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Quinn KA, Ahlman MA, Alessi HD, LaValley MP, Neogi T, Marko J, Novakovich E, Grayson PC. Association of 18 F-Fluorodeoxyglucose-Positron Emission Tomography Activity With Angiographic Progression of Disease in Large Vessel Vasculitis. Arthritis Rheumatol 2023; 75:98-107. [PMID: 35792044 PMCID: PMC9797426 DOI: 10.1002/art.42290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess whether vascular activity seen on 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan is associated with angiographic change in large vessel vasculitis (LVV). METHODS Patients with LVV were recruited into a prospective cohort. All patients underwent magnetic resonance angiography or computed tomography angiography and FDG-PET imaging. Follow-up imaging using the same imaging modalities was obtained ≥6 months later per a standardized imaging protocol. Arterial damage, defined as stenosis, occlusion, or aneurysm, and corresponding FDG uptake were evaluated in 17 arterial territories. On follow-up, development of new lesions was recorded, and existing lesions were characterized as improved, worsened, or unchanged. RESULTS A total of 1,091 arterial territories from 70 patients with LVV (38 patients with Takayasu arteritis, 32 patients with giant cell arteritis) were evaluated. Over a median 1.6 years of follow-up, new lesions developed only in 8 arterial territories in 5 patients with Takayasu arteritis. Arterial lesions improved in 16 territories and worsened in 6 territories. Most arterial territories that did not have vascular activity on FDG-PET scan at baseline had no angiographic change over the follow-up period (787 [99%] of 793). Few territories with baseline FDG-PET activity had angiographic change over time (24 [8%] of 298), but of the territories that developed angiographic change, 80% had FDG-PET activity at baseline. Within the same patient, an arterial territory with baseline FDG-PET activity had significantly increased risk for angiographic change compared to a paired arterial territory without FDG-PET activity (odds ratio 19.49 [95% confidence interval 2.44-156.02]; P < 0.01). Concomitant edema and wall thickening further increased risk for angiographic change. CONCLUSION Development of angiographic change was infrequent in this cohort of patients with LVV. A lack of baseline FDG-PET activity was strongly associated with stable angiographic disease. In cases of angiographic progression, change was preceded by the presence of FDG-PET activity.
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Affiliation(s)
- Kaitlin A. Quinn
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Mark A. Ahlman
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Hugh D. Alessi
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Michael P. LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Tuhina Neogi
- Division of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Jamie Marko
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Elaine Novakovich
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Peter C. Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
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Alessi HD, Quinn KA, Ahlman MA, Novakovich E, Saboury B, Luo Y, Grayson PC. Longitudinal Characterization of Vascular Inflammation and Disease Activity in Takayasu Arteritis and Giant Cell Arteritis: A Single-Center Prospective Study. Arthritis Care Res (Hoboken) 2022; 75:1362-1370. [PMID: 35762866 DOI: 10.1002/acr.24976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine and compare disease activity over time in giant cell arteritis (GCA) and Takayasu arteritis (TAK) using multimodal assessment combining clinical, laboratory, and imaging-based testing. METHODS Patients with GCA or TAK were enrolled into a single-center prospective, observational cohort at any point in the disease course. Patients underwent standardized assessment, including 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) at enrollment and follow-up visits. Each FDG-PET finding was subjectively interpreted as active or inactive vasculitis. Global arterial FDG uptake was quantified by the PET Vascular Activity Score (PETVAS). Patients were stratified by disease duration at enrollment (0-2 years; 2-5 years; >5 years). Fisher exact and Mann-Whitney U tests, Spearman's correlation, and linear regression were used for statistical analyses. RESULTS A total of 126 patients with large vessel vasculitis (GCA = 50; TAK = 76) were evaluated across 319 visits. Clinical disease activity was present in 33% of patients in the second to fifth year of disease and in 24% of patients evaluated >5 years after diagnosis. Active vasculitis by PET was observed in 66% of patients in years 2 to 5 after diagnosis and in 50% of patients enrolled >5 years into disease. PETVASs were consistently higher in GCA than TAK in the early and later phases of disease and significantly decreased over time in GCA but not TAK. Correlations between clinical, laboratory, and imaging findings were complex and varied with disease duration. CONCLUSION Disease activity in GCA and TAK is common throughout the disease course. Patterns of vascular PET activity at diagnosis and later in disease differ between GCA and TAK.
