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Stalley E, Verheyden MJ, Eykman E, Deveza L. Hereditary transthyretin amyloidosis as a mimic of giant cell arteritis: a case report. Rheumatology (Oxford) 2024; 63:e107-e109. [PMID: 37773995 DOI: 10.1093/rheumatology/kead530] [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: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Eliza Stalley
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Matthew J Verheyden
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Eykman
- Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Leticia Deveza
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Barde F, Ascione S, Pacoureau L, Macdonald C, Salliot C, Boutron-Ruault MC, Seror R, Nguyen Y. Accuracy of self-reported diagnoses of polymyalgia rheumatica and giant cell arteritis in the French prospective E3N- EPIC cohort: A validation study. Semin Arthritis Rheum 2024; 64:152298. [PMID: 38000317 DOI: 10.1016/j.semarthrit.2023.152298] [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: 08/01/2023] [Revised: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To assess the accuracy of self-reported giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) diagnoses in a large French population-based prospective cohort, and to devise algorithms to improve their accuracy. METHODS The E3N-EPIC cohort study (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale) includes 98,995 French women born between 1925 and 1950, recruited in 1990 to study risk factors of cancer and chronic diseases. They completed biennially mailed questionnaires to update their health-related information and lifestyle characteristics. In three questionnaires, women could self-report a diagnosis of GCA/PMR. Those women were additionally sent a specific questionnaire, designed to ascertain self-reported diagnoses of GCA/PMR. Four algorithms were then devised to improve their identification. Accuracies of self-reported diagnoses and of each algorithm were calculated by comparing the diagnoses with a blinded medical chart review. RESULTS Among 98,995 participants, 1,392 women self-reported GCA/PMR. 830 women sent back the specific questionnaire, and 202 women provided medical charts. After independent review of the 202 medical charts, 87.6 % of the self-reported diagnoses of GCA/PMR were accurate. Using additional data from a specific questionnaire (diagnosis confirmation by a physician, and self-report of >3-month of glucocorticoids), and from a reimbursement database (at least two deliveries of glucocorticoids in less than 3 consecutive months) improved their accuracy (91.8 % to 92.8 %). CONCLUSION The accuracy of self-reported diagnosis of GCA/PMR was high in the E3N-cohort but using additional data as a specific GCA/PMR questionnaire and/or corticosteroid reimbursement database further improved this accuracy. With nearly 600 detected cases of GCA/PMR, we will be able to investigate risk factors for GCA/PMR in women.
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Affiliation(s)
- François Barde
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Sophia Ascione
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Lucas Pacoureau
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Conor Macdonald
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Carine Salliot
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Raphaèle Seror
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology and National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, INSERM UMR1184, Le Kremlin Bicêtre, France.
| | - Yann Nguyen
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology and National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, INSERM UMR1184, Le Kremlin Bicêtre, France; Department of Internal Medicine, AP-HP. Nord, Hôpital Beaujon, Université de Paris, Clichy, France
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Yoshimoto K, Kaneda S, Asada M, Taguchi H, Kawashima H, Yoneima R, Matsuoka H, Tsushima E, Ono S, Matsubara M, Yada N, Nishio K. Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature. Medicina (Kaunas) 2023; 59:2127. [PMID: 38138230 PMCID: PMC10744572 DOI: 10.3390/medicina59122127] [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] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/21/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
Giant cell arteritis (GCA) is a chronic vasculitis that primarily affects the elderly, and can cause visual impairment, requiring prompt diagnosis and treatment. The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been substantial. Although vaccination programs have been a key defense strategy, concerns have arisen regarding post-vaccination immune-mediated disorders and related risks. We present a case of GCA after COVID-19 vaccination with 2 years of follow-up. A 69-year-old woman experienced fever, headaches, and local muscle pain two days after receiving the COVID-19 vaccine. Elevated inflammatory markers were observed, and positron emission tomography (PET) revealed abnormal uptake in the major arteries, including the aorta and subclavian and iliac arteries. Temporal artery biopsy confirmed the diagnosis of GCA. Treatment consisted of pulse therapy with methylprednisolone, followed by prednisolone (PSL) and tocilizumab. Immediately after the initiation of treatment, the fever and headaches disappeared, and the inflammation markers normalized. The PSL dosage was gradually reduced, and one year later, a PET scan showed that the inflammation had resolved. After two years, the PSL dosage was reduced to 3 mg. Fourteen reported cases of GCA after COVID-19 vaccination was reviewed to reveal a diverse clinical picture and treatment response. The time from onset of symptoms to GCA diagnosis varied from two weeks to four months, highlighting the challenge of early detection. The effectiveness of treatment varied, but was generally effective similarly to that of conventional GCA. This report emphasizes the need for clinical vigilance and encourages further data collection in post-vaccination GCA cases.
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Affiliation(s)
- Kiyomi Yoshimoto
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Saori Kaneda
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
- Department of General Medicine, Uda City Hospital, Uda 633-0298, Nara, Japan
| | - Moe Asada
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Hiroyuki Taguchi
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Hiromasa Kawashima
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Ryo Yoneima
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Hidetoshi Matsuoka
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Emiko Tsushima
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Shiro Ono
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Masaki Matsubara
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Noritaka Yada
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan; (S.K.); (M.A.); (H.T.); (H.K.); (R.Y.); (H.M.); (E.T.); (S.O.); (M.M.); (N.Y.); (K.N.)
- Department of General Medicine, Uda City Hospital, Uda 633-0298, Nara, Japan
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Costanzo G, Ledda AG, Sambugaro G. Giant cell arteritis and innovative treatments. Curr Opin Allergy Clin Immunol 2023; 23:327-333. [PMID: 37357797 DOI: 10.1097/aci.0000000000000923] [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] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW Giant cell arteritis (GCA) is an idiopathic and persistent condition characterized by granulomatous vasculitis of the medium and large vessels with overlapping phenotypes, including conventional cranial arteritis and extra-cranial GCA, also known as large-vessel GCA. Vascular problems linked with large vessel involvement may partly be caused by delayed diagnosis, emphasizing the necessity of early detection and the fast beginning of appropriate therapy. Glucocorticoids are the cornerstone of treatment for GCA, but using them for an extended period has numerous, often severe, side effects. RECENT FINDINGS clinical practice and novel discoveries on the pathogenic pathways suggest that steroid-free biologic treatments may be efficient and safe for GCA patients. SUMMARY since now, only Tocilizumab is approved for GCA treatment, but several drugs are currently used, and ongoing trials could give both researchers and patients novel therapeutic strategies for induction, maintenance, and prevention of relapse of GCA. The aims of this work is to synthesize evidence from current studies present in scientific literature about innovative treatment of Giant cell artheritis.
