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Giant Cell Arteritis (giant + cell_arteritis)
Selected AbstractsExtensive Scalp Necrosis and Subepicranial Abscess in a Patient with Giant Cell ArteritisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2004Simon Smitz MD No abstract is available for this article. [source] Association of a nonsynonymous single-nucleotide polymorphism of matrix metalloproteinase 9 with giant cell arteritisARTHRITIS & RHEUMATISM, Issue 6 2008A. Rodríguez-Pla Objective Giant cell arteritis (GCA) is the most common type of primary vasculitis. Matrix metalloproteinase 9 (MMP-9) is present in arterial lesions of GCA and may be involved in its pathogenesis. We investigated whether certain genotypes of 4 single-nucleotide polymorphisms (SNPs) of MMP-9 are overrepresented in patients with histologically confirmed GCA. Methods Four SNPs of MMP-9, rs3918242 in the promoter region and 3 nonsynonymous coding SNPs (rs3918252, rs17576, and rs2250889) were genotyped by polymerase chain reaction,restriction fragment length polymorphism analysis in 58 white patients for whom there was a clinical suspicion of GCA. Thirty of these patients had histologically confirmed GCA (group 1), and 28 patients had negative results of a temporal artery biopsy for GCA (group 2). Estimates of the genotype distributions of each of these SNPs in a white population were determined using publicly available genotype data for a panel of 23 individuals (group 3). Results Although 1 SNP was monomorphic in all 3 groups, we observed statistically significant differences in the genotype distributions for rs2250889 between group 1 and group 2 (P = 0.005) and between group 1 and group 3 (P = 0.009), but not between groups 2 and 3 (P = 0.965). Conclusion These data derived from a sample of patients with GCA suggest that the G allele of MMP-9 polymorphism rs2250889 is overrepresented in patients with histologically confirmed GCA. Clearly, larger sample sizes will be necessary to confirm this suggestive association and better characterize a possible linkage disequilibrium structure among polymorphisms. [source] Clinical Images: Giant cell arteritis revealed by positron emission tomographyARTHRITIS & RHEUMATISM, Issue 5 2006FACP, John M. Loeb MD No abstract is available for this article. [source] Giant cell arteritis: an updated reviewACTA OPHTHALMOLOGICA, Issue 1 2009Aki Kawasaki Abstract. Giant cell arteritis (GCA) is the most common primary vasculitis of adults. The incidence of this disease is practically nil in the population under the age of 50 years, then rises dramatically with each passing decade. The median age of onset of the disease is about 75 years. As the ageing population expands, it is increasingly important for ophthalmologists to be familiar with GCA and its various manifestations, ophthalmic and non-ophthalmic. A heightened awareness of this condition can avoid delays in diagnosis and treatment. It is well known that prompt initiation of steroids remains the most effective means for preventing potentially devastating ischaemic complications. This review summarizes the current concepts regarding the immunopathogenetic pathways that lead to arteritis and the major phenotypic subtypes of GCA with emphasis on large vessel vasculitis, novel modalities for disease detection and investigative trials using alternative, non-steroid therapies. [source] Giant cell arteritis and the ophthalmologistACTA OPHTHALMOLOGICA, Issue 4 2002Ahti Tarkkanen [source] Giant cell arteritis with spontaneous remissionCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2007Valerie Purvin MD Abstract Background:, Clinical manifestations of giant cell arteritis (GCA) are variable. Whether signs and symptoms present in an explosive fashion or insidiously, once manifest the course is usually progressive unless treatment is initiated. Methods:, A retrospective review of patients with GCA seen in an outpatient neuro-ophthalmology clinic. Results:, We report four patients with biopsy-proven GCA who experienced spontaneous remission. Clinical manifestations consisted of headache and diplopia in two patients, constitutional symptoms in one patient and facial pain in another. Conclusions:, Clinicians should be aware of this aspect of the disease in order to avoid a delay in diagnosis and treatment. [source] Giant cell arteritis: managing the ophthalmic medical emergencyCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2003Helen Danesh-Meyer FRANZCO No abstract is available for this article. [source] Giant cell arteritis on 18F-FDG PET/CTCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2009Thomas F. Heston Summary Purpose:, We present a case of incidentally noted giant cell arteritis in a patient undergoing 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. The patient was originally referred to PET/CT for staging of his renal transitional