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Giant cell arteritis

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https://www.readbyqxmd.com/read/28815188/painless-aortic-dissection-diagnostic-dilemma-with-fatal-outcomes-what-do-we-learn
#1
Saeeda Fatima, Konika Sharma
Aortic dissection is the most catastrophic clinical condition that involves the aorta. It has a high mortality as well as high rate of misdiagnosis due to frequent unusual presentation. Typically, it presents with acute chest, back, and tearing abdominal pain. However, it can present atypically with minimal or no pain, making diagnosis difficult. Physicians should always suspect acute aortic dissection in patients with certain clinical conditions like difficult-to-control hypertension, giant cell arteritis, bicuspid aortic valve, intracranial aneurysms, simple renal cysts, family history of aortic disease, and Marfan syndrome, especially when a patient presents with ischemic symptoms involving multiple organ without an obvious cause...
July 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28810043/amalric-triangular-syndrome-associated-with-outer-nuclear-layer-infarction
#2
Sean T Garrity, Eric J Holz, David Sarraf
An 85-year-old man presented with temporal headache and bilateral paracentral scotomas. Clinical examination, laboratory testing, and temporal artery biopsy confirmed the diagnosis of giant cell arteritis. Fluorescein angiography illustrated Amalric triangular choroidal infarction of the left eye. Spectral-domain optical coherence tomography of the left eye demonstrated outer nuclear layer abnormalities adjacent to the choroidal infarct. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:668-670.].
August 1, 2017: Ophthalmic Surgery, Lasers & Imaging Retina
https://www.readbyqxmd.com/read/28806315/nonarteritic-jaw-claudication
#3
Christine A Petersen, Courtney E Francis
A 60-year-old woman with decreased visual acuity in her right eye and right-sided jaw claudication was found to have ocular ischemic syndrome secondary to complete occlusion of the brachiocephalic artery. Although jaw claudication is often considered to be pathognomonic for giant cell arteritis, it has a broad differential diagnosis including both vascular and nonvascular conditions.
September 2017: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
https://www.readbyqxmd.com/read/28800947/-from-pathogenesis-of-giant-cell-arteritis-to-new-therapeutic-targets
#4
M Samson, B Bonnotte
Giant cell arteritis (GCA) is the most common vasculitis in adults. GCA is a granulomatous large-vessel vasculitis involving the aorta and its major branches in people>50 years. Glucocorticoids (GC) remain the cornerstone of GCA treatment. Prednisone is usually started at 0.7 or 1mg/kg/day depending on the occurrence of ischemic complications. Then, GC are progressively tapered and stopped after a mean duration of 18 months. GC are very efficient but relapses often occur during their tapering. Moreover, GC-related side effects are very common during this long term GC therapy...
August 8, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/28799318/giant-cell-arteritis-presenting-as-puo
#5
Sham Santhanam, Sampath Kumar Mani
Giant cell arteritis(GCA) is a primary granulomatous vasculitis affecting the large and medium sized arteries. We present here a case of GCA with pyrexia of unknown origin (PUO) as the presenting manifestation in the absence of other typical features. On evaluation, the patient had raised inflammatory markers with features of large vessel vasculitis on whole body PET-CT scan. The colour doppler ultrasonography(CDUS) of the temporal arteries showed bilateral halo sign. Since bilateral 'halo sign' is more specific for the diagnosis of GCA, temporal artery biopsy is not mandatory...
August 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28791802/a-26-week-feasibility-study-comparing-the-efficacy-and-safety-of-modified-release-prednisone-with-immediate-release-prednisolone-in-newly-diagnosed-cases-of-giant-cell-arteritis
#6
Charles Raine, Philip P Stapleton, Dimos Merinopoulos, Win Win Maw, Katerina Achilleos, Dawn Gayford, Sarah Mapplebeck, Craig Mackerness, Paul Schofield, Bhaskar Dasgupta
OBJECTIVE: A feasibility study to assess efficacy and safety of modified release (MR) prednisone (Lodotra™) compared to immediate release (IR) prednisolone in patients with newly diagnosed giant cell arteritis (GCA). METHODS: Twelve patients with new diagnosis of GCA were initially treated with high-dose prednisolone (40-60 mg) daily for 4 weeks and then randomized to two open arms to continue tapering steroid treatment with either standard IR prednisolone or MR prednisone...
August 9, 2017: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/28783392/occult-giant-cell-arteritis-with-an-abnormal-temporal-artery-finding-and-normal-blood-markers
#7
Simon Madge, Emma Samia-Aly
No abstract text is available yet for this article.
August 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/28774474/classification-of-large-vessel-vasculitis-can-we-separate-giant-cell-arteritis-from-takayasu-arteritis
#8
Matthew J Koster, Kenneth J Warrington
The two main variants of large vessel vasculitis include Takayasu arteritis and giant cell arteritis. While these two conditions have historically been considered different conditions, recent evidence questions whether they are a spectrum of the same disease. Classification criteria are limited in distinguishing between cases with phenotypic overlap. The limitations of the current criteria and directions of future research are reviewed.