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Affiliation(s)
- Hugh D Alessi
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Kaitlin A Quinn
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Mark A Ahlman
- NIH/Radiology and Imaging Sciences, Bethesda, Maryland
| | - Elaine Novakovich
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Babak Saboury
- NIH/Radiology and Imaging Sciences, Bethesda, Maryland
| | - Yiming Luo
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Peter C Grayson
- NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
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Dashora HR, Rosenblum JS, Quinn KA, Alessi H, Novakovich E, Saboury B, Ahlman MA, Grayson P. Comparing Semi-quantitative and Qualitative Methods of Vascular FDG-PET Activity Measurement in Large-Vessel Vasculitis. J Nucl Med 2021; 63:280-286. [PMID: 34088771 DOI: 10.2967/jnumed.121.262326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
The study rationale was to assess the performance of qualitative and semi-quantitative scoring methods for 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) assessment in large-vessel vasculitis (LVV). Methods: Patients with giant cell arteritis (GCA) or Takayasu's arteritis (TAK) underwent clinical and imaging assessment, blinded to each other, within a prospective observational cohort. FDG-PET-CT scans were interpreted for active vasculitis by central reader assessment. Arterial FDG uptake was scored by qualitative visual assessment using the PET vascular activity score (PETVAS) and by semi-quantitative assessment using standardized uptake values (SUV) and target-to-background ratios (TBR) relative to liver/blood activity. Performance of each scoring method was assessed by intra-rater reliability using the intra-class coefficient (ICC) and area under receiver-operator characteristic curves (AUC), using physician assessment of clinical disease activity and reader interpretation of vascular PET activity as independent reference standards. Wilcoxon signed-rank test was used to analyze change in arterial FDG uptake over time. Results: Ninety-five patients (GCA=52; TAK=43) contributed 212 FDG-PET studies. The ICC for semi-quantitative evaluation [0.99 (range 0.98-1.00)] was greater than the ICC for qualitative evaluation [0.82 (range 0.56-0.93)]. PETVAS and TBR metrics were more strongly associated with reader interpretation of PET activity than SUV metrics. All assessment methods were significantly associated with physician assessment of clinical disease activity, but the semi-quantitative metric TBRLiver¬ achieved the highest AUC (0.66). Significant but weak correlations with C-reactive protein were observed for SUV metrics (r = 0.19, p<0.01) and TBRLiver (r = 0.20, p<0.01) but not for PETVAS. In response to increased treatment in 56 patients, arterial FDG uptake was significantly reduced when measured by semi-quantitative (TBRLiver 1.31 to 1.23, 6.1% ∆, p<0.0001) or qualitative (PETVAS 22 to 18, p<0.0001) methods. Semi-quantitative metrics provided complementary information to qualitative evaluation in cases of severe vascular inflammation. Conclusion: Both qualitative and semi-quantitative methods to measure arterial FDG uptake are useful to assess and monitor vascular inflammation in LVV. Compared to qualitative metrics, semi-quantitative methods have superior reliability and better discriminate treatment response in cases of severe inflammation.
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Affiliation(s)
- Himanshu R Dashora
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Joel S Rosenblum
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Kaitlin A Quinn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Hugh Alessi
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Elaine Novakovich
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health
| | - Mark A Ahlman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health
| | - Peter Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, United States
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Quinn KA, Ahlman M, Alessi H, Malayeri A, Marko J, Novakovich E, Grayson P. POS0802 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY AS A PREDICTOR OF ANGIOGRAPHIC PROGRESSION OF DISEASE IN LARGE-VESSEL VASCULITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Giant cell arteritis (GCA) and Takayasu’s arteritis (TAK) are the two main forms of large-vessel vasculitis (LVV). Although angiography is essential to detect vascular disease in patients with LVV, there is limited prospective data characterizing change in arterial lesions over time, and factors that predict angiographic change remain unknown.Objectives:The objectives of this study were to: 1) describe longitudinal change in angiographic studies in patients with GCA and TAK and 2) determine whether FDG-PET activity predicts angiographic progression of disease.Methods:Patients with GCA or TAK were recruited into a prospective, observational cohort. All patients underwent baseline magnetic resonance (MR) or computed tomography (CT) angiography and a follow-up study (same modality) ≥6 months after baseline per a standardized imaging protocol. For patients who had multiple angiograms, the baseline and most recent images were