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British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis

Published on Mar 1, 2020in Rheumatology5.149
· DOI :10.1093/RHEUMATOLOGY/KEZ672
Sarah L. Mackie19
Estimated H-index: 19
(University of Leeds),
Christian Dejaco29
Estimated H-index: 29
(University of Graz)
+ 33 AuthorsAlexandre Wagner Silva de Souza15
Estimated H-index: 15
(UNIFESP: Federal University of São Paulo)
Abstract
  • References (113)
  • Citations (4)
References113
Newest
#1Alojzija HočevarH-Index: 14
#2R. JešeH-Index: 5
Last. Matija TomšičH-Index: 30
view all 4 authors...
Glucocorticoid monotherapy has been the mainstay treatment of giant cell arteritis (GCA) for decades. We aimed to evaluate the role of leflunomide as a steroid-sparing agent in GCA. This open-label study included incipient GCA patients followed for at least 48 weeks at a single secondary/tertiary rheumatology centre. At the time of diagnosis, patients received glucocorticoids. At week 12 of follow-up, leflunomide 10 mg qd was recommended as an adjunctive therapy to all patients without contraind...
7 CitationsSource
#1Francesco Muratore (University of Modena and Reggio Emilia)H-Index: 3
#2Tanaz A. Kermani (UCLA: University of California, Los Angeles)H-Index: 18
Last. Kenneth J. Warrington (Mayo Clinic)H-Index: 36
view all 7 authors...
OBJECTIVE: To compare patients with large-vessel giant cell arteritis (LV-GCA) characterized by wall thickening, stenosis, and/or occlusion of subclavian arteries to those with subclavian dilatation. METHODS: For the purposes of the present retrospective study, 2 different subsets of LV-GCA were identified and compared from an established cohort of patients with radiographic evidence of subclavian artery vasculitis secondary to GCA: LV-GCA with wall thickening, stenosis, and/or occlusion of subc...
6 CitationsSource
#2Karin Niedermann (Zürcher Fachhochschule)H-Index: 8
Last. Theodora P M Vliet Vlieland (American Physical Therapy Association)H-Index: 2
view all 22 authors...
Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are applicable for people with inflammatory arthritis (iA; Rheumatoid Arthritis and Spondyloarthritis) and osteoarthritis (hip/knee OA) in order to develop evidence-based recommendations for advice and guidance on PA in clinical practice. The EULAR standardised operating procedures for the develo...
28 CitationsSource
#1Sriram Vaidyanathan (St James's University Hospital)H-Index: 1
#2Arpita Chattopadhyay (St James's University Hospital)H-Index: 1
Last. Andrew Scarsbrook (St James's University Hospital)H-Index: 25
view all 4 authors...
Objective:Large-vessel vasculitis (LVV) is a serious illness with potentially life-threatening consequences. (18Fluorine) fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has emerged as a valuable diagnostic tool in suspected LVV, combining the strengths of functional and structural imaging. This study aimed to compare the accuracy of FDG PET-CT and contrast-enhanced CT (CECT) in the evaluation of patients with LVV.Methods:A retrospective database review for L...
4 CitationsSource
#1Stavros ChrysidisH-Index: 9
#2Christina Duftner (Innsbruck Medical University)H-Index: 26
Last. Wolfgang A. SchmidtH-Index: 39
view all 30 authors...
Objectives To define the elementary ultrasound (US) lesions in giant cell arteritis (GCA) and to evaluate the reliability of the assessment of US lesions according to these definitions in a web-based reliability exercise. Methods Potential definitions of normal and abnormal US findings of temporal and extracranial large arteries were retrieved by a systematic literature review. As a subsequent step, a structured Delphi exercise was conducted involving an expert panel of the Outcome Measures in R...
17 CitationsSource
#1Christian DejacoH-Index: 29
#2Sofia Ramiro (LUMC: Leiden University Medical Center)H-Index: 29
Last. Wolfgang A. SchmidtH-Index: 39
view all 20 authors...