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Affiliation(s)
- Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari 09100, Italy
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5
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Katz G, Wallace ZS. Environmental Triggers for Vasculitis. Rheum Dis Clin North Am 2022; 48:875-890. [PMID: 36333001 DOI: 10.1016/j.rdc.2022.06.008] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic vasculitides are autoimmune diseases characterized by vascular inflammation. Most types of vasculitis are thought to result from antigen exposure in genetically susceptible individuals, suggesting a likely role for environmental triggers in these conditions. Seasonal and geographic variations in incidence provide insight into the potential role of environmental exposures in these diseases. Many data support infectious triggers in some vasculitides, whereas other studies have identified noninfectious triggers, such as airborne pollutants, silica, smoking, and heavy metals. We review the known and suspected environmental triggers in giant cell arteritis, Takayasu arteritis, polyarteritis nodosa, Kawasaki disease, and antineutrophil cytoplasmic antibody-associated vasculitis.
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Affiliation(s)
- Guy Katz
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Bulfinch 165, 55 Fruit Street, Boston, MA 02114, USA
| | - Zachary S Wallace
- Clinical Epidemiology Program, Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Boston, MA 02114, USA.
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6
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Nichani P, Micieli JA. Granuloma Annulare, Scalp Necrosis, and Ischemic Optic Neuropathy From Giant Cell Arteritis After Varicella-Zoster Virus Vaccination. J Neuroophthalmol 2021; 41:e145-e148. [PMID: 32235218 DOI: 10.1097/wno.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Prem Nichani
- Faculty of Medicine (PN), University of Toronto, Toronto, Canada ; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada ; and Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Canada
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7
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Thomsen H, Li X, Sundquist K, Sundquist J, Försti A, Hemminki K. Familial risks between giant cell arteritis and Takayasu arteritis and other autoimmune diseases in the population of Sweden. Sci Rep 2020; 10:20887. [PMID: 33257751 PMCID: PMC7705754 DOI: 10.1038/s41598-020-77857-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023] Open
Abstract
Giant cell arteritis (GCA, also called temporal arteritis) is a rare and Takayasu arteritis (TA) is an even rarer autoimmune disease (AID), both of which present with inflammatory vasculitis of large and medium size arteries. The risk factors are largely undefined but disease susceptibility has been associated with human leukocyte antigen locus. Population-level familial risk is not known. In the present nation-wide study we describe familial risk for GCA and for GCA and TA with any other AID based on the Swedish hospital diagnoses up to years 2012. Family relationships were obtained from the Multigeneration Register. Familial standardized incidence ratios (SIRs) were calculated for offspring whose parents or siblings were diagnosed with GCA, TA or any other AID. The number of GCA patients in the offspring generation was 4695, compared to 209 TA patients; for both, familial patients accounted for 1% of all patients. The familial risk for GCA was 2.14, 2.40 for women and non-significant for men. GCA was associated with 10 other AIDs and TA was associated with 6 other AIDs; both shared associations with polymyalgia rheumatica and rheumatoid arthritis. The results showed that family history is a risk factor for GCA. Significant familial associations of both GCA and TA with such a number of other AIDs provide evidence for polyautoimmunity among these diseases.
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Affiliation(s)
- Hauke Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany.
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
- GeneWerk GmbH, Im Neuenheimer Feld 582, 69120, Heidelberg, Germany.
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Functional Pathology, School of Medicine, Center for Community-Based Healthcare Research and Education (CoHRE), Shimane University, Matsue, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Functional Pathology, School of Medicine, Center for Community-Based Healthcare Research and Education (CoHRE), Shimane University, Matsue, Japan
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Centre (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic
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Abstract
Polymyalgia rheumatica is an inflammatory rheumatic disease of the elderly characterised by pain and stiffness in the neck and pelvic girdle, and is the second most common inflammatory rheumatic condition in this age group, after rheumatoid arthritis. Polymyalgia rheumatica can occur independently or in association with giant cell arteritis, which is the most common form of primary vasculitis. The diagnosis of polymyalgia rheumatica is usually based on clinical presentation and increase of inflammatory markers. There are no pathognomonic findings that can confirm the diagnosis. However, different imaging techniques, especially ultrasonography, can assist in the identification of polymyalgia rheumatica. Glucocorticoids are the cornerstone of the treatment of polymyalgia rheumatica, but they might be associated with different adverse events. A subgroup of patients presents with a refractory disease course and, in these cases, adding methotrexate as a steroid-sparing agent could be useful. In this review, we summarise the latest findings regarding the pathogenesis, diagnosis and management of polymyalgia rheumatica and try to highlight the possible pitfalls, especially in elderly patients.
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Affiliation(s)
- Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy.
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Andrea Giusti
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy
| | - Giuseppe Girasole
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy
| | - Gerolamo Bianchi
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy
| | - Christian Dejaco
- Dienst für Rheumatologie, Servizio di reumatologia, Südtiroler Sanitätsbetrieb, Azienda Sanitaria dell'Alto Adige, Krankenhaus Bruneck, Ospedale di Brunico, Bruneck, Italy
- Department of Rheumatology, Medical University Graz, Graz, Austria
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Oiwa H, Katoh N, Kojo S, Yoshinaga T, Taniguchi K, Shiote Y. Temporal artery involvement in AL amyloidosis: an important differential diagnosis for giant cell arteritis. A case report and literature review. Mod Rheumatol Case Rep 2020; 4:90-94. [PMID: 33086955 DOI: 10.1080/24725625.2019.1650993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/08/2019] [Accepted: 07/29/2019] [Indexed: 06/11/2023]
Abstract
AL amyloidosis (AL) is a systemic disorder due to extracellular tissue deposition of amyloid fibrils, composed of immunoglobulin light chains. Since the description of AL involving temporal arteries in 1986, this disorder has been known as one of the differential diagnoses of giant cell arteritis (GCA). We encountered a case of an elderly female presenting with headache and tender and enlarged temporal arteries, that was pathologically diagnosed with temporal artery involvement of AL due to Bence-Jones-type MM. To our knowledge, this was the first case of AL with temporal artery involvement in Japan, that presented with GCA-like features. Literature review of AL cases with temporal artery involvement showed close similarity between these disorders, but suggested that vasculature involvement (extremity claudication, kidney or heart), macroglossia, carpal tunnel syndrome and normal or low (<0.5 mg/dL) CRP levels may predict AL rather than GCA. Physicians should keep in mind that AL involving temporal arteries can be a pitfall in the diagnosis of GCA, as seen in our and previous cases.