compared. Arterial lesions, defined as stenosis, occlusion, or aneurysm, were evaluated by visual inspection in 4 segments of the aorta and 13 branch arteries by a single reader blinded to clinical status. On follow up angiography, the development of new lesions in these same territories was recorded, and existing lesions were characterized as improved, worsened, or unchanged by visual inspection, with confirmation by an independent reader.All patients underwent FDG-PET on the same date as angiography. Qualitative assessment of FDG uptake was performed in each corresponding arterial territory evaluated by angiography. Active vasculitis was defined as greater FDG uptake in the arterial wall compared to the liver by visual inspection.Results:At the baseline visit, there were 248 arterial lesions (21%) out of 1162 arterial territories evaluated from 70 patients with LVV (TAK=38; GCA=32). Baseline characteristics were as follows: Age [TAK=29.5 years (18.4-39.5), GCA=69.6 years (60.7-75.5)], Female gender [TAK=30 patients (79%), GCA=23 patients (72%)], Disease duration [TAK=2.2 years (0.6-5.5), GCA=0.7 years (0.1-2.6)], Active clinical disease [TAK=17 patients (45%), GCA=20 patients (63%)].Over 1.6 years (1.0-2.7) of median follow-up, no angiographic change was observed in 1,132 (97%) arterial territories. New lesions developed in 8 arterial territories, exclusively in 5 patients with TAK. Arterial lesions improved in 16 territories (GCA = 7, TAK = 9) and worsened in 6 territories (GCA = 1, TAK = 5). Patients with angiographic improvement were initially imaged earlier in the disease course compared to patients with new/worsening lesions (median 1.1 vs 16.4 months, p=0.09). Patients with angiographic improvement had significantly lower acute phase reactants at follow-up compared to patients with new/worsening arterial lesions [median ESR 3.0 (2.0-15.0) vs. 27.0 (7.3-39) mm/h, p<0.01; median CRP 0.7 (0.3-1.4) vs. 6.1 (3.1-19.6) mg/L, p<0.01]. Seventy-nine percent of patients with new/worsening arterial lesions had received increased treatment over the follow-up interval compared to 100% patients with improved arterial lesions, p=0.09.FDG-PET activity was evaluated in 1091/1162 (94%) of corresponding arterial territories. PET activity in an arterial territory at baseline was significantly associated with change in that arterial territory (either new/worsening or improvement) on follow-up angiography (p<0.01) (FIGURE 1). PET activity had a sensitivity of 80% and specificity of 74% for predicting change in arterial lesions. Most arterial territories without PET activity at baseline remained unchanged over time by angiography, yielding a negative predictive value of 99%. (FIGURE 1).Conclusion:Development of new arterial lesions is infrequent in LVV. Change in arterial lesions is dynamic, and improvement can occur. FDG-PET activity predicts change in angiographic lesions, and lack of PET activity is strongly associated with stable angiographic disease. These data may inform guideline recommendations for imaging monitoring in LVV.Figure 1.Disclosure of Interests:None declared
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Quinn KA, Dashora H, Novakovich E, Ahlman MA, Grayson PC. Use of 18F-fluorodeoxyglucose positron emission tomography to monitor tocilizumab effect on vascular inflammation in giant cell arteritis. Rheumatology (Oxford) 2021; 60:4384-4389. [PMID: 33369678 DOI: 10.1093/rheumatology/keaa894] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/21/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To evaluate the time-dependent effects of tocilizumab on vascular inflammation as measured by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in GCA. METHODS Patients with GCA treated with tocilizumab were selected from a prospective, observational cohort. Patients underwent FDG-PET at the baseline visit prior to initiation of tocilizumab and at subsequent follow-up visits performed at 6-month intervals. All imaging findings were interpreted blinded to clinical data. The PET vascular activity score (PETVAS) was used to quantify arterial FDG uptake. Wilcoxon signed rank test was used to compare change in PETVAS between visits. Linear regression was used to determine change in PETVAS over multiple timepoints. RESULTS Twenty-five patients with GCA were included. All patients had physician-determined active vasculitis at the baseline visit by clinical assessment and FDG-PET interpretation. PETVAS was significantly reduced in association with tocilizumab treatment from the baseline to the most recent follow-up visit [24.0 (IQR 22.3-27.0) vs 18.5 (IQR 15.3-23.8); P <0.01]. A significant reduction in PETVAS was observed over a two-year treatment period (P <0.01 for linear trend), with a similar degree of improvement in both the first and second years of treatment. Repeat FDG-PET scans after tocilizumab discontinuation showed worsening PET activity in five out of six patients, with two patients subsequently experiencing clinical relapse. CONCLUSION Treatment of patients with GCA with tocilizumab was associated with both clinical improvement and reduction of vascular inflammation as measured by serial FDG-PET. Future clinical trials in GCA should study direct treatment effect on vascular inflammation as an outcome measure.
