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Takayasu arteritis and giant cell arteritis: are they a spectrum of the same disease?

Published on Jan 1, 2019in International Journal of Rheumatic Diseases1.938
· DOI :10.1111/1756-185X.13288
Tanaz A. Kermani18
Estimated H-index: 18
(UCLA: University of California, Los Angeles)
Abstract
: Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are forms of large-vessel vasculitides that affect the aorta and its branches. There is ongoing debate about whether they are within a spectrum of the same disease or different diseases. Shared commonalities include clinical features, evidence of systemic inflammation, granulomatous inflammation on biopsy, role of T-helper (Th)-1 and Th17 in the pathogenesis, and, abnormalities of the aorta and its branches on imaging. However, there are also several differences in the geographic distribution, genetics, inflammatory cells and responses to treatment. This review highlights the similarities and differences in the epidemiology, pathogenesis, clinical manifestations, imaging findings and treatment responses in these conditions. Current data supports that they are two distinct conditions despite the numerous similarities.
  • References (61)
  • Citations (8)
References61
Newest
#1Yoshikazu NakaokaH-Index: 24
#2Mitsuaki Isobe (Tokyo Medical and Dental University)H-Index: 49
Last. Norihiro Nishimoto (TMU: Tokyo Medical University)H-Index: 53
view all 9 authors...
Objective To investigate the efficacy and safety of the interleukin-6 receptor antibody tocilizumab in patients with Takayasu arteritis (TAK). Methods Patients with TAK who had relapsed within the previous 12 weeks were induced into remission with oral glucocorticoid therapy. In this double-blind, placebo-controlled trial, patients were randomly assigned 1:1 to receive weekly tocilizumab 162 mg or placebo subcutaneously, and oral glucocorticoids were tapered 10 %/week from week 4 to a minimum of...
85 CitationsSource
#1Antoine G. Sreih (UPenn: University of Pennsylvania)H-Index: 13
#1Antoine G. Sreih (UPenn: University of Pennsylvania)H-Index: 6
Last. Peter A. MerkelH-Index: 71
view all 15 authors...
Objective. Among the challenges in conducting clinical trials in large-vessel vasculitis (LVV), including both giant cell arteritis (GCA) and Takayasu arteritis (TA), is the lack of standardized and meaningful outcome measures. The Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group initiated an international effort to develop and validate data-driven outcome tools for clinical investigation in LVV. Methods. An international Delphi exercise was completed to gather opinions from c...
14 CitationsSource
#1Sibel Zehra Aydin (Ottawa Hospital Research Institute)H-Index: 17
#2Haner Direskeneli (Marmara University)H-Index: 40
Last. Peter A. Merkel (UPenn: University of Pennsylvania)H-Index: 71
view all 3 authors...
Objective. To arrive at consensus for candidate outcomes for disease activity assessment in large-vessel vasculitis (LVV) in clinical trials. Methods. A Delphi survey including 99 items was circulated among international experts for 3 rounds. Results. Fifty-seven items were accepted for both giant cell arteritis and Takayasu arteritis. Sixty-seven percent of experts voted to have a common approach for both diseases with additional disease-specific items such as weight loss, scalp tenderness/necr...
10 CitationsSource
#1John H. Stone (Harvard University)H-Index: 72
#2Katie Tuckwell (Hoffmann-La Roche)H-Index: 9
Last. Neil Collinson (Hoffmann-La Roche)H-Index: 19
view all 16 authors...
BackgroundGiant-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. MethodsIn 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...
294 CitationsSource
#1Birgir Gudbrandsson (Oslo University Hospital)H-Index: 4
#2Øyvind Molberg (Oslo University Hospital)H-Index: 36
Last. Øyvind Palm (Oslo University Hospital)H-Index: 19
view all 3 authors...
Background Magnetic resonance imaging (MRI) and computed tomography (CT) angiography have now largely replaced interventional angiography in the diagnoses and follow up of Takayasu arteritis (TAK) but data on the effects of this change of imaging method on diagnostic delay and vascular damage, and detailed data on the effect of different treatment regimens on the accumulation of vascular damage are missing. The aim of this study was to assess time trends in diagnostic delay, therapeutic approach...