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Affiliation(s)
- Hiroshi Oiwa
- Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Nagaaki Katoh
- Department of Neurology and Rheumatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shoichiro Kojo
- Department of Nephrology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tsuneaki Yoshinaga
- Department of Neurology and Rheumatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kohei Taniguchi
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Shiote
- Department of Hematology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Nakayama T, Katagiri S, Kikkawa T, Obara T, Mori T, Kiriu T. Multiple atypical thymic carcinoids with paraneoplastic giant cell arteritis. Gen Thorac Cardiovasc Surg 2019; 68:1212-1215. [PMID: 31625085 DOI: 10.1007/s11748-019-01230-3] [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: 07/04/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022]
Abstract
Multiple thymic carcinoids are rare, and giant cell arteritis (GCA) is one of the less recognized paraneoplastic diseases. The co-occurrence of these two diseases is therefore extremely rare. We report herein a patient with multiple atypical thymic carcinoids and asymptomatic paraneoplastic GCA. All the thymic carcinoids were diagnosed histopathologically as atypical thymic carcinoids with an intrathymic metastasis. Treatment consisted of a complete tumor resection followed by observation of the GCA without any adjuvant therapy. Subsequent positron emission tomography revealed a decrease in F-fludeoxyglucose accumulation in the systemic arteries. Based on these findings, paraneoplastic GCA was diagnosed. Thymic carcinoids rarely involve intrathymic metastasis or cause neopleonastic GCA. However, when they do, a complete tumor resection is the best option for management.
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Affiliation(s)
- Takashi Nakayama
- Department of General Thoracic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.
| | - Sayaka Katagiri
- Department of General Thoracic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Takuma Kikkawa
- Department of General Thoracic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Tetsuya Obara
- Department of General Thoracic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Tatsuo Mori
- Department of Intermedicine of Rheumatism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Takahiro Kiriu
- Department of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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Yukawa K, Mokuda S, Yoshida Y, Hirata S, Sugiyama E. Large-vessel vasculitis associated with PEGylated granulocyte-colony stimulating factor. Neth J Med 2019; 77:224-226. [PMID: 31391329] [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: 06/10/2023]
Abstract
A 71-year-old female with advanced endometrial cancer was treated with pegfilgrastim. She developed a fever within seven days, and contrast-enhanced computed tomography scans repeated within three days revealed rapidly progressive thickening of the aortic wall. When clinicians administer PEGylated granulocyte-colony stimulating factor (G-CSF) to cancer patients, drug-associated vasculitis should be suspected. This report discusses the manifestation of G-CSF-associated large-vessel vasculitis (LVV).
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Affiliation(s)
- K Yukawa
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
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Abstract
We report the case of an 80-year-old man with generalized granuloma annulare (GGA) who subsequently developed giant cell arteritis (GCA). Steroid treatment was effective for both diseases in this case. Although cases of concomitant GGA and GCA have rarely been reported, previous studies suggest that common histological characteristics underlie the two diseases. It is therefore necessary to recognize that GGA can be complicated by GCA, particularly when typical symptoms, such as headache and visual disturbance, are present.
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Affiliation(s)
- Yuichi Torisu
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Japan
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Japan
| | - Tohru Michitsuji
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Rheumatology, Sasebo City General Hospital, Japan
| | - Chieko Kawahara
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Takahiro Mori
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Abstract
Is reported a case of Wegener's granulomatosis originally presenting with a clinical picture of temporal arteritis. The presentation included an arteritic anterior ischaemic optic neuropathy occurring with no demonstrable orbital inflammation. The treatment of these two systemic vasculitides is quite different, however, and this case emphasizes the importance of questioning the original diagnosis if the clinical course of the disease does not progress as anticipated.
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Affiliation(s)
- L Howe
- Department of Ophthalmology, UMDS, London, U.K
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Frölich A, Schwarze I, Neumann C. Polymyalgia rheumatica detected by SPECT/CT using 99mTc-labeled monoclonal antibody Fab'-fragments. Nuklearmedizin 2017; 56:N1-N2. [PMID: 28004845 DOI: 10.3413/nukmed-0849-16-09] [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] [Received: 09/19/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
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Bakula M, Cerovec M, Mayer M, Huić D, Anić B. GIANT CELL AORTITIS DIAGNOSED WITH PET/CT - PARANEOPLASTIC SYNDROME? Lijec Vjesn 2016; 138:152-158. [PMID: 29182827] [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: 06/07/2023]
Abstract
Vasculitides are heterogenic group of autoimmune connective tissue diseases which often present difficulties in early diagnosing. Giant cell arteritis is vasculitis of large and medium arteries. It predominantly presents with symptoms of affection of the external carotid artery branches. Furthermore, the only symptoms can be constitutional. In clinical practice, vasculitides are sometimes considered as paraneoplastic, but no definite association with malignancies has been established and the mechanisms are still debated. The gold standard for diagnosing giant cell arteritis is a positive temporal artery biopsy, but the results can often be false negative. Additionally, more than half of the patients have aorta and its main branches affected. Considering aforementioned, imaging studies are essential in confirming large-vessel vasculitis, amongst which is highly sensitive PET/CT. We present the case of a 70-year-old female patient with constitutional symptoms and elevated sedimentation rate. After extensive diagnostic tests, she was admitted to our Rheumatology unit. Aortitis of the abdominal aorta has been confirmed by PET/CT and after the introduction of glucocorticoids the disease soon went into clinical and laboratory remission. Shortly after aortitis has been diagnosed, lung carcinoma was revealed of which the patient died. At the time of the comprehensive diagnostics, there was no reasonable doubt for underlying malignoma. To the best of our knowledge, there are no recent publications concerning giant cell arteritis and neoplastic processes in the context of up-to-date non-invasive diagnostic methods (i.e. PET/CT). In the light of previous research results, we underline that the sensitivity of PET/CT is not satisfactory when estimating cancer dissemination in non-enlarged lymph nodes and that its value can at times be overestimated.