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Affiliation(s)
- Kaitlin A Quinn
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS
| | - Himanshu Dashora
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS
| | | | - Mark A Ahlman
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, MD, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS
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Rimland CA, Quinn KA, Rosenblum JS, Schwartz MN, Bates Gribbons K, Novakovich E, Sreih AG, Merkel PA, Ahlman MA, Grayson PC. Outcome Measures in Large Vessel Vasculitis: Relationship Between Patient-, Physician-, Imaging-, and Laboratory-Based Assessments. Arthritis Care Res (Hoboken) 2020; 72:1296-1304. [PMID: 31785185 DOI: 10.1002/acr.24117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/26/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess the relationship between measures of disease assessment in patients with large vessel vasculitis. METHODS Patients with giant cell arteritis (GCA) or Takayasu arteritis (TAK) were recruited into a prospective, observational cohort. Assessments within the following outcomes were independently recorded: 1) patient-reported outcomes (Multidimensional Fatigue Inventory, patient global assessment of disease activity [PtGA], Short Form 36 health survey [SF-36], Brief Illness Perception Questionnaire), 2) physician global assessment of disease activity (PhGA), 3) laboratory outcomes (C-reactive protein [CRP] level, erythrocyte sedimentation rate [ESR]), and 4) imaging outcomes (PETVAS, a qualitative score of vascular 18 F-fluorodeoxyglucose-positron emission tomography activity). RESULTS Analyses were performed on 112 patients (GCA = 56, TAK = 56), over 296 visits, with a median follow-up of 6 months. Correlation network analysis revealed assessment measures clustered independently by type of outcome. PhGA was centrally linked to all other outcome types, but correlations were modest (ρ = 0.12-0.32; P < 0.05). PETVAS, CRP level, and PtGA were independently associated with clinically active disease. All 4 patient-reported outcomes strongly correlated with each other (ρ = 0.35-0.60; P < 0.0001). Patient-reported outcomes were not correlated with PETVAS, and only PtGA correlated with CRP level (ρ = 0.16; P < 0.01). Patients whose clinical assessment changed from active disease to remission (n = 29) had a corresponding significant decrease in ESR, CRP level, and PETVAS at the remission visit. Patients whose clinical assessment changed from remission to active disease (n = 11) had a corresponding significant increase in CRP level and PtGA at the active visit. CONCLUSION Measures of disease assessment in large vessel vasculitis consist of independent, yet complementary, outcomes, supporting the need to develop composite outcome measures or a standard set of measures covering multiple types of outcomes.
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Affiliation(s)
- Casey A Rimland
- NIH, Bethesda, Maryland, and University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Kaitlin A Quinn
- NIH, Bethesda, Maryland, and MedStar Georgetown University Hospital, Washington, District of Columbia
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Quinn KA, Gribbons KB, Carette S, Cuthbertson D, Khalidi N, Koening C, Langford C, Mcalear C, Monach P, Moreland L, Pagnoux C, Seo P, Sreih A, Warrington KJ, Ytterberg SR, Novakovich E, Merkel PA, Grayson P. THU0318 PATTERNS OF CLINICAL PRESENTATION IN TAKAYASU’S ARTERITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Takayasu’s arteritis (TAK) is a clinically heterogenous disease. Patterns of clinical presentation in TAK at diagnosis have not been well described, and a “triphasic pattern” of constitutional symptoms evolving into vascular inflammation and fibrosis has been reported but never systematically evaluated.Objectives:To describe patterns of clinical presentation in TAK at diagnosis and evaluate the presence of an antecedent triphasic disease pattern in patients with TAK who presented with a major ischemic event at diagnosis.Methods:Patients with TAK were prospectively recruited from the National Institutes of Health (NIH) and the Vasculitis Clinical Research Consortium (VCRC). All patients fulfilled the 1990 American College of Rheumatology (ACR) Classification Criteria for TAK. Based on clinical presentation at diagnosis, patients were divided into five groups from the different stages of the triphasic pattern of disease as follows: 1) constitutional symptoms (phase I), 2) carotidynia (phase II), 3) other vascular-associated symptoms (phase II), 4) major ischemic event (phase III) defined as CVA or TIA, retinal ischemia, MI, renovascular hypertension, or mesenteric ischemia, or 5) asymptomatic. Phase II was divided into two separate groups because patients with carotidynia reportedly have a higher rate of relapsing disease.Associated clinical characteristics were evaluated in each group and differences among groups were assessed by chi square test and Kruskal-Wallis test, as appropriate. Preceding symptoms were also assessed to determine the presence of a triphasic disease pattern.Results:A total of 275 patients with TAK were included (VCRC=208; NIH=67). Similar heterogeneity of clinical presentation was identified in each cohort: constitutional symptoms (8%), carotidynia (13-15%), other vascular symptoms (43-47%), major ischemic event (28-30%), and asymptomatic (2-6%). Frequency of male gender was more common in patients who presented with constitutional symptoms or were asymptomatic at diagnosis (p<0.01). Patients who presented with constitutional symptoms and major ischemic events were youngest at diagnosis. Patients in the asymptomatic group were oldest at diagnosis and often were not treated (p<0.01). Involvement of the abdominal vasculature was associated with major ischemic events and asymptomatic presentations. Major ischemic events after diagnosis were infrequent in the groups who did not present with a major ischemic event, occurring in 10-20% cases. Relapse (p<0.01) and recurrent pharyngitis preceding diagnosis (p<0.01) was most frequent in patients who presented with carotidynia.A total of 79 patients [VCRC=59 patients, NIH=20 patients] presented with a major ischemic event. The majority of these patients (53%) reported symptoms of active disease prior to the major ischemic event. Few patients (19%) who presented with a major ischemic event reported a triphasic pattern of disease.Conclusion:There is heterogeneity in clinical presentation at the time of diagnosis in TAK and this heterogeneity can be used to group patients according to pattern of disease presentation. Patients do not necessarily progress sequentially through phases of disease, but the majority of patients presenting with a major ischemic event report some preceding symptoms. Data from this study demonstrate distinct subgroups within TAK and supports the concept that TAK is possibly a heterogenous collection of multiple diseases.References:N/ADisclosure of Interests:None declared
