional immunosuppressive agents, including methotrexate and cyclophosphamide, are sometimes required. Newer approaches, such as the use of anti-tumor necrosis factor or B cell therapies, are being tried in resistant cases. Patients can experience considerable treatment-related toxicity, especially infection from immunosuppressive therapy and adverse effects from steroids (e.g., osteoporosis, diabetes mellitus, cataract). Vitamin D and calcium prophylaxis are recommended in patients on long-term steroid therapy.
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Affiliation(s)
- Poonam Sharma
- Creighton University Medical Center, Omaha, NE 68131, USA
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Sampaio L, Silva L, Terroso G, Pimenta S, Brandão F, Pinto J, Prisca A, Brito J, Ventura F. Hansen's disease mimicking a systemic vasculitis. Acta Reumatol Port 2011; 36:61-64. [PMID: 21483282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hansen's disease, caused by Mycobacterium leprae, classically presents with cutaneous and neurological manifestations. Rheumatologic manifestations present in 1 to 5% of the patients, and include arthritis, arthralgias, Charcot arthropathy, erythema nodosum and vasculitis. We report a case of a 86 year old woman with polyarthritis, subcutaneous nodules and leg ulcers whose differential diagnosis included primary vasculitis and diffuse connective tissue diseases and ended to be leprosy in a non endemic country.
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Affiliation(s)
- L Sampaio
- Serviços de Reumatologia do Hospital de São João e da Faculdade de Medicina do Porto, Portugal.
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Seitz M. [Which clinical symptoms suggest distinct autoantibody measurements?]. Praxis (Bern 1994) 2010; 99:1429-1434. [PMID: 21082596 DOI: 10.1024/1661-8157/a000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The detection of autoantibodies is an important cornerstone in the diagnosis of systemic autoimmune disorders such as autoimmune connectivitides and small vessel vasculitides. Antinuclear antibodies (ANAs ) and antineutrophil cytoplasmic antibodies (c+p-ANCAs) are appropriate diagnostic screening tools for autoimmune connectivitides and small vessel vasculitides. For economic and intellectual/didactic reasons more extensive autoantibody diagnostics should be performed only in particular situations when patients history and clinical exam lead to strong diagnostic suspicion.
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Affiliation(s)
- Michael Seitz
- Universitätsklinik für Rheumatologie, Klinische Immunologie und Allergologie, Inselspital Bern.
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Cibicková L, Soukup T, Toms J, Klzo L, Abdalla AM, Bradna P. [Central hemiparesis as manifestation of systemic vasculitis]. Vnitr Lek 2010; 56:1194-1197. [PMID: 21250498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present a case report of patient with systemic vasculitis with affection of heart, skin, gastrointestinal tract and rare involvement of central nervous system. Diagnosis of systemic vasculitis was based on clinical manifestations, blood hypereosinophilia and brain magnetic resonance imaging. Immunosuppressive therapy led to regression of symptoms including initially present neurologic manifestation.
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Affiliation(s)
- L Cibicková
- II. Interní klinika Lékarské fakulty UK a FN Hradec Králové.
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Defuentes G, Cremades S, Carmoi T, Ficko C, Mangouka L, Dutasta F, Nielly H, Margery J, Berets O. [Pleuropulmonary manifestations of necrotising vasculitis]. Rev Pneumol Clin 2010; 66:295-301. [PMID: 21087724 DOI: 10.1016/j.pneumo.2010.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/24/2010] [Indexed: 05/30/2023]
Abstract
The pleuropulmonary manifestations of necrotising vasculitis are frequent and polymorphic. If the existence of extrapulmonary signs and the presence of neutrophil polynuclear anticytoplasmic antibodies are helpful for the diagnosis of a bout of vasculitis, the existence of pleuropulmonary symptoms can also make for discussion of infections or iatrogenic effects induced by immunosuppressive treatments.
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Affiliation(s)
- G Defuentes
- Service de médecine interne, hôpital d'instruction des armées Percy, Clamart, France.
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