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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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Nwadibia U, Larson E, Fanciullo J. Polymyalgia Rheumatica and Giant Cell Arteritis: A Review Article. S D Med 2016; 69:121-123. [PMID: 27156261] [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
Polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) are two rheumatological conditions with significant overlap that typically affect the older white population. PMR is the most common inflammatory rheumatic disease of the elderly and shares many pathogenetic and epidemiological features with GCA. Diagnosis is made primarily on clinical grounds with supporting laboratory evidence. Typical symptoms of PMR are bilateral aching of the shoulders and pelvic girdle associated with stiffness. PMR is associated with GCA and is considered to be on a disease continuum. Approximately half of patients diagnosed with GCA have already been or will be diagnosed with PMR. GCA is the most common vasculitis in adults and affects medium and large arteries and can result in blindness if untreated. Clinically it may present either gradually or abruptly. The most common presentation is headache with an aching pain classically localizing to the temporal region of moderate intensity which responds poorly to analgesics. Patients may also experience jaw or tongue claudication with weakening or pain in the muscles of mastication that is relieved by rest. The temporal artery may exhibit palpable beading, diminished pulses, bruits and tenderness.
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Suzuki M. [Polymyalgia rheumatica]. Nihon Rinsho 2015; 73 Suppl 7:711-715. [PMID: 26480782] [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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Ruocco E, Lo Schiavo A, Gambardella A, Ruocco V. Annular Elastolytic Giant Cell Granuloma and Temporal Arteritis Following Herpes Zoster. Skinmed 2015; 13:267-269. [PMID: 26861422] [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] [Indexed: 06/05/2023]
Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy;
| | - Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
| | | | - Vincenzo Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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Panzarelli A, Fernández K. Annular Elastolytic Giant Cell Granuloma and Temporal Arteritis Following Herpes Zoster. Skinmed 2015; 13:321-324. [PMID: 26861435] [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: 06/05/2023]
Abstract
A 70-year-old woman, who presented with pain and functional limitation of her right shoulder, without any previous traumatic incident, was evaluated in an emergency department. A shoulder x-ray was performed, and she received an intrajoint injection of an unspecified amount of triamcinolone. Forty-eight hours later, she noticed a papulovesicular and bullous eruption with a dermatomal distribution on her nape, supraclavicle, and left brachial and antebrachial regions (T1-T2-C5-C6-8). A diagnosis of herpes zoster (HZ) was made, for which she received valacyclovir 1 g every 8 hours for 10 days, pregabalin 75 mg every 8 hours, and topical acyclovir, with good response. The lesions and pain subsided, and results from general laboratory tests were normal or negative.
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Affiliation(s)
- Amalia Panzarelli
- Dermatology, Private Practice in Clinica Vista Alegre, Caracas, Venezuela;
| | - Katrina Fernández
- Pathology, Private Practice in Clinica Vista Alegre, Caracas, Venezuela
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Bashar K, Healy D, Clarke-Moloney M, Burke P, Kavanagh E, Walsh SR. Effects of neck radiation therapy on extra-cranial carotid arteries atherosclerosis disease prevalence: systematic review and a meta-analysis. PLoS One 2014; 9:e110389. [PMID: 25329500 PMCID: PMC4199672 DOI: 10.1371/journal.pone.0110389] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/12/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Radiation arteritis following neck irradiation as a treatment for head and neck malignancy has been well documented. The long-term sequelae of radiation exposure of the carotid arteries may take years to manifest clinically, and extra-cranial carotid artery (ECCA) stenosis is a well-recognised vascular complication. These carotid lesions should not be regarded as benign and should be treated in the same manner as standard carotid stenosis. Previous studies have noted increased cerebrovascular events such as stroke in this cohort of patients because of high-grade symptomatic carotid stenosis resulting in emboli. Aim To evaluate the effect of radiation therapy on ECCA atherosclerosis progression. Methods Online search for case-control studies and randomised clinical trials that reported on stenosis in extra-cranial carotid arteries in patients with neck malignancies who received radiation therapy (RT) comparing them to patients with neck malignancies who did not receive RT. Results Eight studies were included in the final analysis with total of 1070 patients – 596 received RT compared to 474 in the control group. There was statistically significant difference in overall stenosis rate (Pooled risk ratio = 4.38 [2.98, 6.45], P = 0.00001) and severe stenosis (Pooled risk ratio = 7.51 [2.78, 20.32], P <0.0001), both being higher in the RT group. Pooled analysis of the five studies that reported on mild stenosis also showed significant difference (Pooled risk ratio = 2.74 [1.75, 4.30], 95% CI, P = 0.0001). Conclusion The incidence of severe ECCA stenosis is higher among patients who received RT for neck malignancies. Those patients should be closely monitored and screening programs should be considered in all patients who receive neck RT.