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Quinn KA, Gribbons KB, Carette S, Cuthbertson D, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland LW, Pagnoux C, Seo P, Sreih AG, Warrington KJ, Ytterberg SR, Novakovich E, Merkel PA, Grayson PC. Patterns of clinical presentation in Takayasu's arteritis. Semin Arthritis Rheum 2020; 50:576-581. [PMID: 32460147 DOI: 10.1016/j.semarthrit.2020.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Takayasu's arteritis (TAK) is a clinically heterogenous disease. Patterns of clinical presentation in TAK at diagnosis have not been well described, and a "triphasic pattern" of constitutional symptoms evolving into vascular inflammation and fibrosis has been reported but never systematically evaluated. METHODS Patients with TAK were prospectively recruited from the National Institutes of Health (NIH) and the Vasculitis Clinical Research Consortium (VCRC). Based on clinical presentation at diagnosis, patients were divided into five categories: (1) constitutional symptoms alone, (2) carotidynia, (3) other vascular-associated symptoms, (4) major ischemic event, or (5) asymptomatic. Associated clinical characteristics were evaluated in each category. Preceding symptoms were also assessed to determine the presence of a triphasic disease pattern. RESULTS A total of 275 patients with TAK were included (VCRC=208; NIH=67). Similar heterogeneity of clinical presentation was identified in each cohort: constitutional symptoms (8%), carotidynia (13-15%), other vascular symptoms (43-47%), major ischemic event (28-30%), and asymptomatic (2-6%). An increased relative proportion of males was seen in patients who presented with constitutional symptoms or were asymptomatic at diagnosis (p<0.01). Patients who presented with constitutional symptoms and major ischemic events were youngest at diagnosis. Patients in the asymptomatic group were oldest at diagnosis and often were not treated (p<0.01). Relapse was most frequent in patients who presented with carotidynia (p<0.01). A minority of patients (19%) who presented with a major ischemic event reported a triphasic pattern of disease. CONCLUSION There are diverse clinical presentations at diagnosis in TAK. Patients do not necessarily progress sequentially through phases of disease.
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Affiliation(s)
- Kaitlin A Quinn
- Division of Rheumatology, MedStar Georgetown University Hospital, Washington DC, USA; Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA.
| | - K Bates Gribbons
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, CA
| | - David Cuthbertson
- Department of Biostatistics, University of South Florida, Tampa, FL, USA
| | | | - Curry L Koening
- Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Carol A Langford
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carol A McAlear
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Monach
- Division of Rheumatology, VA Boston Healthcare System, Boston, MA, USA
| | | | - Christian Pagnoux
- Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, CA
| | - Philip Seo
- Division of Rheumatology, Johns Hopkins University, MD, USA
| | - Antoine G Sreih
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Elaine Novakovich
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Peter A Merkel
- Division of Rheumatology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, MD, USA
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Schwartz MN, Rimland CA, Quinn KA, Ferrada MA, Gribbons KB, Rosenblum JS, Goodspeed W, Novakovich E, Grayson PC. Utility of the Brief Illness Perception Questionnaire to Monitor Patient Beliefs in Systemic Vasculitis. J Rheumatol 2020; 47:1785-1792. [PMID: 32238516 DOI: 10.3899/jrheum.190828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the validity and clinical utility of the Brief Illness Perception Questionnaire (BIPQ) to measure illness perceptions in multiple forms of vasculitis. METHODS Patients with giant cell arteritis (GCA), Takayasu arteritis (TA), antineutrophil cytoplasmic antibody-associated vasculitis (AAV), and relapsing polychondritis (RP) were recruited into a prospective, observational cohort. Patients independently completed the BIPQ, Multidimensional Fatigue Inventory (MFI), Medical Outcomes Study 36-item Short Form survey (SF-36), and a patient global assessment (PtGA) at successive study visits. Physicians concurrently completed a physician global assessment (PGA) form. Illness perceptions, as assessed by the BIPQ, were compared to responses from the full-length Revised Illness Perception Questionnaire (IPQ-R) and to other clinical outcome measures. RESULTS There were 196 patients (GCA = 47, TA = 47, RP = 56, AAV = 46) evaluated over 454 visits. Illness perception scores in each domain were comparable between the BIPQ and IPQ-R (3.28 vs 3.47, P = 0.22). Illness perceptions differed by type of vasculitis, with the highest perceived psychological burden of disease in RP. The BIPQ was significantly associated with all other patient-reported outcome measures (rho = |0.50-0.70|, P < 0.0001), but did not correlate with PGA (rho = 0.13, P = 0.13). A change in the BIPQ composite score of ≥ 7 over successive visits was associated with concomitant change in the PtGA. Change in the MFI and BIPQ scores significantly correlated over time (rho = 0.38, P = 0.0008). CONCLUSION The BIPQ is an accurate and valid assessment tool to measure and monitor illness perceptions in patients with vasculitis. Use of the BIPQ as an outcome measure in clinical trials may provide complementary information to physician-based assessments.
