Pneumocystis jiroveci pneumonia in giant cell arteritis: A case series

Bronchiectasis is characterized by permanent destruction of the airways that presents with productive cough, as well as bronchial wall thickening and luminal dilatation on computed tomographic (CT) scan of the chest; it is associated with high mortality. Accumulating data suggests higher rates of bronchiectasis among the HIV-positive population. This case series involves 14 patients with bronchiectasis and HIV followed at two major urban institutions from 1999 to 2018. Demographics, clinical presentation, microbiology, radiographic imaging, and outcomes were collected and compiled. Mean age was 42 years (range 12-77 years). 36% had a CD4 count greater than 500 cells/mm3, 28% had a CD4 count between 200 and 500 cells/mm3, and 36% had AIDS. 43% were treated for Pneumocystis jiroveci pneumonia (PJP) and 50% for Mycobacterium avium complex (MAC) infection. 21% had COPD, 7% had asthma, and 7% had a history of pulmonary aspergillosis. Two patients were followed up by pulmonary services after diagnosis of bronchiectasis on CT. The timeline of the follow-up in these cases was within months and after three years respectively. It is posited that the prevalence of bronchiectasis in HIV patients may be underestimated. Improving recognition and management of bronchiectasis could help diminish rehospitalization rates.

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FRI0333 Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a consecutive case series

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-eular.1460 ◽

2013 ◽

Vol 72 (Suppl 3) ◽

pp. A487.1-A487

Author(s):

H. Hetland ◽

G. Myklebust ◽

A. P. Diamantopoulos

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Polymyalgia Rheumatica ◽

Case Series ◽

Consecutive Case

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Ultrasonography of occipital arteries to diagnose giant cell arteritis: a case series and literature review

Clinical Rheumatology ◽

10.1007/s10067-017-3946-5 ◽

2017 ◽

Vol 37 (2) ◽

pp. 569-573 ◽

Cited By ~ 1

Author(s):

Jonathan Pinnell ◽

Carl Tiivas ◽

Phillip Perkins ◽

Tim Blake ◽

Shanmugam Saravana ◽

...

Keyword(s):

Literature Review ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Case Series

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African Australians living with HIV: a case series from Victoria

Sexual Health ◽

10.1071/sh09120 ◽

2010 ◽

Vol 7 (2) ◽

pp. 142 ◽

Cited By ~ 4

Author(s):

Chris N. Lemoh ◽

Samia Baho ◽

Jeffrey Grierson ◽

Margaret Hellard ◽

Alan Street ◽

...

Keyword(s):

Delayed Diagnosis ◽

Case Series ◽

Cd4 Count ◽

Horn Of Africa ◽

Hiv Diagnosis ◽

Pneumocystis Jiroveci ◽

Pneumocystis Jiroveci Pneumonia ◽

Hiv Prevention Strategies ◽

Industrialised Countries ◽

Living With Hiv

Background: This research aimed to describe the characteristics of African-born Victorians living with HIV, identify associations with delayed HIV diagnosis and describe their response to combination antiretroviral therapy (cART). Methods: A case series of African-born adults living with HIV in Victoria was conducted. Data was collected in interviews and reviews of case notes. Associations with delayed HIV diagnosis (CD4 below 200 cells µL–1 at diagnosis and/or AIDS within 3 months of HIV diagnosis) were explored using univariate regression. AIDS-defining illnesses and response to cART were described. Results: Fourteen males and six females were included. Ten were born in the Horn of Africa (nine in Ethiopia). Sixteen had sexual exposure (12 heterosexual; four male-to-male sex). Seven reported acquiring HIV in Australia. Median CD4 count at diagnosis was 145 cells µL–1. Ten had delayed HIV diagnosis, of whom eight were born in the Horn of Africa. Delayed HIV diagnosis was associated with birth in the Horn of Africa (odds ratio: 11.56). Nine had a diagnosis of AIDS, including three cases of tuberculosis, three of Pneumocystis jiroveci pneumonia and two of cerebral toxoplasmosis. Eighteen had received cART, of which 16 achieved virological suppression and 15 achieved a CD4 count above 200 cells µL–1. Clinical failure and virological failure occurred in seven and five cases, respectively. Conclusions: HIV prevention strategies for Victoria’s African communities should address HIV exposure in Australia. Ethiopian-born Victorians with HIV appear to be at particular risk of delayed diagnosis. Response to cART in this series was comparable to that observed in other industrialised countries.