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Affiliation(s)
- Khalid Bashar
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
- * E-mail:
| | - Donagh Healy
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Mary Clarke-Moloney
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Paul Burke
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Eamon Kavanagh
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Stewart-Redmond Walsh
- Department of surgery, National University of Ireland Galway (NUIG), Galway, County Galway, Ireland
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González-López JJ, González-Moraleja J, Burdaspal-Moratilla A, Rebolleda G, Núñez-Gómez-Álvarez MT, Muñoz-Negrete FJ. Factors associated to temporal artery biopsy result in suspects of giant cell arteritis: a retrospective, multicenter, case-control study. Acta Ophthalmol 2013; 91:763-8. [PMID: 22938720 DOI: 10.1111/j.1755-3768.2012.02505.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 11/28/2022]
Abstract
PURPOSE To evaluate the positivity rate of temporal artery biopsies (TAB) performed in suspects of giant cell arteritis (GCA) and to study the epidemiological and clinical factors associated to the biopsy result. METHODS A retrospective, multicenter, case-control study was performed, including three hundred and thirty-five patients who underwent TAB for a suspicion of GCA from 2001 to 2010. Clinical, epidemiological and pathology data were recovered from the patients' clinical records. Histologic diagnosis of GCA was made when active inflammation or giant cells were found in the arterial wall. RESULTS Eighty-one biopsies (24.2%) were considered positive for GCA. Clinical factors independently associated to TAB result in a logistic regression analysis were temporal cutaneous hyperalgesia (OR = 10.8; p < 0.001), jaw claudication (OR = 4.6; p = 0.001), recent-onset headache (OR = 4.4; p = 0.001), decreased temporal pulse (OR = 2.8; p = 0.02), pain and stiffness in neck and shoulders (OR = 2.3; p = 0.05), unintentional weight loss (OR = 1.33; p = 0.003) and age (OR = 1.085; p = 0.004). Other factors such as length of the surgical specimen (OR = 1.079; p = 0.028) and erythrocyte sedimentation rate (OR = 1.042; p < 0.001) were also statistically significant. The model was accurate (C-index = 0.921), reliable (pHosmer-Lemeshow = 0.733) and consistent in the bootstrap sensitivity analysis. No significant association was detected between TAB result and number of days of previous systemic corticosteroid treatment (p = 0.146). However, an association was observed between TAB result and the total accumulated dose of previous systemic corticotherapy (p = 0.043). CONCLUSIONS Exhaustive anamnesis and clinical examination remain of paramount importance in the diagnosis of GCA. To improve the yield of TAB, it should be performed specially in older patients with GCA-compatible clinic. TAB could be avoided in patients with an isolated elevation of acute phase reactants, without GCA-compatible clinic.
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Affiliation(s)
- Julio J González-López
- Ophthalmology Service, Hospital Universitario Ramón y Cajal, Madrid, España, SpainDepartamento de Cirugía, Facultad de Medicina, Universidad de Alcalá, Madrid, España, SpainInternal Medicine Service, Complejo Hospitalario de Toledo, Toledo, España, SpainPathology Service, Hospital Universitario Ramón y Cajal, Madrid, España, Spain
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Hakman P, Vallelian F, Nowak A. [Giant cell arteritis]. Praxis (Bern 1994) 2013; 102:703-710. [PMID: 23735760 DOI: 10.1024/1661-8157/a001344] [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] [Indexed: 06/02/2023]
Affiliation(s)
- Patrick Hakman
- Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
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Cameselle-Teijeiro J, Caneiro-Gómez J, Ghazzawi A, Piso-Neira M, Fernández-Rodríguez R, Reyes-Santías R, Abdulkader I. Giant cell arteritis of the thyroid gland as first evidence of systemic disease. J Clin Endocrinol Metab 2013; 98:441-2. [PMID: 23253616 DOI: 10.1210/jc.2012-3596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Haftgoli N, Favrat B, Pécoud A, Cornuz J, Vu F. [Headaches, five expert opinions: the pitfalls involved in the diagnosis of giant cell arteritis]. Rev Med Suisse 2011; 7:2328-2331. [PMID: 22232853] [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: 05/31/2023]
Abstract
Giant cell arteritis (GCA) (or Horton's disease) is a systemic disease affecting the vessels of medium and large sizes. The incidence increases with age (the disease develops rarely before age 50) and the etiology remains unknown. Clinical manifestations may vary (including asthenia, temporal headache, visual disturbances, etc.) and GCA can potentially lead to dramatic consequences (permanent loss of vision). Although some anomalies in the investigations may help in the diagnosis of GCA, research and confirmation of the diagnosis of GCA may be difficult, especially when the symptoms presented by patients are spread out in time and appear to be nonspecific at first.
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Abstract
The initial therapeutic approach to acute ischemic stroke consists of thrombolytic therapy and early initiation of supportive care, usually commenced prior to the determination of the underlying stroke etiology. Varying stroke mechanisms may call for specific, etiology-based treatment. The majority of strokes result from cardioembolism, large-vessel atherothromboembolism, and small-vessel occlusive disease. There are scant data to support the use of acute anticoagulation therapy over anti-platelet therapy in cardioembolic stroke and large-vessel atherosclerosis, although it may be reasonable in a certain subset of patients. However, augmentation of blood flow with early surgery, stenting, or induced hypertension, may play a role in patients with large artery stenosis. The less commonly identified stroke mechanisms may warrant special consideration in treatment. Controversy remains regarding the optimal anti-thrombotic treatment of arterial dissection. Reversible cerebral vasoconstriction syndrome may benefit from therapy with calcium channel blockers, high-dose steroids, or magnesium, although spontaneous recovery may occur. Inflammatory vasculopathies, such as isolated angiitis of the central nervous system and temporal arteritis, require prompt diagnosis as the mainstay of therapy is immunosuppression. Cerebral venous thrombosis is a rare cause of stroke, but one that needs early identification and treatment with anticoagulation. Rapid determination of stroke mechanism is essential for making these critical early treatment decisions.
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Affiliation(s)
- Neelofer Shafi
- Department of Neurology, Comprehensive Stroke Center, Comprehensive Stroke Center, Philadelphia, PA 19104 USA
| | - Scott E. Kasner
- Department of Neurology, Comprehensive Stroke Center, Comprehensive Stroke Center, Philadelphia, PA 19104 USA
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César S, García A, Parada E, Soriano A. Cavernous sinus thrombosis due to invasive community-associated methicillin-resistant Staphylococcus aureus infection. Enferm Infecc Microbiol Clin 2010; 28:755-6. [PMID: 20417585 DOI: 10.1016/j.eimc.2009.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 10/19/2009] [Accepted: 12/03/2009] [Indexed: 11/29/2022]
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Abstract
A 61-year-old female presented with a moderate decrease in vision in the left eye. The patient denied any other ocular or systemic symptoms related to giant cell arteritis. Visual acuity was 20/50 in the left eye with a 2+ relative afferent pupillary defect and markedly abnormal color vision. Dilated fundus examination and flourescein angiography revealed optic disc edema as well as a cilioretinal artery occlusion. Erythrocyte sedimentation rate was only slightly elevated. Subsequent biopsy of the superficial temporal artery confirmed the diagnosis of giant cell arteritis. Cilioretinal arteries are anatomical variants derived from the short posterior ciliary arteries. Arteritic anterior ischemic optic neuropathy typically results from thrombotic occlusion of the short posterior ciliary arteries. Consequently, arteritic occlusion of the short posterior ciliary arteries can result in concomitant occlusion of the cilioretinal artery. This case highlights the situation where clinical symptoms were not suspicious for giant cell arteritis but the presence of an anterior ischemic optic neuropathy and a cilioretinal artery occlusion was virtually pathognomonic for giant cell arteritis.