July 31, 2017: La Presse Médicale
https://www.readbyqxmd.com/read/28774422/polymyalgia-rheumatica
#9
REVIEW
Miguel A González-Gay, Eric L Matteson, Santos Castañeda
Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease...
July 31, 2017: Lancet
https://www.readbyqxmd.com/read/28768257/autoimmunity-in-the-elderly-insights-from-basic-science-and-clinics-a-mini-review
#10
Abdulla Watad, Nicola Luigi Bragazzi, Mohammad Adawi, Howard Amital, Elias Toubi, Bat-Sheva Porat, Yehuda Shoenfeld
Advancements in the field of biomedicine, including the control of infectious diseases through antibiotics and vaccination practices and the prevention of chronic disorders, have led to reduced mortality, increased life expectancy and, as such, growth of the older population. Ageing is accompanied by profound morphological and physiological alterations. In particular, the immune system undergoes a complex series of remodeling/restructuring events, involving almost all compartments - both the innate and the adaptive system...
July 29, 2017: Gerontology
https://www.readbyqxmd.com/read/28767581/diagnostic-value-of-pet-ct-for-giant-cell-arteritis-combined-with-pulmonary-embolism-presenting-case-report-and-literature-review
#11
Xiaoming Shu, Xiaoxiang Xu, Qinglin Peng, Xin Lu, Li Ma, Na Mi, Guochun Wang
RATIONALE: Giant cell arteritis (GCA) combined with concomitant pulmonary embolism (PE) is extremely difficult to diagnose because of its low incidence and atypical clinical presentations. PATIENT CONCERNS: A 62-year-old male developed fever of unknown origin. DIAGNOSES: Positron emission tomography/computed tomography (PET/CT) revealed increased glucose metabolism in the vascular walls of the ascending and descending aorta and pulmonary artery, leading to a diagnosis of GCA combined with PE...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28758504/investigational-drugs-in-systemic-vasculitis
#12
Adrien Mirouse, Patrice Cacoub, Anne Claire Desbois, Cloé Comarmond, Christian Pagnoux, David Saadoun
Treatment of systemic vasculitis is based on glucocorticoids (GC) in association with immunosuppressive therapy. There are still unmet needs, including earlier onset of response, more targeted therapies, reduction of relapse-risk and decrease of long-term GC and classic immunosuppressants toxicities. Areas covered: In this review, we discuss investigational drugs in early phase clinical trials for induction of remission in vasculitis. We focus on ANCA-associated vasculitis, Behçet's disease, giant cell arteritis, Takayasu arteritis, and cryoglobulinemic vasculitis...
August 4, 2017: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/28758156/varicella-zoster-virus-and-large-vessel-vasculitis-the-absence-of-an-association
#13
Gary W Procop, Charis Eng, Alison Clifford, Alexandra Villa-Forte, Leonard H Calabrese, Eric Roselli, Lars Svensson, Douglas Johnston, Gosta Pettersson, Edward Soltesz, Lisa Lystad, Julian D Perry, Alexander Blandford, Deborah A Wilson, Gary S Hoffman
OBJECTIVE: It is controversial whether microorganisms play a role in the pathogenesis of large and medium vessel vasculitides (eg, giant cell arteritis [GCA], Takayasu arteritis [TAK] and focal idiopathic aortitis [FIA]). Recent studies have reported the presence of Varicella Zoster Virus (VZV) within formalin-fixed, paraffin-embedded temporal arteries and aortas of about three-quarters or more of patients with these conditions, and in a minority of controls. In a prospective study, we sought to confirm these findings using DNA extracted from vessels that were harvested under surgically aseptic conditions and snap frozen...
2017: Pathogens & Immunity
https://www.readbyqxmd.com/read/28747747/involvement-of-monocyte-subsets-in-the-immunopathology-of-giant-cell-arteritis
#14
Yannick van Sleen, Qi Wang, Kornelis S M van der Geest, Johanna Westra, Wayel H Abdulahad, Peter Heeringa, Annemieke M H Boots, Elisabeth Brouwer
Monocytes/macrophages are critical in systemic and local inflammation in giant cell arteritis (GCA) and possibly in clinically overlapping polymyalgia rheumatica (PMR). Therefore, we aimed to understand the contribution of monocyte subsets and the CX3CR1-CX3CL1 and CCR2-CCL2 migratory pathways, to the pathology of GCA. Peripheral blood monocytes were enumerated in samples from newly-diagnosed, untreated GCA and PMR patients and after prednisone-induced remission. The distribution of classical (CD14(bright)CD16(neg)) and the more pro-inflammatory, intermediate (CD14(bright)CD16+) and non-classical (CD14(dim)CD16+) monocyte subsets was analysed by flow cytometry...