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FRI0545 A META-ANALYSIS OF GIANT CELL ARTERITIS TEMPORALLY AND ACROSS REGIONS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3412 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 873.2-874

Author(s):

D. Semenov ◽

K. LI ◽

M. Turk ◽

J. Pope

Keyword(s):

Mortality Rate ◽

Giant Cell Arteritis ◽

Giant Cell ◽

English Literature ◽

Meta Analysis ◽

Case Series ◽

List Type ◽

Case Control Studies ◽

Biologic Treatment ◽

Cross Sectional

Background:Giant cell arteritis (GCA) is an immune-mediated disease of the large vessels, and occurs in adults over 50 years old1. It is the most commonly seen form of chronic vasculitis and is associated with significant rates of morbidity2. This meta-analysis examines the geographical and temporal epidemiology of GCA, including incidence, prevalence and mortality.Objectives:To identify changes in incidence rate, prevalence, and mortality rate over timeTo compare these rates between geographic regions around the worldMethods:A systematic review of the English literature was conducted using the EMBase, Scopus and PubMed databases. Articles were included if they were cohort or cross-sectional studies with 50 or more patients with GCA and reported on population, location and time-frame parameters. Articles on mortality were included if they compared mortality to age and gender matched population. Review articles, case-control studies and case series were excluded. Two reviewers extracted data and a third verified inclusion of studies. Study quality was assessed by using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Mortality rate was standardized across cohorts to deaths per 1000 people per year.Results:Of the 3569 citations identified by the literature search, 107 were included in analysis. The pooled incidence of GCA internationally was 10.00 [9.22, 10.78] cases per 100 000 people over 50 years old (Figure). This incidence was highest in Scandinavia 21.57 [18.90, 24.23], followed by North and South America 10.89 [8.78, 13.00], Europe 7.26 [6.05, 8.47], and Oceania 7.85 [1.48,17.19]. Nine studies reported prevalence. Pooled prevalence from these 9 was 51.74 [42.04,61.43] cases per 100 000 people over 50 years old. Overall, pooled mortality was 20.44 [17.84,23.03] deaths/1000 per year. Mortality had a generally decreasing trend over the years of publication.Conclusion:The incidence of GCA varies regionally almost 3-fold. Likely genetic and environmental factors may explain this trend. Incidence and prevalence are important for tracking the efficacy and side effects of current therapies, as well as planning for the costs of biologic treatment.References:[1] Floris A, Piga M, Cauli A, Salvarani C, Mathieu A. Polymyalgia rheumatica: an autoinflammatory disorder?. RMD Open. 2018;4(1):e000694. Published 2018 Jun 4. doi:10.1136/rmdopen-2018-000694[2] Crow RW, Katz BJ, Warner JE, et al. Giant cell arteritis and mortality. J Gerontol A Biol Sci Med Sci. 2009;64(3):365–369. doi:10.1093/gero na/gln030Acknowledgments:Both Daniel Semenov and Katherine Li equally contributed and sharing first authorshipFunding in part was from the Canadian Rheumatology Association summer studentshipDisclosure of Interests:Daniel Semenov: None declared, Katherine Li: None declared, Matthew Turk: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

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P184 Developing a pathway for tocilizumab treatment in giant cell arteritis: a South London regional experience

Rheumatology ◽

10.1093/rheumatology/keaa111.179 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Pratyasha Saha ◽

Virinderjit Sandhu ◽

Helena Robinson ◽

Amara Ezeonyeji ◽

Israa Al-Shakarchi ◽

...