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Affiliation(s)
- Mollie N Schwartz
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Casey A Rimland
- C.A. Rimland, PhD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and University of North Carolina at Chapel Hill School of Medicine, Medical Scientist Training Program, Chapel Hill, North Carolina
| | - Kaitlin A Quinn
- K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, Bethesda, Maryland, and Division of Rheumatology, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Marcela A Ferrada
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - K Bates Gribbons
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Joel S Rosenblum
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Wendy Goodspeed
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Elaine Novakovich
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland
| | - Peter C Grayson
- M.N. Schwartz, BS, M.A. Ferrada, MD, K.B. Gribbons, BS, J.S. Rosenblum, BS, W. Goodspeed, RN, E. Novakovich, RN, P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland;
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10
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Banerjee S, Quinn KA, Gribbons KB, Rosenblum JS, Civelek AC, Novakovich E, Merkel PA, Ahlman MA, Grayson PC. Effect of Treatment on Imaging, Clinical, and Serologic Assessments of Disease Activity in Large-vessel Vasculitis. J Rheumatol 2019; 47:99-107. [PMID: 30877209 DOI: 10.3899/jrheum.181222] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Disease activity in large-vessel vasculitis (LVV) is traditionally assessed by clinical and serological variables rather than vascular imaging. This study determined the effect of treatment on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) vascular activity in relation to clinical- and serologic-based assessments. METHODS Patients with giant cell arteritis (GCA) or Takayasu arteritis (TA) were prospectively evaluated at 6-month intervals in an observational cohort. Treatment changes were made at least 3 months before the followup visit and categorized as increased, decreased, or unchanged. Imaging (FDG-PET qualitative analysis), clinical, and serologic (erythrocyte sedimentation rate, C-reactive protein) assessments were determined at each visit and compared over interval visits. RESULTS Serial assessments were performed in 52 patients with LVV (GCA = 31; TA = 21) over 156 visits. Increased, decreased, or unchanged therapy was recorded for 36-, 23-, and 32-visit intervals, respectively. When treatment was increased, there was significant reduction in disease activity by imaging, clinical, and inflammatory markers (p ≤ 0.01 for each). When treatment was unchanged, all 3 assessments of disease activity remained similarly unchanged over 6-month intervals. When treatment was reduced, PET activity significantly worsened (p = 0.02) but clinical and serologic activity did not significantly change. Treatment of GCA with tocilizumab and of TA with tumor necrosis factor inhibitors resulted in significant improvement in imaging and clinical assessments of disease activity, but only rarely did the assessments both become normal. CONCLUSION In addition to clinical and serologic assessments, vascular imaging has potential to monitor disease activity in LVV and should be tested as an outcome measure in randomized clinical trials.
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Affiliation(s)
- Shubhasree Banerjee
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Kaitlin A Quinn
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - K Bates Gribbons
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Joel S Rosenblum
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Ali Cahid Civelek
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Elaine Novakovich
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Peter A Merkel
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Mark A Ahlman
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS
| | - Peter C Grayson
- From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA. .,S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS.