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Affiliation(s)
- John M Galasso
- Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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30
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Spierings ELH. Migraine: migraine headache pathogenesis in historical perspective. Rev Neurol Dis 2009; 6:E77-E80. [PMID: 19587636] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Egilius L H Spierings
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Guillevin L, Pagnoux C. [Classification of systemic vasculitides]. Rev Prat 2008; 58:480-486. [PMID: 18524103] [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: 05/26/2023]
Abstract
Systemic vasculitides are characterized by different histological aspects: fibrinoid necrosis of the arterial wall, giant cell arteritis, non-necrotizing arteritides without granuloma or giant cell infiltration. Each histological form is associated with a spectrum of diseases with variable clinical expression: giant cell angeitides, such as Takayasu's arteritis and giant cell arteritis, necrotizing angeitides, such as polyarteritis nodosa, Kawasaki disease, Wegener's granulomatosis, Henoch-Schönlein purpura or Churg-Strauss syndrome. The detection of anti-neutrophilic cytoplasmic antibodies (ANCA) also makes it possible to classify necrotizing vasculitides by isolating a group of diseases different from necrotizing vasculitidies without ANCA (Wegener's granulomatosis, microscopic polyangitis, allergic granulomatous angiitis).
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Affiliation(s)
- Loïc Guillevin
- Service de médecine interne, Centre de référence maladies rares Vascularites et Sclérodermies systémiques, hôpital Cochin, Université Paris-V-René-Descartes, Paris.
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Trassierra Villa M, Bonillo García MA, Cervera Miguel JI, Ramírez Backhaus M, Palmero Marti JL, Jiménez Cruz F. [Temporal arteritis as initial manifestation of renal cell carcinoma]. Actas Urol Esp 2008; 31:1179-81. [PMID: 18314659 DOI: 10.1016/s0210-4806(07)73783-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vasculitis as paraneoplastic syndrome of renal cell carcinoma has been rarely report. We report a patient who initially was studied for temporal arteritis, and was later diagnosed of a renal cell carcinoma. The vasculitis resolves after surgery treatment of the tumour.
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Souvirón Encabo R, García de Pedro F, Encinas A, Rodríguez A, Scola Yurrita B. [Necrosis of the tongue secondary to bilateral carotid thrombosis after radiotherapy]. Acta Otorrinolaringol Esp 2007; 58:331-2. [PMID: 17683702] [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: 05/16/2023]
Abstract
Necrosis of the tongue is an atypic process, because it has a high irrigation that depends of the right and left lingual arteries. But, there isn't a good anastomosis between both arteries except in the tip and the tongue base. We focus on an exceptional case report about a patient that presented a great necrotic lesion in the middle of the tongue due to a bilateral external carotid thrombosis, because of a radiation therapy some years before.
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Abstract
Life-threatening vascular complications of the skin are rare and usually reflect underlying systemic diseases. Lesions are sudden in onset, become necrotic and may be severe or life-threatening. Effective management requires an understanding of the underlying medical condition, such as arterial thrombosis, temporal arteritis, calciphylaxis and purpura fulminans. In contrast, the acute painful symptoms of erythromelalgia often lead to an urgent dermatologic consultation but pose no acute risk.
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Affiliation(s)
- B Kahle
- Klinik für Dermatologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.
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When arteries get inflamed. Headaches are the most common symptom of temporal arteritis, but the anemia, weight loss, and malaise it produces means other diseases are often suspected. Harv Health Lett 2006; 32:6. [PMID: 17278293] [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: 05/13/2023]
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37
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Koskivirta I, Rahkonen O, Mäyränpää M, Pakkanen S, Husheem M, Sainio A, Hakovirta H, Laine J, Jokinen E, Vuorio E, Kovanen P, Järveläinen H. Tissue inhibitor of metalloproteinases 4 (TIMP4) is involved in inflammatory processes of human cardiovascular pathology. Histochem Cell Biol 2006; 126:335-42. [PMID: 16521002 DOI: 10.1007/s00418-006-0163-8] [Citation(s) in RCA: 56] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2006] [Indexed: 10/24/2022]
Abstract
Tissue inhibitors of matrix metalloproteinases (TIMPs) comprise a family of four members, of which TIMP4 is characterized by being primarily restricted to cardiovascular structures. We demonstrate with immunohistochemical analysis of healthy human tissue that TIMP4 is present in medial smooth muscle cells and adventitial capillaries of arteries as well as in cardiomyocytes. Animal studies have suggested a role for TIMP4 in several inflammatory diseases and cardiovascular pathologies. We therefore examined whether TIMP4 is involved in human inflammatory cardiovascular disorders, specifically atherosclerosis, giant cell arteritis and chronic rejection of heart allografts. TIMP4 was most clearly visible in cardiovascular tissue areas populated by abundant inflammatory cells, mainly macrophages and CD3+ T cells. Using western blotting and immunocytochemistry, human blood derived lymphocytes, monocytes/macrophages and mast cells were shown to produce TIMP4. In advanced atherosclerotic lesions, TIMP4 was detected around necrotic lipid cores, whereas TIMP3 and caspase 3 resided within and around the core regions, indicating different roles for TIMP3 and TIMP4 in inflammation-induced apoptosis and in matrix turnover. In conclusion, the data demonstrate upregulation of TIMP4 in human cardiovascular disorders exhibiting inflammation, suggesting its future use as a novel systemic marker for vascular inflammation.
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Affiliation(s)
- Ilpo Koskivirta
- Department of Medical Biochemistry and Molecular Biology, University of Turku, Turku, Finland
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Abstract
Giant cell arteritis and polymyalgia rheumatica were described separately more than 100 years ago. However, the original reports of both conditions were neglected for many years. After the article by Horton et al on giant cell arteritis in the 1930s and studies published by others in the 1940s, giant cell arteritis began to be recognized as a specific disease. In the 1950s and 1960s, many of the numerous presentations and complications of giant cell arteritis were recorded. In a somewhat similar fashion, physicians became cognizant of polymyalgia rheumatica only after several independent descriptions in the 1940s and 1950s. The rapid response of both syndromes to glucocorticoid therapy was discovered shortly after cortisone's effect on rheumatoid arthritis was described. The origin of the proximal aching and stiffness in polymyalgia rheumatica was more difficult to understand. The relatively minor findings in the joints on physical examination seemed insufficient to account for the severe discomfort. As the link between polymyalgia rheumatica and giant cell arteritis became apparent, some thought the aching in polymyalgia rheumatica was related to vasculitis. The debate about whether proximal synovitis or vasculitis was the cause of the symptoms continued after 1970. Although the reason these 2 conditions were associated was not considered by 1970, the establishment of the syndromes as clinically linked entities provided the groundwork for further progress in the next decades.
