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steroid associated arteritis

Jem Ninan, Susan Lester, Catherine Hill
Giant cell arteritis (GCA) is the most common vasculitis of the elderly. The diagnosis can be challenging at times because of the limitation of the American Rheumatology Association (ARA) classification criteria and the significant proportion of biopsy-negative patients with GCA. We discuss the role of advanced imaging techniques, including positron emission tomography (PET) scanning, in establishing diagnosis and improved histopathology techniques to improve the sensitivity of temporal artery biopsy. There have been significant advances in the understanding of the pathogenesis of GCA, particularly the role of cytokine pathways such as the interleukins, IL-6-IL-17 axis, and the IL-12-interferon-γ axis and their implication for new therapies...
February 2016: Best Practice & Research. Clinical Rheumatology
Tomoki Origuchi, Shoichi Fukui, Masataka Umeda, Ayako Nishino, Yoshikazu Nakashima, Tomohiro Koga, Shin-Ya Kawashiri, Naoki Iwamoto, Kunihiro Ichinose, Mami Tamai, Hideki Nakamura, Atsushi Kawakami
Takayasu arteritis (TA) is a type of vasculitis that affects the large elastic arteries, specifically the aorta and its main branches. It has been reported that TA occurred most frequently in Nagasaki Prefecture, the western area in Japan. We retrospectively collected the information of 34 patients with TA, diagnosed using the American College of Rheumatology 1990 criteria for the classification of TA, from the medical records of Nagasaki University Hospital from 2003 to 2015, and we investigated the clinical characteristics of these TA patients...
2016: Tohoku Journal of Experimental Medicine
Muhammad Raza Cheema, Shakawan M Ismaeel
Temporal arteritis, also known as giant cell arteritis (GCA), is a systemic vasculitis that predominantly involves the temporal arteries. It is a medical emergency and should be treated promptly as it can lead to permanent loss of vision. It is very commonly associated with a raised erythrocyte sedimentation rate (ESR), usually >50 mm/h, one of the essential criteria defined by the American College of Rheumatology classification of GCA. Here, we describe the case of a 73-year-old male presenting with a 2-day history of a sudden onset of a severe left-sided headache, which had the signs and symptoms consistent with GCA but he had an ESR of only 27 mm/h...
2016: Clinical Interventions in Aging
Naoko Sato, Koji Irie, Ryoji Kouzuma, Katsumi Inoue, Toshiyuki Nakayama
A 19-year-old woman with a history of recurrent aphthous stomatitis and genital ulceration was diagnosed with Behçet disease. She was treated with steroids and immunosuppressive agents for more than 30 years, but multiple complications manifested including ileocecal ulcer, aortic valve regurgitation, renal failure, ischemic enterocolitis, and arteriosclerotic obliterans until her death at the age of 56 from pneumonia. An autopsy examination demonstrated an entirely calcified aorta and major aortic branches...
January 18, 2016: Pathology International
Zsuzsa Schmidt, Gyula Poór
Polymyalgia rheumatica is an inflammatory musculoskeletal disorder of people aged 50 years or over, characterised by pain, aching and morning stiffness in the shoulder girdle and often hip girdle and neck. Marked systemic inflammation and rapid response to corticosteroid therapy are characteristic features. Giant cell arteritis is a well-known association of polymyalgia rheumatica. Recent clinical evidence and scientific results in the field have provided new challenges for rheumatologists. Besides the aspecific - although characteristic - proximal syndrome, less well recognizable and more variable distal musculoskeletal manifestations were observed...
January 3, 2016: Orvosi Hetilap
Jorge Vega, Francisco J Guarda
Pauci-immune glomerulonephritis in systemic vasculitides usually have anti-neuthrophil cytoplasmic antibodies (ANCA). However, vasculitides of large vessels such as Takayasu's and giant cell (temporal) arteritis do not. Exceptionally ANCA(+) small vessel vasculitides are associated with large vessel vasculitis. It may be a coincidence or both vasculitides have a common pathogenesis. We report a 30 years old woman on hemodialysis due to a chronic glomerulonephritis ANCA(+) diagnosed nine years ago. Eight years later, she presented with an aortitis with severe stenosis of distal aorta and vasculitis of left subclavian artery...