cell carcinoma. Methods:, The patient was injected intravenously with 370 MBq of 18F-FDG. After a 60 min uptake period, PET/CT imaging was performed from the skull base to the mid thighs. Results:, A small para-aortic node in the region of the surgical bed showed increased tracer uptake of concern for malignancy. In addition, there were several non-calcified pulmonary nodules present, also concerning for malignancy. Incidentally noted was diffusely increased tracer uptake throughout the aorta and a thickened aortic wall on CT images. Diffuse tracer uptake was also present in the proximal branches of the aorta, including the carotid, iliac, femoral, and subclavian arteries. The patient had biopsy proven giant cell arteritis. Conclusion:, Increased 18F-FDG uptake by the aorta on PET/CT imaging is an abnormal finding that prompts a more thorough assessment for malignancy, and also can indentify important co-morbidities in cancer patients. Evaluation of aortic uptake should be a routine practice in the interpretation of 18F-FDG PET/CT scans. [source] Platelet factor 4 and ,-thromboglobulin in inflammatory bowel disease and giant cell arteritisEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2000Vrij Background As platelet factors are important in the inflammatory response, we examined the course of platelet factor 4 and ,-thromboglobulin in relation to disease activity in inflammatory bowel disease and in giant cell arteritis. Patients and methods In a prospective study, the platelet count, platelet factor 4 and ,-thromboglobulin were measured in 20 patients with Crohn's disease, 18 with ulcerative colitis and 19 with giant cell arteritis, during active and inactive disease, as well as in 51 controls without inflammation. Results Platelet counts were significantly higher in active vs. inactive Crohn's disease, ulcerative colitis and giant cell arteritis. Levels of platelet factor 4 and ,-thromboglobulin were significantly higher in active inflammatory bowel disease and giant cell arteritis, as well as in inactive inflammatory bowel disease and giant cell arteritis, than in the non-inflammatory controls. A positive correlation was found between the Crohn's disease activity index and the platelet count, platelet factor 4 and ,-thromboglobulin. Also, a positive correlation was found between the ulcerative colitis activity index and ,-thromboglobulin. However, even after 12 months of follow-up, in Crohn's disease and ulcerative colitis the mean levels of platelet factor 4 and ,-thromboglobulin were significantly higher than the levels of the controls. Conclusion Platelet factors were correlated with inflammatory bowel disease activity. Levels of platelet factor 4 and ,-thromboglobulin, however, were markedly raised for a long time in clinically inactive inflammatory bowel disease, which might point to a pre-thrombotic state of disease. [source] Unusual presentations of giant cell arteritis (temporal arteritis)INTERNAL MEDICINE JOURNAL, Issue 11 2004N. A. G. Fa'amatuainu No abstract is available for this article. [source] DRB1 alleles in polymyalgia rheumatica and rheumatoid arthritis in southern FranceINTERNATIONAL JOURNAL OF IMMUNOGENETICS, Issue 1 2001D. Reviron To investigate the association of HLA-DRB1 alleles with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA), 55 patients with PMR without giant cell arteritis, 203 patients with RA and 230 controls, all from the European population of Marseille, were HLA-DRB1 genotyped by PCR-SSO. HLA-DRB1*01 was significantly increased in both the PMR and RA groups compared to controls (35% versus 17%, Pc < 0.05, and 41% versus 17%, Pc < 0.001, respectively). HLA-DRB1*04 was significantly increased in the RA group compared to controls (48% versus 23%, Pc < 0.001) but not in the PMR group. HLA-DRB1*04 subtype frequencies were significantly different between PMR patients and RA patients. Shared epitope-positive HLA-DRB1*04 alleles (DRB1*0401, 0404, 0405, 0408) were significantly overrepresented in RA patients compared to PMR patients and shared epitope-negative HLA-DRB1*04 alleles were overrepresented in PMR patients compared to RA patients. In conclusion, in the Mediterranean population studied, HLA-DRB1*01 is associated with RA and PMR whereas HLA-DRB1*04 is associated with RA only. [source] Scalp necrosis and giant cell arteritis: case report and issues in wound managementINTERNATIONAL WOUND JOURNAL, Issue 4 2005Stefan J Landis Abstract Scalp necrosis is rare in patients with giant cell arteritis. Here, we report the case of an 81-year-old woman who presented with a management problem that required a truly multidisciplinary approach to treatment. A combined approach of effective wound bed preparation with selective debridement, prolonged antimicrobial therapy, corticosteroid use and careful dressing choices resulted in a successful outcome in a potentially disastrous