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NCBI: db=pubmed; Term=vasculitis AND ((English[lang] OR French[lang]) AND adult[MeSH] AND "last 90 days"[PDat])
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Epidemiology of hypocomplementaemic urticarial vasculitis (anti-C1q vasculitis).

lun, 13/08/2018 - 14:15
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Epidemiology of hypocomplementaemic urticarial vasculitis (anti-C1q vasculitis).

Rheumatology (Oxford). 2018 08 01;57(8):1400-1407

Authors: Sjöwall C, Mandl T, Skattum L, Olsson M, Mohammad AJ

Abstract
Objectives: The aim was to describe the clinical characteristics and epidemiology of hypocomplementaemic urticarial vasculitis (HUV; anti-C1q vasculitis) in two geographically defined areas of Sweden.
Methods: In the health-care districts surrounding Skåne University Hospital (mean population 950 560) and Linköping University Hospital (mean population 428 503), all incident cases of HUV residing within the study areas at the onset of disease were identified during the years 2000-15. The diagnosis of HUV was confirmed by review of medical records. Only patients meeting the proposed diagnostic HUV criteria and/or the 2012 Chapel Hill consensus definitions in combination with an ever-positive anti-C1q antibody test were included.
Results: Sixteen patients (14 females) were identified during the study period. The median (interquartile range) age at diagnosis was 51 (40.7-56.7) years. Median (interquartile range) time of follow-up from diagnosis to 31 December 2015, or death, was 94 (46.5-136.2) months. The most frequent manifestations at diagnosis were urticaria (100%), arthritis (88%), followed by biopsy-proven glomerulonephritis (19%), episcleritis/scleritis (19%) and recurrent abdominal pain (13%). The annual incidence rate per million inhabitants was estimated as 0.7 (95% CI: 0.4, 1.1). Sixty-three per cent suffered from pulmonary disease at the last follow-up. Two patients died during the follow-up period. One patient underwent lung transplantation, and two patients proceeded to end-stage renal disease. The point prevalence on 31 December 2015 was 9.5/million (95% CI: 4.5, 14.5).
Conclusion: Hypocomplementaemic urticarial vasculitis constitutes a rare, but not always benign condition. Renal and lung manifestations were severe in some cases, highlighting the need for careful screening and monitoring of this potentially serious condition.

PMID: 29718374 [PubMed - indexed for MEDLINE]

CD3 immunohistochemistry is helpful in the diagnosis of giant cell arteritis.

lun, 13/08/2018 - 14:15
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CD3 immunohistochemistry is helpful in the diagnosis of giant cell arteritis.

Rheumatology (Oxford). 2018 Aug 01;57(8):1377-1380

Authors: Ciccia F, Ferrante A, Guggino G, Cavazza A, Salvarani C, Rizzo A

Abstract
Objective: To evaluate whether CD3 staining performed routinely on temporal artery biopsy specimens might improve the sensitivity of temporal artery biopsy in patients with biopsy-negative GCA.
Methods: Two hundred and seventy biopsies were considered for this study, stained with haematoxylin and eosin and with an anti-CD3 antibody.
Results: The addition of CD3 staining modified the sensibility and the specificity of the histologic examination in 89.47 and 95.00%, respectively, with a positive and negative predictive values of 97.00 and 79.78% .
Conclusion: The addition of CD3 immunostaining to the classic histologic evaluation is accompanied by a significant increase in the sensibility with a comparable specificity.

PMID: 29697809 [PubMed - indexed for MEDLINE]

Comment on: The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults: reply.

ven, 10/08/2018 - 12:21
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Comment on: The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults: reply.