Keyword(s):

Side Effects ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Case Series ◽

Liver Function Tests ◽

University Hospitals ◽

Antibody Treatment ◽

Hub And Spoke ◽

Monoclonal Antibody Treatment ◽

Gastroprotective Agent

Abstract Background Tocilizumab is now approved by the National Institute of Health and Care Excellence (NICE) for up to a year in relapsing or refractory giant cell arteritis (GCA). The practicalities of developing a pathway for referral using a hub and spoke model were previously unknown. Here we discuss our novel experiences utilising tocilizumab for GCA in its first year of licensing, after the introduction of a new regional multi-disciplinary team referral pathway. Methods We assessed all patients started on tocilizumab for GCA between August 2018-May 2019. The central assessing hub is St George’s University Hospitals NHS Foundation Trust, a large tertiary rheumatology department in the South of England, serving a population of 1.3 million. Results As per Table 1 below. A total of 9 patients were identified: 6 female and 3 male, with an average age of 74.2 (range 63-80). 5 patients were referred internally from clinicians at St George’s Hospital, with the remainder from local district general hospitals. Steroid protocols between patients were varied, and two-thirds required a 3-day IV methylprednisolone course, including all 4 patients with visual symptoms. A third of patients were on concurrent methotrexate, a disease-modifying antirheumatic drug. 8 of 9 patients were on alendronate, vitamin D/calcium, and a gastroprotective agent, and 7 were on aspirin. Reported side effects from steroids were common, with weight gain, increased appetite and osteoporosis noted. All our 9 patients continue their tocilizumab injections, with one individual having a 3-month break for a routine hip operation, and another a 1-month hiatus due to temporary derangement in liver function tests. Tocilizumab proffered improved disease control and few side effects were noted. 3 patients have now been on tocilizumab for 12 months and raise interesting discussions about ongoing funding and treatment efficacy. Conclusion Our case series shows the development and delivery of an effective hub and spoke referral pathway for tocilizumab treatment in GCA. We show that steroid dosing could be reduced with tocilizumab, and that all subjects received full funding for treatment. Our referral pathway has encouraged the uptake of the IL-6 monoclonal antibody treatment for GCA and compliance with NICE guidelines. Disclosures P. Saha None. V. Sandhu None. H. Robinson None. A. Ezeonyeji None. I. Al-Shakarchi None. S. Chander None. R. Suresh None. A. Kaul None. N. Sofat None.

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Leflunomide as a Corticosteroid-Sparing Agent in Giant Cell Arteritis and Polymyalgia Rheumatica: A Case Series

BioMed Research International ◽

10.1155/2013/120638 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 51

Author(s):

Andreas P. Diamantopoulos ◽

Helene Hetland ◽

Geirmund Myklebust

Keyword(s):

Randomized Controlled Trials ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Polymyalgia Rheumatica ◽

Case Series ◽

Controlled Trials ◽

Prednisolone Dose ◽

Randomized Controlled

Objectives. Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) affect individuals older than 50 years of age and corticosteroids are the mainstay of treatment. The aim of our study was to explore the role of leflunomide as a corticosteroid-sparing agent in GCA and PMR patients.Methods. Patients with difficult-to-treat GCA and PMR were retrospectively identified in the period from 2010 to 2013. The doses of corticosteroids and CRP values were noted before, after three months, and at the end of the treatment with leflunomide (for patients continuing treatment, censoring date was January 1, 2013).Results. Twenty-three patients were identified (12 with PMR and 11 with GCA). A reduction of 6 mg/dL (CI 95% –10.9–34.2,P=0.05) in CRP and 3.7 mg (CI 95% 0.5–7.0,P=0.03) in prednisolone dose was observed in the PMR group. In GCA patients, the reduction was 12.4 mg/dL (CI 95% 0.7–25.5,P=0.06) in CRP and 6.6 mg (CI 95% 2.8–10.3,P<0.01) in prednisolone dose.Conclusion. Leflunomide seems to be effective as a corticosteroid-sparing agent in patients with difficult-to-treat GCA and PMR. Randomized controlled trials are warranted in order to confirm the usefulness of leflunomide in the therapy of GCA/PMR.

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