scholarly journals Vision Loss in Patients with Giant Cell Arteritis Treated with Tocilizumab

2020 ◽  
Author(s):  
Jennifer Amsler ◽  
Iveta Kysela ◽  
Christoph Tappeiner ◽  
Luca Seitz ◽  
Lisa Christ ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Structural Changes ◽  
Vision Loss ◽  
Treated Patient ◽  
Laboratory Data ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
Low Incidence ◽  
Initiation Of Therapy

Abstract Objectives: Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ.Methods: In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical and laboratory data were analyzed. Results: A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed in magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6-17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0-8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p=0.032), had a lower C-reactive protein (p=0.002), more often cranial symptoms (p<0.001) or jaw claudication (p=0.031) and showed a negative association with MRA of the aorta (p=0.006). Two patients (1.1%) developed vision loss, both at initiation of TCZ treatment.Conclusion: Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.

scholarly journals Vision loss in patients with giant cell arteritis treated with tocilizumab

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Jennifer Amsler ◽  
Iveta Kysela ◽  
Christoph Tappeiner ◽  
Luca Seitz ◽  
Lisa Christ ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Structural Changes ◽  
Vision Loss ◽  
Treated Patient ◽  
Laboratory Data ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
Low Incidence ◽  
Initiation Of Therapy

Abstract Objectives Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ. Methods In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical, and laboratory data were analyzed. Results A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed by magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6–17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0–8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p = 0.032), had a lower C-reactive protein (p = 0.002), and showed a negative association with MRA of the aorta (p = 0.006). Two patients (1.1%) developed vision loss, both at the initiation of TCZ treatment. Conclusion Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at the initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether a shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.

scholarly journals OP0149 VISUAL LOSS IN PATIENTS WITH GIANT CELL ARTERITIS TREATED WITH TOCILIZUMAB

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 95.2-95
Author(s):  
J. Amsler ◽  
I. Kysela ◽  
L. Christ ◽  
C. Tappeiner ◽  
L. Seitz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Visual Impairment ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Visual Loss ◽  
Vision Loss ◽  
Laboratory Data ◽  
Favorable Effect ◽  
Reactive Protein ◽  
American College Of Rheumatology

Background:Whether Tocilizumab (TCZ) may prevent vision loss in Giant Cell Arteritis (GCA) to the same extent as glucocorticoids remains a key and unanswered question. A patient cohort observed over up to 8 years addresses this issue.Objectives:To investigate the frequency of vision loss/visual impariment in a GCA cohort treated with TCZ.Methods:In this observational monocentric study, the courses of 192 patients with GCA treated with TCZ between 01.01.2011 and 31.12.2018 were analyzed. Data were extracted from medical records and collected in a Clinical Trial Unit (CTU) - based registry. Demographic, clinical and laboratory data were analyzed.Results:192 patients with GCA were treated with TCZ; 121 (63%) were female, 112 (58%) fulfilled 1990 American College of Rheumatology (ACR) criteria, all others had large vessel vasculitis based on magnetic resonance-angiography (MRA). The cumulative duration of TCZ treatment was 3467 months; the median treatment duration was 13.8 (8.5; 22.8) months. At baseline, visual impairment was present in 71 (37%) and vision loss in 21 (7.8%) patients. Visual loss was associated with higher age (74 (70; 82) vs. 70 (63; 76) years; p=0.029), lower C-reactive protein at baseline (14.0 (3.5; 42.0) vs. 54.5 (21.0; 101.0) mg/l; p<0.001), cranial symptoms (p<0.0001), jaw claudication (p=0.030) and negative MRA of the aorta (p=0.020). Over the observed time span only one patient taking part in a clinical trial developed vision loss. In total 4 (2%) patients with vision impairment showed deterioration and 61 (32%) improvement.Conclusion:Collectively, our data suggest that TCZ is able to prevent visual loss and may have a favorable effect on visual impairment.Disclosure of Interests:Jennifer Amsler: None declared, Iveta Kysela: None declared, Lisa Christ Consultant of: BMS, Christoph Tappeiner: None declared, Luca Seitz: None declared, Godehard Scholz: None declared, Florian Kollert Employee of: Novartis, Stephan Reichenbach: None declared, Peter Villiger Consultant of: MSD, Abbvie, Roche, Pfizer, Sanofi, Speakers bureau: Roche, MSD, Pfizer