Rheumatology (Oxford). 2018 08 01;57(8):1502-1503

Authors: Gordon C, Amissah-Arthur MB, Gayed M, Brown S, Bruce IN, D'Cruz D, Empson B, Griffiths B, Jayne D, Khamashta M, Lightstone L, Norton P, Norton Y, Schreiber K, Isenberg D, British Society for Rheumatology Standards, Audit and Guidelines Working Group

PMID: 29893921 [PubMed - indexed for MEDLINE]

Characteristics, outcome and treatments with cranial pachymeningitis: A multicenter French retrospective study of 60 patients.

sam, 04/08/2018 - 10:49
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Characteristics, outcome and treatments with cranial pachymeningitis: A multicenter French retrospective study of 60 patients.

Medicine (Baltimore). 2018 Jul;97(30):e11413

Authors: Mekinian A, Maisonobe L, Boukari L, Melenotte C, Terrier B, Ayrignac X, Scheinlitz N, Sène D, Hamidou M, Konaté A, Guilpain P, Abisror N, Ghrenassia E, Lachenal F, Cevallos R, Roos-Weil R, Du LTH, Lhote F, Larroche C, Bergmann JF, Humbert S, Fraison JB, Piette JC, Guillevin L, Dhote R, Amoura Z, Haroche J, Fain O

Abstract
The aim of this study was to determine the characteristics, treatment, and outcome according to each etiology of pachymeningitis.We conducted a retrospective multicenter French nationwide study between 2000 and 2016 to describe the characteristics, outcome, and treatment of pachymeningitis.We included 60 patients (median age 55.5 years; interquartile range [IQR] 30-80, female/male ratio 0.43). Neurologic signs were present in 59 patients (98%) and consisted of headache in 43 (72%), cranial nerve palsy in 33 (55%), confusion in 10 (17%), seizures in 7 (12%), and focal neurologic signs in 9 (15%). Fever and weight loss were present in 8 (13%) and 13 cases (22%), respectively. Cerebral venous thrombosis was present in 8 cases (13%). Analysis of cerebrospinal fluid showed moderate hyperproteinorachia (median 0.68 g/L; IQR 0.46-3.2) with or without pleiocytosis. Diagnosis included idiopathic pachymeningitis (n = 18; 30%); granulomatosis with polyangiitis (n = 13; 17%); Erdheim-Chester disease (n = 10; 17%); IgG4-related disease and tuberculosis (n = 3; 5% each); Rosai-Dofman disease, microscopic polyangiitis, and sarcoidosis (n = 2, 3% each); cryptococcal meningitis, Lyme disease, ear-nose-throat infection, postlumbar puncture, low spinal-fluid pressure syndrome, and lymphoma (n = 1 each). We found no difference in demographics and neurologic presentation among idiopathic pachymeningitis, Erdheim-Chester disease, and granulomatosis with polyangiitis. In contrast, frequencies were lower with idiopathic pachymeningitis than Erdheim-Chester disease for general signs (6% and 40%, respectively, P = .041) and complete neurologic response (0% vs 39%, P = .045).The detection of extraneurologic signs and routine screening are needed to classify the pachymeningitis origin. Prospective studies are warranted to determine the best treatment in each case.

PMID: 30045263 [PubMed - indexed for MEDLINE]

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis.

sam, 04/08/2018 - 10:49
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Idiopathic retinal vasculitis, aneurysms, and neuroretinitis.

Indian J Ophthalmol. 2018 08;66(8):1195

Authors: Menia NK, Kiran S, Bansal R

PMID: 30038179 [PubMed - indexed for MEDLINE]

The Utility of Color Duplex Ultrasonography in the Diagnosis of Giant Cell Arteritis: A Prospective, Masked Study. (An American Ophthalmological Society Thesis).

sam, 04/08/2018 - 10:49
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The Utility of Color Duplex Ultrasonography in the Diagnosis of Giant Cell Arteritis: A Prospective, Masked Study. (An American Ophthalmological Society Thesis).