September 2015: Revista Médica de Chile
Maria Wilbe, Sergey V Kozyrev, Fabiana H G Farias, Hanna D Bremer, Anna Hedlund, Gerli R Pielberg, Eija H Seppälä, Ulla Gustafson, Hannes Lohi, Örjan Carlborg, Göran Andersson, Helene Hansson-Hamlin, Kerstin Lindblad-Toh
The complexity of clinical manifestations commonly observed in autoimmune disorders poses a major challenge to genetic studies of such diseases. Systemic lupus erythematosus (SLE) affects humans as well as other mammals, and is characterized by the presence of antinuclear antibodies (ANA) in patients' sera and multiple disparate clinical features. Here we present evidence that particular sub-phenotypes of canine SLE-related disease, based on homogenous (ANA(H)) and speckled ANA (ANA(S)) staining pattern, and also steroid-responsive meningitis-arteritis (SRMA) are associated with different but overlapping sets of genes...
June 2015: PLoS Genetics
Kelly L Hughes, Susanne M Stieger-Vanegas, Beth A Valentine
Patchy meningeal and parenchymal contrast enhancement of the spinal cord with multifocal central canal dilations was noted in a computed tomography myelogram of the cervical spine of a 6-month-old intact female coonhound with a confirmed diagnosis of canine juvenile polyarteritis and associated hemorrhage within the central canal.
June 2015: Canadian Veterinary Journal. la Revue Vétérinaire Canadienne
Samih H Nasr, Tait D Shanafelt, Curtis A Hanson, Mary E Fidler, Lynn D Cornell, Sanjeev Sethi, Kari G Chaffee, Joseph Morris, Nelson Leung
Granulomatous interstitial nephritis (GIN) is an uncommon pathologic lesion encountered in 0.5% to 5.9% of renal biopsies. Drugs, sarcoidosis, and infections are responsible for most cases of GIN. Malignancy is not an established cause of GIN. Here, we report a series of 5 patients with GIN secondary to chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Patients were mostly elderly white males with an established history of CLL/SLL who presented with severe renal impairment (median peak serum creatinine, 7...
June 2015: Annals of Diagnostic Pathology
Takayoshi Matsumura, Eisuke Amiya, Natsuko Tamura, Yasuhiro Maejima, Issei Komuro, Mitsuaki Isobe
Takayasu arteritis (TAK) is an acute and chronic vasculitis of unknown etiology. Recently, our group reported that SNP rs6871626 in the IL12B region had significant association with disease susceptibility to TAK. However, association of the SNP with clinical characteristics of TAK has yet to be determined. Therefore, we assessed whether this SNP was associated with TAK disease severity as represented by early onset and/or refractoriness to medical therapy. A total of 90 patients were genotyped for rs6871626 and their clinical charts were reviewed retrospectively...
June 2016: Heart and Vessels
Michael Czihal, Anne Piller, Angelika Schroettle, Peter Kuhlencordt, Christoph Bernau, Hendrik Schulze-Koops, Ulrich Hoffmann
OBJECTIVE: Color duplex sonography (CDS) today is broadly used in the diagnostic workup of patients with suspected cranial or extracranial giant cell arteritis (GCA). This study aimed to determine the prognostic impact of the disease pattern assessed by CDS on the treatment response in GCA. METHODS: This was a retrospective, longitudinal follow-up study of 43 patients who were diagnosed with GCA at our institution between 2002 and 2010. All patients underwent CDS of the temporal and subclavian/axillary arteries at baseline and were observed for at least 6 months...
May 2015: Journal of Vascular Surgery
D Saadoun, M Garrido, C Comarmond, A C Desbois, F Domont, L Savey, B Terrier, G Geri, M Rosenzwajg, D Klatzmann, P Fourret, P Cluzel, L Chiche, J Gaudric, F Koskas, P Cacoub
OBJECTIVE: Takayasu arteritis (TAK) is a large-vessel vasculitis that induces damage to the aorta and its branches. Glucocorticoids remain the gold standard of therapy for TAK. The nature of the T cells driving vascular inflammation and the effects of glucocorticoids on the systemic components of TAK are not understood. The aim of this study was to analyze T cell homeostasis and cytokine production in peripheral blood and inflammatory lesions of the aorta in patients with TAK. METHODS: T cell homeostasis and cytokine production in peripheral blood and inflammatory lesions of the aorta were analyzed using Luminex analysis, flow cytometry, and immunohistochemical analysis...
May 2015: Arthritis & Rheumatology
Amna Zarar, Taqi T Zafar, Asif A Khan, M Fareed K Suri, Adnan I Qureshi
BACKGROUND: Cerebrovascular ischemic events associated with giant cell arteritis (GCA) are uncommon and have been reported in 3%-4% of patients. We describe a case report of GCA associated with intracranial stenosis and review various angiographic findings. CASE PRESENTATION: A 66-year-old man presented with worsening headache and vision loss. A recent magnetic resonance angiogram of the head and neck showed multiple intracranial stenosis. Cerebrospinal fluid (CSF) analysis demonstrated increased protein of 135...