Giant Cell Arteritis–related Stroke: A Retrospective Multicenter Case-control Study

2017 ◽  
Vol 44 (3) ◽  
pp. 297-303 ◽  
Author(s):  
Hubert de Boysson ◽  
Eric Liozon ◽  
Delphine Larivière ◽  
Maxime Samson ◽  
Jean-Jacques Parienti ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Case Control Study ◽  
Control Group ◽  
C Reactive Protein ◽  
Multivariate Logistic Regression ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
Multicenter Cohort ◽  
Control Study

Objective.Our aim was to describe patients with giant cell arteritis (GCA)–related stroke and to compare them with a control group of GCA patients without stroke.Methods.We created a retrospective multicenter cohort of patients with (1) GCA diagnosed according to the American College of Rheumatology criteria between 1995 and 2015, and (2) stroke occurring at the time of GCA diagnosis or occurring within 4 weeks of starting GCA therapy. The control group consisted of GCA patients without stroke.Results.Forty patients [21 women (53%), median age 78 (60–91) yrs] with GCA-related stroke were included and were compared with 200 control patients. Stroke occurred at GCA diagnosis in 29 patients (73%), whereas it occurred after diagnosis in 11 patients. Vertebrobasilar territory was involved in 29 patients (73%). Seven patients died within a few hours or days following stroke. Compared with the control group, stroke patients had more ophthalmic ischemic symptoms [25 (63%) vs 50 (25%), p < 0.001]. Conversely, they demonstrated lower biological inflammatory variables [C-reactive protein: 61 (28–185) mg/l vs 99 (6–400) mg/l, p = 0.04] and less anemia [22/37 (59%) vs 137/167 (79%), p = 0.03] than patients without stroke. Multivariate logistic regression revealed that the best predictors for the occurrence of stroke were the presence of ophthalmic ischemic symptoms at diagnosis (OR 5, 95% CI 2.14–12.33, p = 0.0002) and the absence of anemia (OR 0.39, 95% CI 0.16–0.99, p = 0.04).Conclusion.Stroke, especially in the vertebrobasilar territory, is more likely to occur in patients with GCA who experience recent ophthalmic ischemic symptoms and who exhibit low inflammatory variables.

Neuro-Ophthalmologic Complications of Giant Cell Arteritis: Diagnosis and Treatment

2019 ◽  
Vol 39 (06) ◽  
pp. 673-681
Author(s):  
Alexander S. Fein ◽  
Melissa W. Ko
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Signs ◽  
The United States ◽  
Great Promise ◽  
External Carotid ◽  
Ischemic Optic Neuropathy ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
Emerging Therapies

AbstractGiant cell arteritis (GCA) is the most common vasculitis in individuals 50 years or older, with a lifetime risk in the United States of 1% in women and 0.5% in men. It is a granulomatous disease that affects large- and medium-sized vessels, most notably the branches of the internal and external carotid arteries. GCA can cause both afferent and efferent visual manifestations, the most common being arteritic anterior ischemic optic neuropathy. Diagnosis of GCA is made using criteria developed by the American College of Rheumatology, which include clinical signs, positive biopsy, and elevated erythrocyte sedimentation rate. C-reactive protein and platelet counts may be elevated in GCA, and noninvasive imaging modalities such as Doppler ultrasound and magnetic resonance imaging are now being used to aid in diagnosis. While glucocorticoids are the mainstay of treatment for GCA, new breakthrough treatments such as tocilizumab (an anti-IL-6 receptor antibody) have shown great promise in causing disease remission and reducing the cumulative glucocorticoid dose. Emerging therapies such as abatacept and ustekinumab are still being studied and may be of use to clinicians in the future.