Trans Am Ophthalmol Soc. 2017 Aug;115:T9

Authors: Bilyk JR, Murchison AP, Leiby BT, Sergott RC, Eagle RC, Needleman L, Savino PJ

Abstract
Purpose: To evaluate the diagnostic yield and concordance of color duplex ultrasound (CDU) of the superficial temporal artery (STA), temporal artery biopsy (TAB), and American College of Rheumatology (ACR) criteria in the diagnosis of giant cell arteritis (GCA).
Methods: Prospective, masked study of all patients evaluated in one institution suspected of having GCA. All patients with a suspected diagnosis of GCA were admitted for pulsed intravenous corticosteroids. Patients underwent serologic work-up and ACR criteria were documented. All patients had a CDU and TAB performed within 3 days of initiation of systemic corticosteroid therapy. Main outcome measure: Concordance of CDU and TAB. Secondary outcome measures: Concordance between unilateral and bilateral CDU and TAB by side and segment, concordance between TAB and ACR criteria, and statistical analysis of serologic markers for GCA.
Results: The diagnosis of biopsy-proven GCA was found in 14 of 71 (19.7%) patients. The sensitivity of CDU compared to the reference standard of TAB ranged between 5.1% and 30.8% depending on the signs studied on CDU and correlation of specific TAB parameters. Of the serologic studies, a platelet count threshold of 400,000μL had the highest positive (18.32) and lowest negative (0.37) likelihood ratios for a diagnosis of GCA.
Conclusions: In this study, CDU showed minimal value in diagnosing GCA compared to TAB. There was poor correlation between CDU results and ACR criteria for GCA. The threshold platelet count had higher positive and negative predictive values for GCA than CDU and is a useful serologic marker for GCA.

PMID: 29967570 [PubMed - indexed for MEDLINE]

Eosinophilic granulomatosis with polyangiitis and laryngeal involvement: review of the literature and a cross-sectional prospective experience.

sam, 04/08/2018 - 10:49
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Eosinophilic granulomatosis with polyangiitis and laryngeal involvement: review of the literature and a cross-sectional prospective experience.

J Laryngol Otol. 2018 Jul;132(7):619-623

Authors: Seccia V, Cristofani-Mencacci L, Dallan I, Fortunato S, Bartoli ML, Sellari-Franceschini S, Latorre M, Paggiaro PL, Baldini C

Abstract
BACKGROUND: Eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis show variable otorhinolaryngological involvement. Up to 14 per cent of granulomatosis with polyangiitis patients have subglottis involvement; little is known about the laryngeal involvement in eosinophilic granulomatosis with polyangiitis.
METHOD: A literature review was conducted, together with a prospective cross-sectional analysis of 43 eosinophilic granulomatosis with polyangiitis patients. All patients underwent fibre-optic laryngoscopy with narrow-band imaging, and completed health-related questionnaires.
RESULTS: The literature review showed only two cases of laryngeal involvement in eosinophilic granulomatosis with polyangiitis; in our cohort, no cases of subglottis stenosis were found, but local signs of laryngeal inflammation were present in 72 per cent of cases. Of the patients, 16.2 per cent had a pathological Reflux Finding Score (of 7 or higher).
CONCLUSION: Laryngeal inflammation in eosinophilic granulomatosis with polyangiitis is frequent. It is possibly due more to local factors than to eosinophilic granulomatosis with polyangiitis itself. However, ENT evaluation is needed to rule out possible subglottis inflammation. These findings are in line with current literature and worthy of confirmation in larger cohorts.

PMID: 29888684 [PubMed - indexed for MEDLINE]

Circulating CD4+CD8+ double-positive T-cells display features of innate and adaptive immune function in granulomatosis with polyangiitis.

sam, 04/08/2018 - 10:49
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Circulating CD4+CD8+ double-positive T-cells display features of innate and adaptive immune function in granulomatosis with polyangiitis.