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Affiliation(s)
- Gene G Hunder
- Emeritus Staff Center, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Abstract
Studies of autoimmune diseases have not yet elucidated why certain organs or vessels become the objects of injury while others are spared. This paper explores the hypothesis that important differences exist in regions of the aorta; these regional variations determine vulnerability to such diseases as atherosclerosis, aortitis, giant-cell arteritis, and Takayasu's disease. The reader is invited to reassess two issues: (1) whether the aorta is indeed a single homogeneous structure; and (2) whether the initial stage of aortitis (and indeed other diseases considered "autoimmune") may primarily be the result of acquired alterations of substrate that influence unique immune profiles, but that by themselves may not be pathogenic. Disease susceptibility and patterns are influenced by many factors that are either inborn or acquired. Examples include genetic background, gender, ethnicity, aging, prior and concomitant illnesses, habits, diet, and exposure to toxins and other environmental hazards. Studies of vascular diseases must assess how such variables affect regional anatomic differences in endothelial cells, subendothelial matrix, and vascular smooth muscle, as well as the response of each to a variety of stimuli.
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Affiliation(s)
- Gary S Hoffman
- Department of Rheumatic and Immunologic Diseases, Center for Vasculitis Care and Research, Cleveland Clinic Foundation A50, Cleveland, OH 44195, USA.
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Larsson K, Nordborg C, Moslemi AR, Nordborg E. A Western blot and molecular genetic investigation of the estrogen receptor beta in giant cell arteritis. Clin Exp Rheumatol 2006; 24:S17-9. [PMID: 16859590] [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: 05/11/2023]
Abstract
OBJECTIVE The epidemiology of giant cell arteritis (GCA) may indicate a pathogenetic relationship between GCA and female sex hormone metabolism; GCA is two to four times more common in women compared with men. Our previous analyses gave no support for the hypothesis that the pathogenesis of GCA should be related to somatic mutations in the estrogen receptor alpha (ERalpha) gene. The object of the present study was to investigate the size of the estrogen receptor beta (ERBeta), and the size and nucleotide sequence of the ERBeta gene in temporal arteries in GCA. METHODS The ERBeta protein was analyzed by Western blot technique and the ERBeta gene by RT-PCR and direct sequencing of the PCR product. RESULTS Western blot analysis revealed an ERBeta of normal size. There were no aberrations in size or nucleotide sequence in the ERBeta gene in the GCA patients. CONCLUSION The present observations gave no support for the hypothesis that somatic mutations in the ERBeta gene should be involved in the pathogenesis of GCA.
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Affiliation(s)
- K Larsson
- Department of Rheumatology, Sahlgrenska University Hospital, Göteborg, Sweden
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Finn BC, Young P, Silva ED, Bruetman JE, Bottaro FJ, Venditti JE, Shanley CM, Ceresetto J, Bullorsky E. [Simultaneous multiple myeloma and giant cell arteritis without systemic amyloidosis]. Medicina (B Aires) 2006; 66:555-7. [PMID: 17240628] [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: 05/13/2023] Open
Abstract
Primary systemic amyloidosis with clinical and histopathologic features of giant cell arteritis has already been described. The association of multiple myeloma (with primary amyloidosis) and giant cell arteritis is also known. We present the first case in the literature of a patient with multiple myeloma and giant cell arteritis without systemic amyloidosis, suggesting a pathogenic relationship between the two diseases.
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Affiliation(s)
- Barbara C Finn
- Servicio de Medicina Interna, Hospital Británico de Buenos Aires.
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Abstract
Giant cell arteritis is a systemic disease that continues to be a sight-threatening medical emergency requiring prompt recognition and treatment in order to avoid devastating ophthalmic consequences. Although there have been advances in the genetic and immunologic understanding of the underlying pathogenesis of the disease, the exact etiology of the condition, to date, remains unclear. Visual manifestations of giant cell arteritis are the common mode of presentation, making the ophthalmologist critically responsible for early diagnosis and treatment. Although temporal artery biopsy remains the only confirmatory procedure, newer laboratory investigations and blood flow studies with fundus fluorescein angiography have aided in the diagnosis of temporal giant cell arteritis. Maintenance of a high index of clinical suspicion is essential to institute prompt adequate treatment, especially in atypical cases. Corticosteroids remain the mainstay of treatment of giant cell arteritis. Recently, immunosuppressive agents as secondary steroid-sparing drugs have been used, particularly in some steroid-resistant cases. A wider recognition of the disease will minimize the prevalence of irreversible visual loss among patients with giant cell arteritis.
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Larsson K, Mellström D, Nordborg E, Nordborg C, Odén A, Nordborg E. Early menopause, low body mass index, and smoking are independent risk factors for developing giant cell arteritis. Ann Rheum Dis 2005; 65:529-32. [PMID: 16126796 PMCID: PMC1798101 DOI: 10.1136/ard.2005.039404] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess female sex hormone related variables in a group of women with biopsy positive giant cell arteritis and a control group. METHODS 49 women with biopsy positive giant cell arteritis, aged 50 to 69 years at the time of diagnosis, answered a questionnaire on hormonal and reproductive factors. The same questions were answered by a large population of women from the same geographical area in connection with routine mammograms. The results were tested statistically, using logistic regression analysis of each variable adjusted for age, and a multivariate logistic regression analysis including age and the variables which differed significantly between giant cell arteritis and controls. RESULTS From the multivariate logistic regression analysis, three independent variables were associated with an increased risk of having giant cell arteritis: smoking and being an ex-smoker (odds ratio (OR) = 6.324 (95% confidence interval (CI), 3.503 to 11.418), p<0.0001); body mass index (a reduction of 1.0 kg/m2 increased the risk by 10% (OR = 0.898 (0.846 to 0.952), p = 0.0003); and menopause before the age of 43 (OR = 3.521 (1.717 to 7.220), p = 0.0006). CONCLUSIONS There was a significant association between hormonal and reproduction related factors and the risk of developing giant cell arteritis in women given the diagnosis before the age of 70. The results suggest a possible role of oestrogen deficiency in the pathogenesis of giant cell arteritis. To confirm the results, an extended study will be needed, including women older than 70.