scholarly journals Giant Cell Arteritis in Ophthalmology Practice: a Case Report

2019 ◽  
Vol 16 (1) ◽  
pp. 109-114
Author(s):  
V. A. Chernukha ◽  
D. S. Atarschikov ◽  
N. V. Khamnagdaeva ◽  
I. V. Pozharov
Keyword(s):  
Case Report ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss ◽  
Systemic Vasculitis ◽  
Ischemic Optic Neuropathy ◽  
Reactive Protein ◽  
Retinal Artery ◽  
The Right

Introduction. Giant cell (temporal) arteritis refers to a group of chronic and acute systemic vasculitis mainly affecting the extracranial and intracranial arteries of large and medium caliber. Loss of vision due to anterior ischemic optic neuropathy (AION) or occlusion of the central retinal artery is one of the most severe and most common complications of giant cell arteritis. This case report describes a patient with giant cell arteritis, the outcome of it was a total vision loss in the right eye. The patient repeatedly visited the ophthalmologists in the outpatient clinics with complaints of intermittent episodes of vision loss.Purpose. To present methods of diagnosis and treatment, through which the doctor at the initial reception will be able to suspect the disease and start treatment timely.Conclusions. The anamnestic criteria for the GCA diagnosis in the practice of ophthalmologist are: female, age over 50 years, headaches with paresthesia, intermittent lameness of the mandible, short-term episodes of vision loss. The necessary laboratory methods of research include: clinical blood test with determination of erythrocyte sedimentation rate, determination of C-reactive protein level.

scholarly journals FRI0197 THE DIAGNOSTIC ACCURACY OF VASCULAR ULTRASOUND IN PATIENTS SUSPECTED OF GCA: A DANISH MULTICENTRE PROSPECTIVE COHORT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 682.1-682
Author(s):  
S. Chrysidis ◽  
U. Møller Døhn ◽  
L. Terslev ◽  
U. Fredberg ◽  
T. Lorenzen ◽  
...  
Keyword(s):  
Multicentre Study ◽  
Diagnostic Accuracy ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Diagnosis ◽  
Axillary Artery ◽  
Laboratory Data ◽  
Temporal Artery ◽  
Large Vessel ◽  
The Us

Background:Giant Cell Arteritis (GCA) is one of the most common systemic vasculitis. Temporal artery biopsy (TAB) has been the standard test to confirm the diagnosis of GCA. However, TAB has a lower sensitivity than clinical diagnosis and up to 44% of biopsy-negative patients are clinically diagnosed as having GCA.In a recent meta-analysis of the diagnostic performance of ultrasound (US) in GCA the sensitivity was 77 % (1). The included studies were performed by expert groups in single centres. In the to date only multicentre study (TABUL) investigating the diagnostic accuracy of US compared to clinical diagnosis after 6 months the sensitivity was lower (54%) (2)Objectives:To evaluate the diagnostic accuracy of vascular US compared to TAB in a multicentre study.Methods:In three Danish centres patients suspected for GCA were included during a period of two years. At baseline, clinical and laboratory data were collected and vascular US of temporal, facial, common carotid and axillary artery were performed. The US examinations were performed with high frequency transducers (15-18 MHZ) and followed by a TAB. All ultrasongraphers had participated in the same standardized US educational program and were blinded to clinical and laboratory data. An external expert blinded to clinical and laboratory data evaluated all images and made the final US diagnosis.A positive sign for vasculitis in cranial arteries was defined as a hypoechoic intima media complex (IMC) thickening (halo sign) and a positive compression sign. A homogeneous IMC increased thickness in axillary artery of ≥1mm and in common carotid artery ≥1.5mm was defined as vasculitis.The consultant rheumatologist’s diagnosis at 6 months after initial presentation was considered as the reference standard for the diagnosis of GCA.Results:During the recruitment period, 112 patients were included, 59% females, mean (SD) age 72.4(7.9) years, among which 91(81.3%) fulfilled the ACR 1990 classification criteria for GCA. 92% of the patients reported a newly emerged localized headache, while 49 (43.8%) experienced polymyalgia rheumatic symptoms.TAB was positive in 46(41.1%) and inconclusive in 6 patients, who were excluded from the analysis. Mean (SD) duration of glucocorticoid therapy prior to US and TAB was 0.91(1.55) and 4.02(2.61) days, respectively. In 62 patients, the final diagnosis was GCA.In all patients with a positive TAB, the US of the temporal artery was also positive for GCA. Of 19 cases with positive US and negative TAB, 12 were clinically diagnosed with GCA of whom 6 had isolated large vessel involvement on US. Among 41 patients with both negative US and TAB, 4 were clinically diagnosed with GCA (Box 1)US had a sensitivity of 93% and specificity of 84% for the diagnosis of GCA, while the sensitivity for TAB was lower (74%) with a specificity of 100%. For the diagnosis of GCA, US had a PPV of 89.2 % and a NPV of 90.2%, while for TAB the PPV was 100% and the NPV 73.3%.Conclusion:US evaluation of the temporal, facial and selected supraaortic arteries performed by trained ultrasonographers can replace biopsy in the diagnosis of GCA.Box.1References:[1]Duftner C, Dejaco C, et al. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and metaanalysis informing the EULAR recommendations. RMD Open 2018;4:e000612.[2]Luqmani R et al. The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study. Health Technol Assess 2016;20:1_238.Disclosure of Interests:stavros chrysidis: None declared, Uffe Møller Døhn: None declared, Lene Terslev Speakers bureau: LT declares speakers fees from Roche, MSD, BMS, Pfizer, AbbVie, Novartis, and Janssen., Ulrich Fredberg: None declared, Tove Lorenzen: None declared, Robin Christensen: None declared, Per Søndergaard: None declared, Jakob Matthisson: None declared, Knud Larsen: None declared, Andreas Diamandopoulos: None declared