December 2014: Journal of Vascular and Interventional Neurology
Delphine Larivière, Karim Sacre, Isabelle Klein, Fabien Hyafil, Laurence Choudat, Marie-Paule Chauveheid, Thomas Papo
Recognizing giant cell arteritis (GCA) in patients with stroke may be challenging. We aimed to highlight the clinical spectrum and long-term follow-up of GCA-specific cerebrovascular accidents. Medical charts of all patients followed in a French Department of Internal Medicine for GCA between January 2008 and January 2014 were retrospectively reviewed. Patients with cerebrovascular accidents at GCA diagnosis were included. Diagnosis of GCA was based on American College of Rheumatology criteria. Transient ischemic attacks and stroke resulting from an atherosclerotic or cardioembolic mechanism were excluded...
December 2014: Medicine (Baltimore)
Elisabeth De Smit, Andrew J Palmer, Alex W Hewitt
OBJECTIVE: To estimate and project the number of people affected worldwide by giant cell arteritis (GCA) by 2050. Modeling the number of people visually impaired as a result of this disease will help establish the projected morbidity and resource burden. METHODS: A systematic literature review up to December 2013 was conducted using PubMed and ISI Web of Science. Studies reporting an incidence rate for GCA were used to model disease incident cases at regional and national levels...
January 2015: Journal of Rheumatology
Raashid Ahmed Luqmani
Anti-neutrophil cytoplasm antibodies (ANCA) are associated with small vessel vasculitides (AASV) affecting the lungs and kidneys. Structured clinical assessment using the Birmingham Vasculitis Activity Score and Vasculitis Damage Index should form the basis of a treatment plan and be used to document progress, including relapse. Severe disease with organ or life threatening manifestations needs cyclophosphamide or rituximab, plus high dose glucocorticoids, followed by lower dose steroid plus azathioprine, or methotrexate...
2014: Frontiers in Immunology
Q Akram, S Knight, R Saravanan
Giant cell arteritis (GCA) is a medium to large vessel vasculitis of unknown aetiology. Commonly, it affects the temporal arteries and is known as temporal arteritis. It has an association with polymyalgia rheumatica and can result in severe complications such as loss of vision and rarely scalp necrosis. There are approximately 100 cases of scalp necrosis in patients with GCA published in the literature to date. We report a case of a man who presented with a 4-week history of bilateral scalp necrosis associated with headache, jaw claudication, temporal artery tenderness, and raised inflammatory markers...
January 2015: Clinical Rheumatology
Patrick J Rooney, Jennifer Rooney, Geza Balint, Peter Balint
OBJECTIVES: On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the epidemiology of this disease and whether such studies have advanced our knowledge of its aetiopathogenesis and management. METHODS: The authors searched Medline and PubMed using the search terms 'polymyalgia rheumatica', 'giant cell arteritis' and 'temporal arteritis'...
February 2015: Scottish Medical Journal
Susan P Mollan, Noor Sharrack, Mike A Burdon, Alastair K Denniston
BACKGROUND: Giant cell arteritis (GCA) is a common inflammatory condition that affects medium and large-sized arteries and can cause sudden, permanent blindness. At present there is no alternative to early treatment with high-dose corticosteroids as the recommended standard management. Corticosteroid-induced side effects can develop and further disease-related ischaemic complications can still occur. Alternative and adjunctive therapies are sought. Aspirin has been shown to have effects on the immune-mediated inflammation in GCA, hence it may reduce damage caused in the arterial wall...
2014: Cochrane Database of Systematic Reviews
Janina Bartels, Brett G Darrow, Scott J Schatzberg, Lijing Bu, Regina Carlson, Andrea Tipold
BACKGROUND: Chemokines such as MIP-3β/CCL19 are important factors in the mechanism of cell migration and pathogenesis of central nervous system (CNS) inflammatory reactions. The hypothesis of this study is that CCL19, also known as MIP-3β, is involved in the pathogenesis of inflammatory and non-inflammatory CNS diseases of dogs. Experiments were performed on cerebrospinal fluid (CSF) and serum samples of dogs affected with steroid responsive meningitis-arteritis (SRMA) during the acute phase as well as during treatment...
2014: BMC Veterinary Research
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