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Julia U. Holle - One of the best experts on this subject based on the ideXlab platform.
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Serum immunoglobulin G4 in Giant Cell Arteritis and polymyalgia rheumatica.
Clinical and Experimental Rheumatology, 2016Co-Authors: Burkel M, Arndt F, Jan H. Schirmer, Frank Moosig, Julia U. HolleAbstract:To date, no specific serum marker for Giant Cell Arteritis and polymyalgia rheumatica has been established in routine practice. Therefore, the aim of this study was to examine whether immunoglobulin G4 serum concentrations could be a potential biomarker for the differentiation of both diseases. Serum immunoglobulin G4 (IgG4) concentrations were measured in patients with Giant Cell Arteritis (n=41) and polymyalgia rheumatica (n=27) by an in-house enzyme-linked immunosorbent assay. In the subgroup of untreated patients with disease activity (polymyalgia rheumatica n=27, Giant Cell Arteritis n=19) additional parameters of T-helper 2 Cell inflammatory responses were analysed. IgG4-values above the prior determined cut-off value of 1400 μg/ml in Giant Cell Arteritis were rare and also significantly less frequent in Giant Cell Arteritis than in polymyalgia rheumatica patients (7.3% vs. 44.4%; p<0.001). The relative risk that patients with clinical features of PMR, presenting without elevated IgG4 levels, have simultaneously GCA was 5.8 compared to those patients with elevated IgG4 levels. In untreated patients absolute counts of eosinophilic leukocytes were lower in Giant Cell Arteritis than in polymyalgia rheumatica (p=0.002) and the cytokines interleukin-4 (p=0.013) and interleukin-10 (p=0.033) were less frequently detectable in Giant Cell Arteritis than in polymyalgia rheumatica. In Giant Cell Arteritis serum levels of IgG4 usually are within the normal range. In polymyalgia rheumatica however, increased IgG4 serum levels are frequently found. Normal IgG4 serum levels in polymyalgia rheumatica may have predictive value in identifying patients with additional, clinically non-apparent Giant Cell Arteritis.
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Serum immunoglobulin G4 in Giant Cell Arteritis and polymyalgia rheumatica.
Clinical and experimental rheumatology, 2016Co-Authors: Mara Burkel, Jan H. Schirmer, Frank Moosig, Fabian Arndt, Julia U. HolleAbstract:OBJECTIVES To date, no specific serum marker for Giant Cell Arteritis and polymyalgia rheumatica has been established in routine practice. Therefore, the aim of this study was to examine whether immunoglobulin G4 serum concentrations could be a potential biomarker for the differentiation of both diseases. METHODS Serum immunoglobulin G4 (IgG4) concentrations were measured in patients with Giant Cell Arteritis (n=41) and polymyalgia rheumatica (n=27) by an in-house enzyme-linked immunosorbent assay. In the subgroup of untreated patients with disease activity (polymyalgia rheumatica n=27, Giant Cell Arteritis n=19) additional parameters of T-helper 2 Cell inflammatory responses were analysed. RESULTS IgG4-values above the prior determined cut-off value of 1400 μg/ml in Giant Cell Arteritis were rare and also significantly less frequent in Giant Cell Arteritis than in polymyalgia rheumatica patients (7.3% vs. 44.4%; p
William H. Frishman - One of the best experts on this subject based on the ideXlab platform.
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Tocilizumab in Giant Cell Arteritis
Cardiology in review, 2018Co-Authors: Vincent J. Mariano, William H. FrishmanAbstract:Giant Cell Arteritis is a granulomatous immune-mediated vasculitis of medium and large vessels. It most commonly affects white females over the age of 50 and is the most common primary vasculitis in the United States. Treatment of this disease has classically been with high-dose corticosteroids, but this therapy has been associated with severe morbidity and mortality. Tocilizumab, a humanized monoclonal antibody targeting the interleukin-6 receptor, has been used with great efficacy and safety in rheumatoid arthritis and systemic-onset juvenile idiopathic arthritis. As interleukin-6 has been shown to be a key cytokine in Giant Cell Arteritis, the use of an inhibiting agent has been explored. In the 15 case reports/series that were reviewed, most patients were given tocilizumab due to refractory Giant Cell Arteritis and/or intolerance to glucocorticoid therapy, and most experienced remission of symptoms. At this time, there are only 2 randomized control trials to evaluate the efficacy and safety of tocilizumab use in Giant Cell Arteritis. The phase II trial by Villiger et al and the GiACTA trial both showed that tocilizumab greatly increased the rate of sustained remission in Giant Cell Arteritis over the course of 1 year. The most common adverse events were similar to those seen with use in rheumatoid arthritis: infections, neutropenia, and increases in lipids and liver function test enzymes. Based on the results of numerous case studies and the 2 randomized control trials, tocilizumab is the first agent to be approved by the Food and Drug Administration for treatment of Giant Cell Arteritis.
Bridget Zimmerman - One of the best experts on this subject based on the ideXlab platform.