July 26, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28745999/trial-of-tocilizumab-in-giant-cell-arteritis
#15
RANDOMIZED CONTROLLED TRIAL
John H Stone, Katie Tuckwell, Sophie Dimonaco, Micki Klearman, Martin Aringer, Daniel Blockmans, Elisabeth Brouwer, Maria C Cid, Bhaskar Dasgupta, Juergen Rech, Carlo Salvarani, Georg Schett, Hendrik Schulze-Koops, Robert Spiera, Sebastian H Unizony, Neil Collinson
BACKGROUND: Giant-cell arteritis commonly relapses when glucocorticoids are tapered, and the prolonged use of glucocorticoids is associated with side effects. The effect of the interleukin-6 receptor alpha inhibitor tocilizumab on the rates of relapse during glucocorticoid tapering was studied in patients with giant-cell arteritis. METHODS: In this 1-year trial, we randomly assigned 251 patients, in a 2:1:1:1 ratio, to receive subcutaneous tocilizumab (at a dose of 162 mg) weekly or every other week, combined with a 26-week prednisone taper, or placebo combined with a prednisone taper over a period of either 26 weeks or 52 weeks...
July 27, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28745998/giant-cell-arteritis-more-ecstasy-less-agony
#16
EDITORIAL
David B Hellmann
New England Journal of Medicine, Volume 377, Issue 4, Page 385-386, July 2017.
July 27, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28736805/giant-cell-arteritis-concordance-study-between-aortic-ct-angiography-and-fdg-pet-ct-in-detection-of-large-vessel-involvement
#17
Hubert de Boysson, Anael Dumont, Eric Liozon, Marc Lambert, Jonathan Boutemy, Gwénola Maigné, Nicolas Martin Silva, Audrey Sultan, Kim Heang Ly, Nicolas Aide, Alain Manrique, Boris Bienvenu, Achille Aouba
PURPOSE: The purpose of our study was to assess the concordance of aortic CT angiography (CTA) and FDG-PET/CT in the detection of large-vessel involvement at diagnosis in patients with giant-cell arteritis (GCA). METHODS: We created a multicenter cohort of patients with GCA diagnosed between 2010 and 2015, and who underwent both FDG-PET/CT and aortic CTA before or in the first ten days following treatment introduction. Eight vascular segments were studied on each procedure...
July 24, 2017: European Journal of Nuclear Medicine and Molecular Imaging
https://www.readbyqxmd.com/read/28724574/the-microvascular-niche-instructs-t-cells-in-large-vessel-vasculitis-via-the-vegf-jagged1-notch-pathway
#18
Zhenke Wen, Yi Shen, Gerald Berry, Farhad Shahram, Yinyin Li, Ryu Watanabe, Yaping Joyce Liao, Jörg J Goronzy, Cornelia M Weyand
Microvascular networks in the adventitia of large arteries control access of inflammatory cells to the inner wall layers (media and intima) and thus protect the immune privilege of the aorta and its major branches. In autoimmune vasculitis giant cell arteritis (GCA), CD4 T helper 1 (TH1) and TH17 cells invade into the wall of the aorta and large elastic arteries to form tissue-destructive granulomas. Whether the disease microenvironment provides instructive cues for vasculitogenic T cells is unknown. We report that adventitial microvascular endothelial cells (mvECs) perform immunoregulatory functions by up-regulating the expression of the Notch ligand Jagged1...
July 19, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/28722366/-large-vessel-vasculitis-pathogenesis-diagnostic-and-medical-management
#19
Alireza Sadrkhah, Jörg D Seebach, Yannick Muller
Large vessels vasculitis includes two diseases : 1) giant cell arteritis, formerly known as Horton's arteritis and 2) Takayasu arteritis. In this article, we will describe and compare the epidemiology, pathogenesis, diagnostic criteria and medical management of both vasculitis. T helper (Th) 1 and Th17 responses, genetic links and the role of viral (varicella zoster) and bacterial infection (Mycoplasma pneumoniae or Chlamydia pneumoniae) will be discussed. Classification criteria, inflammation biomarkers and progress in imaging tools will also be described...
April 5, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28705843/headache-tia-and-subarachnoid-haemorrhage-dissecting-an-unusual-cause-for-stroke-like-symptoms
#20
Elliot T Dawson, Desmond A Brown, Alejandro A Rabinstein
We present a case of supraclinoid internal carotid artery dissection. Eleven months prior, the patient developed isolated periorbital pain and was diagnosed with giant-cell arteritis with iritis. The patient experienced recurrent spells concerning for transient ischaemic attacks and was transferred to our institution for endovascular intervention after head CT revealed an embolic infarct with a 'dense middle cerebral artery sign.' Digital subtraction angiography was negative for occlusion, instead demonstrating luminal stenosis and poststenotic dilatation...
July 13, 2017: BMJ Case Reports
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