Clin Exp Rheumatol. 2018 Mar-Apr;36 Suppl 111(2):93-98

Authors: Kerstein A, Müller A, Pitann S, Riemekasten G, Lamprecht P

Abstract
OBJECTIVES: To examine functional features of CD4+CD8+ double-positive T-cells in patients with granulomatosis with polyangiitis (GPA) using phenotypic and transcriptomic analysis.
METHODS: Staining of cellular surface marker was performed using freshly collected whole blood. For intracellular cytokine staining freshly collected whole blood was stimulated with phorbol myristate acetate and ionomycin. Multicolor flow cytometric analysis was performed on a FACSCanto II cytometer using FACSDiva software. Lymphocytes were gated on CD3, CD4, and CD8 staining. FACS-sorted CD4+CD8+ double-positive T-cells of GPA-patients and HC (n=3 each) were subjected to transcriptional profiling using an Affymetrix Human Genome 2.0 microarray. Differently expressed genes were analysed using biological databases.
RESULTS: Frequency of CD4+CD8+ double-positive T-cells was increased within the total CD3+ T-cell population in GPA, but no difference was detected between patients with active disease and remission. Percentages of interferon γ (Th1-type), interleukin 17 and interleukin 22 (Th17-type) producing CD4+CD8+ double-positive T-cells exceeded the percentage of interleukin 4 (Th2-type) producing cells. There were no significant differences in the percentages of the respective cytokine-positive CD4+CD8+ double-positive T-cells between GPA and HC. Up-regulated genes of CD4+CD8+ double-positive T-cells in GPA were enriched within Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways related to nuclear factor kappa-lightchain-enhancer of activated B cells signalling, toll-like receptor signalling, nucleotide-binding oligomerisation domain-like receptor signalling as well as major histocompatibility complex class-II antigen presentation.
CONCLUSIONS: Employing a combined phenotypic and transcriptomic approach we disclosed a Th1/Th17 phenotype as well as innate and adaptive functions of CD4+CD8+ double-positive T-cells in GPA.

PMID: 29799396 [PubMed - indexed for MEDLINE]

Distribution patterns of 18F-fluorodeoxyglucose in large vessels of Takayasu's and giant cell arteritis using positron emission tomography.

sam, 04/08/2018 - 10:49
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Distribution patterns of 18F-fluorodeoxyglucose in large vessels of Takayasu's and giant cell arteritis using positron emission tomography.

Clin Exp Rheumatol. 2018 Mar-Apr;36 Suppl 111(2):99-106

Authors: Soriano A, Pazzola G, Boiardi L, Casali M, Muratore F, Pipitone N, Catanoso M, Aldigeri R, Cimino L, Versari A, Salvarani C

Abstract
OBJECTIVES: To compare patterns of vascular involvement using 18F-fluorodeoxyglucose-positron emission tomography computed tomography (FDG PET/CT) in patients with giant cell arteritis (GCA) and Takayasu's arteritis (TAK).
METHODS: A total of 130 consecutive 18F-FDG PET/CT scans performed during the disease course for evaluating disease activity in 15 GCA and 13 TAK patients were retrospectively examined by two nuclear physicians blinded to clinical data. Standardised uptake values (SUVmax) in 14 vascular districts including all the aortic segments and the main tributaries were measured. The average SUVmax value for each vascular district was also calculated. Principal component analysis (PCA) and agglomerative hierarchical cluster analysis (CA) were used to explore distribution patterns of vascular FDG uptake.
RESULTS: The aortic segments showed the highest SUV max values among the different districts in both GCA and TAK. SUV max values measured in the different districts were significantly higher in GCA compared to TAK, except for the axillary arteries. Regarding thoracic and abdominal aorta, ascending aorta and aortic arch had the highest correlation in both vasculitis (p<0.0001). CA confirmed that carotid, axillary, subclavian, iliac and femoral arteries clustered with their contralateral counterpart in both vasculitis. The 3 components of thoracic aorta clustered with abdominal aorta in TAK, while aortic arch clustered only with ascending aorta, and descending and abdominal aorta grouped together with iliac and femoral arteries in GCA. PCA analysis identified 3 different components for TAK and GCA explaining 72% and 71% of the total variance respectively in these two vasculitis. Confirming CA, a component including the entire aortic district was identified in TAK, but not in GCA. Similar results in PCA using averaged data were observed.
CONCLUSIONS: Strong similarities, but also a subtle skewing in terms of distribution patterns of arterial involvement assessed by SUVmax values were observed between GCA and TAK.