scholarly journals The impact of Temporal Artery Biopsy for the diagnosis of Giant Cell Arteritis in clinical practice in a tertiary University Hospital

2019 ◽  
Author(s):  
E Kaltsonoudis ◽  
E Pelechas ◽  
A Papoudou-Bai ◽  
E.T. Markatseli ◽  
M Elisaf ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Laboratory Data ◽  
Unknown Origin ◽  
Temporal Artery ◽  
University Hospital ◽  
Temporal Artery Biopsy ◽  
Acute Phase Reactants ◽  
Anemia Of Chronic Disease ◽  
The Impact

ABSTRACTBackgroundTemporal artery biopsy (TAB) is useful in assisting with giant cell arteritis (GCA) diagnosis but lacks sensitivity. The aim of our study was to assess the diagnostic impact of TAB histology in patients with suspected GCA on hospital admission.MethodsA prospectively maintained database was queried for all TABs performed between 1-1-2000 until 31-12-2017 at the University Hospital of Ioannina. Thus, inclusion criteria were made on the grounds of every patient that underwent a TAB during the above-mentioned period, regardless of demographic, clinical and laboratory data.ResultsTwo hundred forty-five TABs were included (149 females and 96 males), with a mean age of 64.5 (±3.5) years. The mean symptoms duration until admission to the hospital was 8.6 (±1.3) weeks and all had elevated acute phase reactants on admission. The reasons of admission were fever of unknown origin (FUO) in 114 (46.5%) patients, symptoms of polymyalgia rheumatica (PMR) in 84 (34.3%), new headache in 33 (13.5%), anemia of chronic disease (ACD) in 8 (3.32%) and eye disturbances in 6 (2.5%) patients. Positive results were found in 49 (20%) TABs. More specifically, in 14% of patients with FUO, 21% in those with PMR, while in patients with a new headache the percentage was 27%. Finally, 5 out of 6 (83.3%) of patients with ocular symptoms and only one (12.5%) of those suffering from ACD. Visual manifestations and FUO are correlated with a positive TAB.ConclusionIt seems that TAB is useful in assisting with GCA diagnosis, but lacks sensitivity.