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Banerjee S, Quinn K, Gribbons K, Rosenblum J, Civelek A, Novakovich E, Merkel P, Ahlman M, Grayson P. 232. CHANGE IN VASCULAR 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY ACTIVITY WITH TREATMENT IN LARGE VESSEL VASCULITIS IN RELATION TO CLINICAL AND SEROLOGIC ASSESSMENT. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez062.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Ali Civelek
- NIAMS/ National Institute of Health Bethesda, MD USA
| | | | | | - Mark Ahlman
- NIAMS/ National Institute of Health Bethesda, MD USA
| | - Peter Grayson
- NIAMS/ National Institute of Health Bethesda, MD USA
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Rimland C, Quinn K, Rosenblum J, Schwartz M, Gribbons K, Novakovich E, Sreih A, Merkel P, Ahlman M, Grayson P. 266. OUTCOME MEASURES IN LARGE-VESSEL VASCULITIS: RELATIONSHIPS BETWEEN PATIENT, PHYSICIAN, IMAGING, AND LABORATORY-BASED DOMAINS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez062.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Casey Rimland
- NIAMS, National Institutes of Health Bethesda, MD USA
| | | | | | | | | | | | | | | | - Mark Ahlman
- National Institutes of Health Bethesda, MD USA
| | - Peter Grayson
- NIAMS, National Institutes of Health Bethesda, MD USA
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13
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Quinn K, Rosenblum J, Rimland C, Gribbons K, Novakovich E, Ahlman M, Grayson P. 109. IMAGING ACQUISITION TECHNIQUE INFLUENCES INTERPRETATION OF POSITRON EMISSION TOMOGRAPHY VASCULAR ACTIVITY IN LARGE-VESSEL VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Mark Ahlman
- National Institutes of Health Bethesda, MD USA
| | - Peter Grayson
- NIAMS/ National Institutes of Health Bethesda, MD USA
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14
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Quinn KA, Ahlman MA, Malayeri AA, Marko J, Civelek AC, Rosenblum JS, Bagheri AA, Merkel PA, Novakovich E, Grayson PC. Comparison of magnetic resonance angiography and 18F-fluorodeoxyglucose positron emission tomography in large-vessel vasculitis. Ann Rheum Dis 2018; 77:1165-1171. [PMID: 29666047 DOI: 10.1136/annrheumdis-2018-213102] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess agreement between interpretation of magnetic resonance angiography (MRA) and 18F-fluorodeoxyglucose positron emission tomography (PET) for disease extent and disease activity in large-vessel vasculitis (LVV) and determine associations between imaging and clinical assessments. METHODS Patients with giant cell arteritis (GCA), Takayasu's arteritis (TAK) and comparators were recruited into a prospective, observational cohort. Imaging and clinical assessments were performed concurrently, blinded to each other. Agreement was assessed by per cent agreement, Cohen's kappa and McNemar's test. Multivariable logistic regression identified MRA features associated with PET scan activity. RESULTS Eighty-four patients (GCA=35; TAK=30; comparator=19) contributed 133 paired studies. Agreement for disease extent between MRA and PET was 580 out of 966 (60%) arterial territories with Cohen's kappa=0.22. Of 386 territories with disagreement, MRA demonstrated disease in more territories than PET (304vs82, p<0.01). Agreement for disease activity between MRA and PET was 90 studies (68%) with Cohen's kappa=0.30. In studies with disagreement, MRA demonstrated activity in 23 studies and PET in 20 studies (p=0.76). Oedema and wall thickness on MRA were independently associated with PET scan activity. Clinical status was associated with disease activity by PET (p<0.01) but not MRA (p=0.70), yet 35/69 (51%) patients with LVV in clinical remission had active disease by both MRA and PET. CONCLUSIONS In assessment of LVV, MRA and PET contribute unique and complementary information. MRA better captures disease extent, and PET scan is better suited to assess vascular activity. Clinical and imaging-based assessments often do not correlate over the disease course in LVV. TRIAL REGISTRATION NUMBER NCT02257866.
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Affiliation(s)
- Kaitlin A Quinn
- Division of Rheumatology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Mark A Ahlman
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Ashkan A Malayeri
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Jamie Marko
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Ali Cahid Civelek
- National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland, USA
| | - Joel S Rosenblum
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Armin A Bagheri
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elaine Novakovich
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
| | - Peter C Grayson
- Systemic Autoimmunity Branch, National Institutes of Health, NIAMS, Bethesda, Maryland, USA
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15
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Grayson PC, Alehashemi S, Bagheri AA, Civelek AC, Cupps TR, Kaplan MJ, Malayeri AA, Merkel PA, Novakovich E, Bluemke DA, Ahlman MA. 18 F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis. Arthritis Rheumatol 2018; 70:439-449. [PMID: 29145713 DOI: 10.1002/art.40379] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the clinical value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in a prospective cohort of patients with large vessel vasculitis (LVV) and comparator subjects. METHODS Patients with Takayasu arteritis and giant cell arteritis were studied, along with a comparator group consisting of patients with hyperlipidemia, patients with diseases that mimic LVV, and healthy controls. Participants underwent clinical evaluation and FDG-PET imaging, and patients with LVV underwent serial imaging at 6-month intervals. We calculated sensitivity and specificity of FDG-PET interpretation for distinguishing patients with clinically active LVV from comparator subjects and from patients with disease in clinical remission. A qualitative summary score based on global arterial FDG uptake, the PET Vascular Activity Score (PETVAS), was used to study associations between activity on PET scan and clinical characteristics and to predict relapse. RESULTS A total of 170 FDG-PET scans were performed in 115 participants (56 patients with LVV and 59 comparator subjects). FDG-PET distinguished patients with clinically active LVV from comparator subjects with a sensitivity of 85% (95% confidence interval [95% CI] 69, 94) and a specificity of 83% (95% CI 71, 91). FDG-PET scans were interpreted as active vasculitis in most patients with LVV in clinical remission (41 of 71 [58%]). Clinical disease activity status, disease duration, body mass index, and glucocorticoid use were independently associated with activity on PET scan. Among patients who underwent PET during clinical remission, future clinical relapse was more common in patients with a high PETVAS than in those with a low PETVAS (55% versus 11%; P = 0.03) over a median follow-up period of 15 months. CONCLUSION FDG-PET provides information about vascular inflammation that is complementary to, and distinct from, clinical assessment in LVV. FDG-PET scan activity during clinical remission was associated with future clinical relapse.