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Affiliation(s)
- K Larsson
- Department of Pathology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden
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Rodríguez-Pla A, Bosch-Gil JA, Rosselló-Urgell J, Huguet-Redecilla P, Stone JH, Vilardell-Tarres M. Metalloproteinase-2 and -9 in giant cell arteritis: involvement in vascular remodeling. Circulation 2005; 112:264-9. [PMID: 15998676 DOI: 10.1161/circulationaha.104.520114] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [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: 11/16/2022]
Abstract
BACKGROUND Both matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9) have been postulated to play roles in the pathophysiology of giant cell arteritis (GCA) because of their ability to degrade elastin. Understanding the specific mediators of arterial damage in GCA could lead to new therapeutic targets in this disease. METHODS AND RESULTS Temporal artery biopsy specimens were obtained from 147 consecutive patients suspected of GCA. Clinical and histopathological data were collected according to protocol. Using immunohistochemistry, we compared the expression of MMP-2 and MMP-9 in the temporal artery biopsies of both GCA cases (n=50) and controls (n=97). MMP-9 was found more frequently in positive than in negative temporal artery biopsies (adjusted odds ratio [OR], 3.20; P=0.01). In contrast, the frequency of MMP-2 was not significantly different between positive and negative biopsies (adjusted OR, 2.18; P=0.22). Both MMP-2 and MMP-9 were found in macrophages and giant cells near the internal elastic lamina and in smooth muscle cells and myofibroblasts of the media and intima. MMP-9 was also found in the vasa vasorum. MMP-9 but not MMP-2 was associated with internal elastic lamina degeneration, intimal hyperplasia, and luminal narrowing, even after adjustment for possible confounding variables. CONCLUSIONS MMP-9 appears more likely than MMP-2 to be involved in the pathophysiology of GCA. MMP-9 not only participates in the degradation of elastic tissue but also is associated with intimal hyperplasia, subsequent luminal narrowing, and neoangiogenesis. The expression of MMP by smooth muscle cells implicates these cells as potential secretory cells in GCA.
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Abstract
A case of juvenile temporal arteritis, which is a rare vascular lesion in children and young adults, associated with Kimura's disease in a healthy 23-year-old asymptomatic man is described. The patient presented with a painless 2.5 cm nodule with eosinophilia and normal erythrocyte sedimentation rate. Histologically, the left superficial artery showed marked intimal thickening with moderate eosinophilic infiltrates, constriction of the vascular lumen, focal disruptions of the internal elastic lamina and media, moderate eosinophilic infiltrates in the adventia, and absence of giant cells. The subcutaneous tissue surrounding the artery was characterized by lymphofollicular hyperplasia, marked eosinophilic infiltrates in the intra- and extra-follicles with abscess, capillary proliferations, lymphocytic, plasma cell and mast cell infiltrates, and fibrosis in the interfollicular region. Immunohistochemically, reticular, positive IgE staining was observed in the germinal centers. Clinically and histologically, the lesion was consistent with juvenile temporal arteritis associated with Kimura's disease. The findings indicate that both entities are closely related and juvenile temporal arteritis may be secondary to Kimura's disease.
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Affiliation(s)
- Masaharu Fukunaga
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan.
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Llorca J, Bringas-Bollada M, Garcia-Porrua C, Gonzalez-Gay MA. Altitude and giant cell arteritis. J Rheumatol 2005; 32:963-4; author reply 964. [PMID: 15868602] [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] [Indexed: 05/02/2023]
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Abstract
Studies of autoimmune diseases have not yet elucidated why certain organs
or vessels become the objects of injury while others are spared. This paper will
explore the hypothesis that important differences exist in regions of the aorta that
determine vulnerability to diseases, such as atherosclerosis, aortitis, giant cell
arteritis and Takayasu's disease. The reader is invited to reassess; (1) whether
the aorta is indeed a single homogeneous structure, and (2) whether the initial
stage of aortitis (and indeed other diseases considered “autoimmune”) may be
primarily due to acquired alterations of substrate, that influence unique immune
profiles, which by themselves may not be pathogenic. Disease susceptibility and
patterns are influenced by many factors that are inborn and acquired. Examples
include genetic background, gender, ethnicity, aging, prior and concomitant
illnesses, habits, diet, toxin and environmental exposures. Studies of vascular
diseases must assess how such variables may affect regional differences in
endothelial cells, subendothelial matrix, vascular
smooth muscle and the response of each to a variety of stimuli.
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Affiliation(s)
- Gary S Hoffman
- Harold C Schott Chair of Rheumatic and Immunologic Diseases, Center for Vasculitis Care and Research, Cleveland Clinic Foundation A50, Cleveland, OH 44195, USA
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Sugraliev AB. [The modern view of the clinical manifestation and classification of nonspecific aortoarteritis]. Klin Med (Mosk) 2005; 83:15-8. [PMID: 16117418] [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: 05/04/2023]
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Spiera R, Spiera H. Inflammatory disease in older adults. Cranial arteritis. Geriatrics (Basel) 2004; 59:25-9; quiz 30. [PMID: 15667019] [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: 05/01/2023] Open
Abstract
Cranial arteritis (CA), also called giant cell arteritis or temporal arteritis, is a vasculitis primarily affecting adults over age 50. It is a large vessel vasculitis, and giant cells classically can be identified on histopathologic examination of temporal arteries, but are not essential for diagnosis. Patients typically present with severe headaches, fatigue, polymyalgia-like symptoms, or ischemic complaints such as jaw claudication. Visual loss is the major feared irreversible outcome and can occur in up to 50% of those with untreated disease. Glucocorticoids, typically high dose prednisone (> or = 60 mg/d) is the first-line treatment and successfully controls the inflammatory disease in the vast majority of patients. Most patients can be tapered off steroids within 6 months to 2 years.
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Affiliation(s)
- Robert Spiera
- Albert Einstein College of Medicine, New York City, USA
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