situation. [source] THE LENGTH OF SUPERFICIAL TEMPORAL ARTERY BIOPSIESANZ JOURNAL OF SURGERY, Issue 6 2007Neil S. Sharma Background: To compare temporal artery biopsy specimen lengths from a tertiary care and a community hospital in New South Wales to recommended clinical guidelines in suspected giant cell arteritis. Design: A retrospective observational study of all patients who underwent temporal artery biopsy at Bathurst Base Hospital (BBH) and Royal Prince Alfred Hospital (RPAH) over a 5-year period. Methods: Patients who underwent temporal artery biopsy during the 5-year period were identified using computerized hospital databases. A retrospective chart review was carried out on all cases. Data were collected regarding patient age, patient sex, length of biopsy specimen, histopathological results and surgical team carrying out the biopsy. Results: During the 5-year period, 157 temporal artery biopsies were carried out at both hospitals, with 38/157(24%) at BBH and 119/157 (76%) at RPAH. There was no significant difference in biopsy length at the two hospitals. The mean specimen length at BBH was 12.1 mm compared with 11.7 mm at RPAH (t = 0.35; P = 0.73). At RPAH, there was no significant difference in specimen length between the surgical specialties carrying out the biopsy (anovaF = 1.37; P = 0.26). Specimens of length 20 mm or greater were 2.8 times more likely to show features of giant cell arteritis than those less than 20 mm. Conclusion: The mean length of temporal artery biopsy specimens at both hospitals was substantially shorter than recommended guidelines of a minimum 20 mm. We recommend all surgeons carrying out temporal artery biopsies ensure a specimen of sufficient length is obtained. [source] Cancer preceding giant cell arteritis: A case,control study,ARTHRITIS & RHEUMATISM, Issue 6 2010Tanaz A. Kermani Objective To study the association between previous cancer and giant cell arteritis (GCA). Methods Using the resources of the Rochester Epidemiology Project, we identified incident cases of GCA diagnosed between January 1, 1950 and December 31, 2004. Each GCA patient was matched for age, sex, and length of medical history to 2 subjects without GCA from the same population. Medical records were reviewed. Diagnosis of cancer was confirmed by histopathologic analysis. Results We identified 204 GCA cases and 407 controls. The GCA group included 163 women (80%) and 41 men (20%). Their mean ± SD age was 76.0 ± 8.2 years. The non-GCA group consisted of 325 women (80%) and 82 men (20%). Their mean ± SD age was 75.6 ± 8.4 years. At the index date, 45 GCA patients (22%) and 125 non-GCA patients (31%) had had a previous cancer. The odds ratio (OR) for previous cancer in cases compared with controls, adjusted for age, sex, and calendar year, was 0.63, and the 95% confidence interval (95% CI) was 0.42,0.94 (P = 0.022). The mean age at diagnosis of the first cancer before the index date was similar in the cases (67.5 ± 11.9 years) and the controls (64.9 ± 13.2 years) (P = 0.32). The mean ± SD duration from the first cancer to the index date was 9.8 ± 9.9 years in the cases and 11.7 ± 10.8 years in the controls (P = 0.31). Cancer types were similar in both groups, but fewer gynecologic malignancies were noted in GCA patients (OR 0.39 [95% CI 0.13,1.15], P = 0.09). Colon cancer also appeared less commonly in the cases compared with the controls (OR 0.22 [95% CI 0.03,1.74], P = 0.15). Conclusion The findings of this population-based case,control study indicate that GCA patients had significantly fewer malignancies prior to the index date as compared with controls. [source] Association of a nonsynonymous single-nucleotide polymorphism of matrix metalloproteinase 9 with giant cell arteritisARTHRITIS & RHEUMATISM, Issue 6 2008A. Rodríguez-Pla Objective Giant cell arteritis (GCA) is the most common type of primary vasculitis. Matrix metalloproteinase 9 (MMP-9) is present in arterial lesions of GCA and may be involved in its pathogenesis. We investigated whether certain genotypes of 4 single-nucleotide polymorphisms (SNPs) of MMP-9 are overrepresented in patients with histologically confirmed GCA. Methods Four SNPs of MMP-9, rs3918242 in the promoter region and 3 nonsynonymous coding SNPs (rs3918252, rs17576, and rs2250889) were genotyped by polymerase chain reaction,restriction fragment length polymorphism analysis in 58 white patients for whom there was a clinical suspicion of GCA. Thirty of these patients had histologically confirmed GCA (group 1), and 28 patients had negative results of a temporal artery biopsy for GCA (group 2). Estimates of the genotype distributions of each of these SNPs in a white population were determined using publicly available genotype data for a panel of 23 individuals (group 3). Results Although 1 SNP was monomorphic in all 3 groups, we observed statistically significant differences in the genotype