To develop evidence-based recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV) including giant cell arteritis (GCA) and Takayasu arteritis (TAK). European League Against Rheumatism (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (PET) in LVV. Based on evidence and expe...
114 CitationsSource
#1Hubert de Boysson (UNICAEN: University of Caen Lower Normandy)H-Index: 14
#2Aurélie DaumasH-Index: 1
Last. Achille Aouba (UNICAEN: University of Caen Lower Normandy)H-Index: 23
view all 15 authors...
Abstract Objectives Large-vessel involvement (LVI) can occur in giant-cell arteritis (GCA) and may represent a distinct disease subgroup with a higher risk for aortic dilation. This study aimed to better characterize the presentation and evolution of LVI in patients with GCA. Patients and methods A retrospective multicenter study enrolled 248 GCA patients with LVI and 301 GCA patients without LVI on imaging. Factors associated with aortic dilation were identified in a multivariable model. Result...
15 CitationsSource
#1Matthew J. Koster (Mayo Clinic)H-Index: 9
#2Eric L. Matteson (Mayo Clinic)H-Index: 68
Last. Kenneth J. Warrington (Mayo Clinic)H-Index: 36
view all 3 authors...
: GCA is a chronic, idiopathic, granulomatous vasculitis of medium and large arteries. It comprises overlapping phenotypes including classic cranial arteritis and extra-cranial GCA, otherwise termed large-vessel GCA (LV-GCA). Vascular complications associated with LV-GCA may be due, in part, to delayed diagnosis, highlighting the importance of early identification and prompt initiation of effective therapy. Advancements in imaging techniques, including magnetic resonance angiography, CT angiogra...
18 CitationsSource
#1Ivana Vodopivec (Harvard University)H-Index: 10
#2Joseph F. Rizzo (Harvard University)H-Index: 48
: GCA, the most common systemic arteritis, affects medium-sized and larger extradural arteries that have the internal elastic lamina. Involvement of the ophthalmic artery and its branches results in visual loss, which is often complete but is usually painless. Visual loss may be monocular or binocular developing simultaneously or sequentially. Rarely, it stems from occipital lobe infarct that result in homonymous hemianopia, a visual field defect involving the two identical halves (right or left...
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...
207 CitationsSource
Cited By4
Newest
#2Frances Borg (Southend University Hospital NHS Foundation Trust)H-Index: 3
Last. Bhaskar Dasgupta (Southend University Hospital NHS Foundation Trust)H-Index: 35
view all 8 authors...
We thank Ghajari and Sabour for their interest in our work and appreciation of our study.1 We have reported that the extent of vascular inflammation on ultrasound, as quantified by the halo score, is associated with ocular ischaemia in patients with giant cell arteritis (GCA).2 Furthermore, we investigated the diagnostic accuracy of the halo score for a clinical diagnosis of GCA, as well as a positive temporal artery biopsy.2 Here, we discuss the points raised by the authors. First, the authors ...
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: Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) both belong to the group of large vessel vasculitides and require long-term drug treatment. Glucocorticoids (GC) are the first choice for the treatment of both diseases. For GCA immunosuppressants, such as tocilizumab or methotrexate should be considered in cases of treatment refractory and relapses or if there is a high risk for GC-related adverse events. In TAK patients the use of immunosuppressive agents should be considered for all ...
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We describe a possible systemic vasculitis involving electively large veins. The patient presented with severe febrile lower limb pain. Diagnosis was made by color Doppler ultrasound (CDU) and confirmed by anatomopathological examination of the long saphenous vein, but not by examination of the temporal artery which was normal. CDU found a unilateral halo sign of one temporal artery and a major wall swelling of the lower limb proximal deep veins. The etiology of this possible vasculitis is still...
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#1Susan P. Mollan (University Hospitals Birmingham NHS Foundation Trust)H-Index: 16
#1Susan P Mollan (University Hospitals Birmingham NHS Foundation Trust)H-Index: 3
Last. Alexandra J Sinclair (HealthPartners)H-Index: 19
view all 5 authors...
BACKGROUND AND AIM: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. METHODS: The...
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