17 CitationsSource
#1Carol A. Langford (Cleveland Clinic)H-Index: 36
#2David Cuthbertson (USF: University of South Florida)H-Index: 35
Last. Jennifer HarrisH-Index: 1
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Objective To compare the efficacy of abatacept to that of placebo for the treatment of giant cell arteritis (GCA). Methods In this multicenter trial, patients with newly diagnosed or relapsing GCA were treated with abatacept 10 mg/kg intravenously on days 1, 15, and 29 and week 8, together with prednisone administered daily. At week 12, patients in remission underwent a double-blinded randomization to continue to receive abatacept monthly or switch to placebo. Patients in both study arms receive...
121 CitationsSource
#1F.D. Carmona (CSIC: Spanish National Research Council)H-Index: 13
#2Patrick Coit (UM: University of Michigan)H-Index: 19
Last. Amr H. Sawalha (UM: University of Michigan)H-Index: 42
view all 15 authors...
Analysis of the common genetic component of large-vessel vasculitides through a meta-Immunochip strategy
20 CitationsSource
The increasing availability and improvement of imaging techniques are making a profound impact in the evaluation and management of patients with vasculitis, particularly for those with large vessel vasculitis, and will most likely play an ever more important role in the future. Deep, large vessels can be examined by CT or MRI, while ultrasound is the method of choice for the evaluation of superficial vessels (such as temporal, carotid, and axillary arteries). PET is very sensitive in detecting l...
28 CitationsSource
#1Tanaz A. Kermani (UCLA: University of California, Los Angeles)H-Index: 18
#2David Cuthbertson (USF: University of South Florida)H-Index: 35
Last. Eric L. Matteson (Mayo Clinic)H-Index: 68
view all 15 authors...
Objective. To evaluate the performance of the Birmingham Vasculitis Activity Score (BVAS) in the assessment of disease activity in giant cell arteritis (GCA). Methods. Patients with GCA enrolled in a prospective, multicenter, longitudinal study with symptoms of active vasculitis during any visit were included. Spearman’s rank correlation was used to explore the association of the BVAS with other measures of disease activity. Results. During a mean (SD) followup of 2.3 (1.6) years, symptoms of ac...
9 CitationsSource
#1Peter M. Villiger (University of Bern)H-Index: 44
#2Sabine Adler (University of Bern)H-Index: 12
Last. Stephan Reichenbach (University of Bern)H-Index: 38
view all 9 authors...
Summary Background Giant cell arteritis is an immune-mediated disease of medium and large-sized arteries that affects mostly people older than 50 years of age. Treatment with glucocorticoids is the gold-standard and prevents severe vascular complications but is associated with substantial morbidity and mortality. Tocilizumab, a humanised monoclonal antibody against the interleukin-6 receptor, has been associated with rapid induction and maintenance of remission in patients with giant cell arteri...
221 CitationsSource
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OBJECTIVE: Takayasu arteritis (TAK) is a progressive autoimmune large vessel vasculitis with infiltration of proinflammatory T cells, with a largely unknown etiology. This study was undertaken to explore the involvement of mechanistic target of rapamycin (mTOR) in proinflammatory T cell differentiation and disease progression in TAK. METHODS: Ninety-five patients with TAK, 26 patients with small vessel vasculitis, and 40 healthy donors were enrolled. Naive and memory CD4+ T cells were activated ...
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Abstract This report describes the case of a previously healthy 30-year-old woman who presented with uncontrolled hypertension and renal failure. This case emphasizes the importance of considering renal artery disease. The differential diagnosis for renal artery stenosis is discussed, and the diagnosis and management of Takayasu9s arteritis in this patient are highlighted. (Level of Difficulty: Beginner.)
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Large vessel vasculitis (LVV) is a type of vasculitis characterized by granulomatous inflammation of medium- and large-sized arteries. Clinical assessment of acute phase reactants has been conventionally used to diagnose and monitor diseases; however, accurate assessment of vascular disease activity status can be difficult. In this study, we investigated comprehensive immuno-phenotyping to explore useful biomarkers associated with clinical characteristics. Consecutive patients with newly diagnos...
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#1Gökhan Keser (Ege University)H-Index: 26
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