THU0309 UNILATERAL TEMPORAL ARTERY BIOPSY IS SUFFICIENT FOR DIAGNOSING GIANT CELL ARTERITIS IF THE SERUM C-REACTIVE PROTEIN LEVEL IS 10 MG/DL OR HIGHER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 383-384
Author(s):  
T. Kise ◽  
E. Takamasu ◽  
Y. Miyoshi ◽  
N. Yokogawa ◽  
K. Shimada
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
High Dose ◽  
Temporal Artery Biopsy ◽  
C Reactive Protein ◽  
Positive Group ◽  
Reactive Protein ◽  
Discordance Rate ◽  
Serum Crp

Background:Temporal artery biopsy (TAB) is the gold standard for diagnosing giant cell arteritis (GCA). However, previous studies have reported that the discordance rate of TAB is 3-45%,i.e., in unliteral TAB, GCA may be overlooked in one in five patients, approximately. Evidence as to whether bilateral TAB should be performed initially or one-sided TAB is sufficient for diagnosing GCA is lacking.Objectives:To investigate the predictors of patients with GCA in whom one-sided TAB is sufficient.Methods:The present study was a cross-sectional, single center study conducted from April 1, 2011 to July 31, 2019 at Tokyo Metropolitan Tama Medical Center. Of all consecutive GCA cases for which bilateral TAB was performed, bilaterally positive cases and unilaterally positive cases were extracted as bilateral positive group (BPG) and unilateral positive group (UPG), respectively. GCA was defined in accordance with the classification criteria of the 1990 American College of Rheumatology, and GCA was diagnosed if no other etiology was found within six months after beginning of high-dose glucocorticoid treatment. Demographic, clinical and laboratory data were obtained from the medical records, and the BPG and the UPG were compared statistically in each variable. Statistical significance was defined asp< 0.05.Results:During study, 264 biopsies were performed for 145 cases, who suspected GCA and underwent TAB. The pathological positivity rate was 26.1% (68 / 264 biopsies). Of these, 53 cases had final diagnosis of GCA, in which 43 cases were biopsy proven GCA. Thirty-seven biopsy proven GCA with bilateral TAB were enrolled; 64.9% women; mean (SD) age 75 (8.9) years; median [IQR] TAB length 17.5 [13.0,20.0] mm; headache 54.1%; jaw claudication 45.9%; scalp tenderness 16.2%; temporal artery (TA) tenderness 32.4%; TA engorgement 32.4%; TA pulse abnormality 5.4%; visual symptoms 2.7%; a fever of 38.5°C or higher 40.5%; shoulder girdle pain 48.6%; imaging of aortitis or arteritis 40.5%; median [IQR] white blood cell 9,100 [7200, 12050] /μl; median [IQR] platelet cell 37.5 [27.0, 46.3] ×104/μl; median [IQR] C-reactive protein (CRP) 10.1 [3.9, 16.5] mg/dL; erythrocyte sedimentation rate [IQR] 105 [66, 129] mm/h. Thirty-one in 37 cases were positive bilaterally while 6 in 37 cases were positive unilaterally; and the discordance rate was 16.2%. The median sample length after formalin fixation was 19.0 mm for the BPG and 14.5 mm for the UPG (p= 0.171). The parameters above were compared between UPG and BPG. Of these, only the serum CRP value (mg/dL) differed statistically between groups, and the median value of the two groups was 10.6 and 6.5, respectively (median test:p= 0.031). To predict BPG, in whom unilateral TAB is sufficient for diagnosing GCA, the cut-off value of serum CRP with a specificity of 100% and a sensitivity of 61.3% was set at 9.3 mg/dL (ROC analysis: AUC 0.726).Conclusion:When the serum CRP level is 10 mg/dL or higher in GCA suspected patients, an unilateral TAB alone was sufficient for an accurate diagnosis.References:[1]Hellmich, B, et al.Ann Rheum Dis2020;79(1):19-30.[2]Breuer, GS, et al.J Rheumatol. 2009;36(4):794-796.[3]Czyz CN, et al.Vascular2019;27(4):347-351.[4]Durling B, et al.Can J Ophthalmol2014;49(2):157-161.Figure.Comparison of median CRP levels between unilaterally positive group and bilaterally positive group.Disclosure of Interests:None declared

Vision Loss From Giant Cell Arteritis in Patients With Other Ocular Diagnoses

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Prem Nichani ◽  
Valérie Biousse ◽  
Nancy J. Newman ◽  
Jonathan A. Micieli
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Vision Loss
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