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Affiliation(s)
- Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Sara Alehashemi
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Armin A Bagheri
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Mariana J Kaplan
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Elaine Novakovich
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | - Mark A Ahlman
- Radiology and Imaging Sciences, NIH, Bethesda, Maryland
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Grayson PC, Yazici Y, Merideth M, Sen HN, Davis M, Novakovich E, Joyal E, Goldbach-Mansky R, Sibley CH. Treatment of mucocutaneous manifestations in Behçet's disease with anakinra: a pilot open-label study. Arthritis Res Ther 2017; 19:69. [PMID: 28335798 PMCID: PMC5364674 DOI: 10.1186/s13075-017-1222-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/06/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The effect of IL-1 blocking therapy on mucocutaneous manifestations of Behçet's disease is incompletely understood. METHODS Six patients with Behçet's disease and ongoing oral/genital ulcers for ≥1 month were enrolled into an adaptive, two-phase clinical trial and included in the analysis. Study duration was 6 months with extension up to 16 months. All were treated non-blinded with anakinra 100 mg subcutaneous daily with the option to escalate the dose to 200 mg in partial responders after 1 month and 300 mg after 6 months. Patients recorded the number and severity of ulcers in daily diaries. The primary outcome was remission defined as no ulcers on physical exam for two consecutive monthly visits between months 3 and 6. Secondary outcomes included the number and severity of patient-reported ulcers, patient/physician global scores, and standardized disease activity scores. RESULTS Two of six patients achieved the primary outcome. Five of six patients had improvement in the number and severity of ulcers. Non-statistically significant improvements were seen in secondary outcomes. Over the entire study, patients reported ≥1 oral and ≥1 genital ulcer on 665 (66%) and 139 (14%) days, respectively. On anakinra 200 mg vs 100 mg, patients reported fewer days with oral ulcers (65% vs 74% of days, p = 0.01) and genital ulcers (10% vs 22% of days, p < 0.001) and milder oral ulcer severity (p < 0.001). Increase of anakinra to 300 mg did not result in further improvements. Adverse events were notable for mild infections. CONCLUSION Anakinra at an optimal dose of 200 mg daily had an acceptable safety profile and was partially effective in the treatment of resistant oral and genital ulcers in Behçet's disease. TRIAL REGISTRATION Clinicaltrials.gov. NCT01441076 . Registered on 24 September 2011.
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Affiliation(s)
| | | | | | - H Nida Sen
- National Institutes of Health, NIAMS, Bethesda, MD, USA
| | - Michael Davis
- National Institutes of Health, NIAMS, Bethesda, MD, USA
| | | | | | | | - Cailin H Sibley
- National Institutes of Health, NIAMS, Bethesda, MD, USA. .,Oregon Health & Science University, 3181 SW Sam Jackson Park Rd OP-09, Portland, OR, 97239, USA.
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Abstract
Advances in clinical care for patients with vasculitis have improved survival rates and created new challenges related to the ongoing management of chronic disease. Lack of curative therapies, burden of disease, treatment-related side effects, and fear of relapse contribute to patient-perceived reduction in quality of life. Patient-held beliefs about disease and priorities may differ substantially from the beliefs of their health care providers, and research paradigms are shifting to reflect more emphasis on understanding vasculitis from the patient's perspective. Efforts are ongoing to develop disease outcome measures in vasculitis that better represent the patient experience. Health care providers who care for patients with vasculitis should be sensitive to the substantial burdens of disease commonly experienced by patients living with the disease and should strive to provide comprehensive care directed towards the medical and biopsychological needs of these patients.
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Affiliation(s)
- Elaine Novakovich
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States
| | - Peter C Grayson
- National Institutes of Health/NIAMS, Vasculitis Translational Research Program, Bethesda, MD 20892, United States.
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