distributions for rs2250889 between group 1 and group 2 (P = 0.005) and between group 1 and group 3 (P = 0.009), but not between groups 2 and 3 (P = 0.965). Conclusion These data derived from a sample of patients with GCA suggest that the G allele of MMP-9 polymorphism rs2250889 is overrepresented in patients with histologically confirmed GCA. Clearly, larger sample sizes will be necessary to confirm this suggestive association and better characterize a possible linkage disequilibrium structure among polymorphisms. [source] Endothelial nitric oxide synthase gene polymorphisms in giant cell arteritisARTHRITIS & RHEUMATISM, Issue 11 2003Carlo Salvarani Objective To examine potential associations of the Glu/Asp298 polymorphism in exon 7 and the 4a/b polymorphism in intron 4 of the endothelial nitric oxide synthase (eNOS) gene with susceptibility to and clinical expression of giant cell arteritis (GCA), particularly in patients with versus those without ischemic complications. Methods Ninety-one consecutive patients with biopsy-proven GCA, who were residents of Reggio Emilia, Italy, and 133 population-based controls from the same geographic area were genotyped by polymerase chain reaction and allele-specific oligonucleotide techniques for eNOS polymorphisms in exon 7 and intron 4. The patients were separated into 2 subgroups according to the presence or absence of ischemic complications (visual loss and/or jaw claudication and/or aortic arch syndrome). Results The distribution of the Glu/Asp298 genotype differed significantly between GCA patients and controls (corrected P [Pcorr] = 0.003). Carriers of the Asp298 allele (Asp/Asp or Glu/Asp) were significantly more frequent among the GCA patients than among the controls (Pcorr = 0.0002, odds ratio 3.3, 95% confidence interval 1.7,6.3). The distribution of the 4a/b genotype was similar in GCA patients and controls. No significant associations were found when GCA patients with and without ischemic complications were compared. Conclusion Our findings show that the Glu/Asp298 polymorphism of the eNOS gene is associated with GCA susceptibility. [source] Disparate results in studies of methotrexate plus corticosteroids in the treatment of giant cell arteritis: Comment on the article by Hoffman et alARTHRITIS & RHEUMATISM, Issue 4 2003Juan Angel Jover MD No abstract is available for this article. [source] 1242: Over-reliance on negative test resultsACTA OPHTHALMOLOGICA, Issue 2010V PURVIN Purpose This course focuses on areas of frequent diagnostic confusion in the field of neuro-ophthalmology. Methods The course uses a case-based method. Cases are presented as unknowns, each illustrating the specific clinical feature or features that should point to the correct diagnosis. Results Certain tests may provide misleading information, apparently "ruling out" a particular disorder, when in fact that is the correct diagnosis. Examples include serologic tests for ocular myasthenia, falsely negative temporal artery biopsy for giant cell arteritis and MRI scans in certain some disorders. Conclusion In order to interpret the results of ancillary testing we must know the clinical features of the disease in question and the limitations of the tests we use. [source] 4343: What next when the biopsy is negative in suspected giant cell arteritis (GCA)?ACTA OPHTHALMOLOGICA, Issue 2010A BOSCHI Purpose To present and discuss the approach of GCA when temporal artery biopsy (TAB) is negative. Recommendations for reducing the rate of negative TAB Methods GCA is the commonest vasculitis. Visual loss occurs in up to one-fifth of patients, which may be preventable by prompt recognition and treatment. Features predictive of ischaemic neuro-ophthalmic complications are: jaw claudication, diplopia, and temporal artery abnormalities on physical examination. These manifestations and particularly blindness and jaw claudication seems to be more commonly associated with positive TAB. Results Despite visual symptoms TAB may result negative. Rate of negative TAB varies from 7% to 40% in pat suspected of GCA. TAB should be done 2 to 6 weeks after commencement of treatment, and at least 1 cm. Contralateral biopsy is controversies, usually it increases the rate of GCA diagnosis of only 5%. Conclusion If TAB is still however negative, but clinical suspicion high or Ultra-Sound suggests GCA or complications typical of GCA, like anterior ischemic optic neuropathy, patient should be treat as biopsy-positive GCA patient. If the clinical suspicion is low, features considered atypical or alternative explanations available, rapid glucocorticoid therapy should be tapered. [source] A need for new diagnostic tools for giant cell arteritisACTA OPHTHALMOLOGICA, Issue 1 2009Andrzej Grzybowski No abstract is available for this article. [source] Translational Mini-Review Series on Immunology of Vascular Disease: Accelerated atherosclerosis in vasculitisCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2009J. W. Cohen Tervaert Premature atherosclerosis has been observed during the course of different systemic inflammatory diseases such as rheumatoid arthritis and sytemic lupus erythematosus. Remarkably, relatively few studies have been published on the occurrence of accelerated atherosclerosis in patients with vasculitis. In giant cell arteritis (GCA), mortality because of ischaemic heart disease is not increased. In addition, intima media thickness (IMT) is lower in patients with GCA than in age-matched controls. In contrast, IMT is increased significantly in Takayasu arteritis, another form of large vessel vasculitis occurring in younger patients. In Takayasu arteritis and in Kawasaki disease, a form of medium-sized vessel vasculitis, accelerated atherosclerosis has been well documented. In small vessel vasculitis because of anti-neutrophil cytoplasmic autoantibodies-associated vasculitis, cardiovascular diseases are a major cause of mortality. IMT measurements reveal conflicting results. During active disease these patients experience acceleration of the atherosclerotic process. However, when inflammation is controlled, these patients have atherosclerotic development as in healthy subjects. Several risk factors, such as diabetes and hypertension, are present more often in patients with vasculitis compared with healthy controls. In addition, steroids may be pro-atherogenic. Most importantly, many patients have impaired renal function, persistent proteinuria and increased levels of C-reactive protein, well-known risk factors for acceleration of atherosclerosis. Enhanced oxidation processes, persistently activated T cells and reduced numbers of regulatory T cells are among the many pathophysiological factors that play a role during acceleration of atherogenesis. Finally, autoantibodies that may be relevant for acceleration of atherosclerosis are found frequently in elevated titres in patients with vasculitis. Because patients have an increased risk for cardiovascular events, vasculitis should be treated with as much care as possible. In addition, treatment should be considered with angiotensin-converting-enzyme inhibitors and/or angiotensin receptor-1 blockers, statins and acetylsalicyl acid. Finally, classical risk factors for cardiovascular disease should be monitored and treated as much as possible. [source] Giant cell arteritis with spontaneous remissionCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 1 2007Valerie Purvin MD Abstract Background:, Clinical manifestations of giant cell arteritis (GCA) are variable. Whether signs and symptoms present in an explosive fashion or insidiously, once manifest the course is usually progressive unless treatment is initiated. Methods:, A retrospective review of patients with GCA seen in an outpatient neuro-ophthalmology clinic. Results:, We report four patients with biopsy-proven GCA who experienced spontaneous remission. Clinical manifestations consisted of headache and diplopia in two patients, constitutional symptoms in one patient and facial pain in another. Conclusions:, Clinicians should be aware of this aspect of the disease in order to avoid a delay in diagnosis and treatment. [source] Giant cell arteritis on 18F-FDG PET/CTCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2009Thomas F. Heston Summary Purpose:, We present a case of incidentally noted giant cell arteritis in a patient undergoing 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. The patient was originally referred to PET/CT for staging of his renal transitional cell carcinoma. Methods:, The patient was injected intravenously with 370 MBq of 18F-FDG. After a 60 min uptake period, PET/CT imaging was performed from the skull base to the mid thighs. Results:, A small para-aortic node in the region of the surgical bed showed increased tracer uptake of concern for malignancy. In addition, there were several non-calcified pulmonary nodules present, also concerning for malignancy. Incidentally noted was diffusely increased tracer uptake throughout the aorta and a thickened aortic wall on CT images. Diffuse tracer uptake was also present in the proximal branches of the aorta, including the carotid, iliac, femoral, and subclavian arteries. The patient had biopsy proven giant cell arteritis. Conclusion:, Increased 18F-FDG uptake by the aorta on PET/CT imaging is an abnormal finding that prompts a more thorough assessment for malignancy, and also can indentify important co-morbidities in cancer patients. Evaluation of aortic uptake should be a routine practice in the interpretation of 18F-FDG PET/CT scans. [source] Clinical images: The multifaceted pathogenesis of polymyalgia rheumatica/giant cell arteritisARTHRITIS & RHEUMATISM, Issue 9 2009Dario Camellino No abstract is available for this article. [source] | ||||||||||||||||||||||