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ocular manifestations of Giant Cell Arteritis
American Journal of Ophthalmology, 1998Co-Authors: Sohan Singh Hayreh, Patricia Podhajsky, Bridget ZimmermanAbstract:Purpose To report the ocular manifestations of Giant Cell Arteritis using the strict criterion of a positive temporal artery biopsy for diagnosis of Giant Cell Arteritis. Methods In a prospective study from 1973 to 1995, we investigated 170 patients whose diagnosis of Giant Cell Arteritis was confirmed on temporal artery biopsy. At the initial visit, all patients were questioned regarding systemic and ocular signs and symptoms of Giant Cell Arteritis and underwent ophthalmic, erythrocyte sedimentation rate (Westergren), and C-reactive protein evaluations. Any patient with a high index of suspicion of Giant Cell Arteritis was immediately started on systemic corticosteroid therapy and had temporal artery biopsy performed as soon as possible. Results Eighty-five (50.0%) of the 170 patients with Giant Cell Arteritis proven by temporal artery biopsy presented with ocular involvement. Ocular symptoms in patients with ocular involvement were visual loss of varying severity in 83 (97.7%), amaurosis fugax in 26 (30.6%), diplopia in five (5.9%), and eye pain in seven (8.2%); ocular ischemic lesions consisted of arteritic anterior ischemic optic neuropathy in 69 (81.2%), central retinal artery occlusion in 12 (14.1%), cilioretinal artery occlusion in 12 (of 55 patients with satisfactory fluorescein angiography [21.8%]), posterior ischemic optic neuropathy in six (7.1%), and ocular ischemia in one (1.2%). In almost every patient with Giant Cell Arteritis, fluorescein fundus angiography disclosed occlusive disease of the posterior ciliary arteries. Conclusion Because Giant Cell Arteritis is a potentially blinding disease and its early diagnosis is the key to preventing blindness, it is important to recognize its various ocular manifestations.
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Occult Giant Cell Arteritis: ocular manifestations.
American journal of ophthalmology, 1998Co-Authors: Sohan Singh Hayreh, Patricia Podhajsky, Bridget ZimmermanAbstract:Purpose To report the incidence, visual symptoms, and ocular signs of occult Giant Cell Arteritis in patients who initially presented with visual symptoms and ocular signs of Giant Cell Arteritis. Occult Giant Cell Arteritis was defined as ocular involvement by Giant Cell Arteritis without any systemic symptoms and signs of Giant Cell Arteritis. Methods In a prospective study from 1973 to 1995, we investigated 85 patients who had ocular involvement caused by Giant Cell Arteritis and whose diagnosis of Giant Cell Arteritis was confirmed on temporal artery biopsy. At the initial visit, patients were questioned specifically on systemic and ocular symptoms and signs of Giant Cell Arteritis at or before the onset of visual disturbance. Erythrocyte sedimentation rate (Westergren) and C-reactive protein level were evaluated before the start of systemic corticosteroid therapy. Results Eighteen (21.2%) of 85 patients had occult Giant Cell Arteritis. There was no significant difference in age and sex distribution between patients with and without systemic symptoms of Giant Cell Arteritis. Although both groups of patients had abnormal erythrocyte sedimentation rate and C-reactive protein level, there was a significant difference in erythrocyte sedimentation rate (P Conclusions Because occult Giant Cell Arteritis is a potential cause of blindness, its early diagnosis is the key to preventing blindness; it is important to recognize that 21.2% of patients with Giant Cell Arteritis and visual loss do not have any systemic symptoms of Giant Cell Arteritis. Thus, in persons older than 55 years, amaurosis fugax or visual loss, development of an acute ocular ischemic lesion (particularly arteritic anterior ischemic optic neuropathy), and abnormal C-reactive protein level, with or without elevated erythrocyte sedimentation rate and systemic symptoms, should raise a high index of suspicion for Giant Cell Arteritis.
Jean-françois Besancenot - One of the best experts on this subject based on the ideXlab platform.
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Efficacy of tocilizumab in refractory Giant Cell Arteritis.
Joint bone spine, 2012Co-Authors: Julien Vinit, Philip Bielefeld, G. Muller, Jean-françois BesancenotAbstract:Giant Cell Arteritis is the most frequent form of vasculitis characterized by a high risk of vascular thrombosis. Major complications are blindness and other vascular ischemia but bowel ischemic involvement is rare. Treatment is based on long-term steroid therapy with numerous side effects. The efficacy of immunosuppressive drugs like azathioprine methotrexate or anti-tumor necrosis factor antibodies appears to be too low to reduce the use of steroids. Th17 lymphocytes and interleukin-6 play an important role in pathogenesis of Giant Cell Arteritis. We report here a case of effective interleukin-6 blocker in the treatment of refractory Giant Cell Arteritis with ileitis and high-dose steroid dependence despite 2 years of treatment with steroids and methotrexate. After infusions of tocilizumab, no relapse at 6 months was found despite the decrease in corticosteroids.
R. N. Thompson - One of the best experts on this subject based on the ideXlab platform.
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Small bowel infarction in association with Giant Cell Arteritis.
British journal of rheumatology, 1993Co-Authors: M. J. I. Phelan, Kenneth Y.y. Kok, C. Burrow, R. N. ThompsonAbstract:Giant Cell Arteritis is not uncommonly found in extracranial arteries in postmortem studies of patients with temporal Arteritis. Presentation with vasculitis involving extracranial arteries is, however, unusual. This report describes a case of Giant Cell Arteritis presenting with and complicated by infarction of the small bowel. Following surgical resection of the infarcted segment of bowel and commencement of steroid therapy, the patient is now well and free of symptoms. The literature concerning extracranial and in particular small bowel Giant Cell Arteritis is reviewed.