PMID: 29799393 [PubMed - indexed for MEDLINE]

Manifestation of granulomatosis with polyangiitis in head and neck.

sam, 04/08/2018 - 10:49
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Manifestation of granulomatosis with polyangiitis in head and neck.

Clin Exp Rheumatol. 2018 Mar-Apr;36 Suppl 111(2):78-84

Authors: Kühn D, Hospowsky C, Both M, Hey M, Laudien M

Abstract
OBJECTIVES: Granulomatosis with polyangiitis is a rare autoimmune disease of the group of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Involvement of the ear, nose and throat (ENT)-region is only described in a few case series and case reports. The objective of this study is to systematically characterise the ENT-involvement in a large series of GPA patients.
METHODS: GPA patients examined in the Department of Otorhinolayngology of the Christian-Albrechts-University of Kiel between 1990 and 2012 were included. Diagnosis was based on histological, serological and clinical parameters. GPA patients were examined in a standardised way based on the Ear Nose and Throat Activity Score (ENTAS) or its precursor. Medical history, ENT examination, diagnostic findings (ear, nose) and cranial radiology were documented cumulatively.
RESULTS: A total of 230 GPA patients were included in this study. Over 95% of them showed ENT-involvement. 59% of the patients showed nasal obstructions, 57% a loss of smell. A hearing loss was diagnosed in 23% of the patients, 50% involvement in MR or CT scans and 15% showed laryngeal involvement.
CONCLUSIONS: The data of the largest monocentric study presented here demonstrate a frequent ENT-involvement in GPA patients. Rhinological and ontological manifestations are most common.

PMID: 29799391 [PubMed - indexed for MEDLINE]

Subclinical aortitis after starting nivolumab in a patient with metastatic melanoma. A case of drug-associated aortitis?

sam, 04/08/2018 - 10:49
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Subclinical aortitis after starting nivolumab in a patient with metastatic melanoma. A case of drug-associated aortitis?

Clin Exp Rheumatol. 2018 Mar-Apr;36 Suppl 111(2):171

Authors: Loricera J, Hernández JL, García-Castaño A, Martínez-Rodríguez I, González-Gay MÁ, Blanco R

PMID: 29799390 [PubMed - indexed for MEDLINE]

Distinct characteristics and outcomes in elderly-onset IgA vasculitis (Henoch-Schönlein purpura) with nephritis: Nationwide cohort study of data from the Japan Renal Biopsy Registry (J-RBR).

sam, 04/08/2018 - 10:49
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Distinct characteristics and outcomes in elderly-onset IgA vasculitis (Henoch-Schönlein purpura) with nephritis: Nationwide cohort study of data from the Japan Renal Biopsy Registry (J-RBR).

PLoS One. 2018;13(5):e0196955

Authors: Komatsu H, Fujimoto S, Maruyama S, Mukoyama M, Sugiyama H, Tsuruya K, Sato H, Soma J, Yano J, Itano S, Nishino T, Sato T, Narita I, Yokoyama H

Abstract
BACKGROUND: The clinical presentation and prognosis of adult and elderly patients with IgA vasculitis (Henoch-Schönlein purpura) accompanied by nephritis (IgAV-N) have not been investigated in detail. We therefore surveyed the features and outcomes of IgAV-N based on nationwide data derived from the Japan Renal Biopsy Registry (J-RBR).
METHODS: This multi-center cohort study compared the clinicopathological parameters at diagnosis, initial therapies and outcomes between 106 adult (age 19-64 years) and 46 elderly (≥65 years) patients with IgAV-N who were registered in the J-RBR between 2007 and 2012. The primary end-points comprised a 50% increase in serum creatinine (sCr) values or end-stage kidney disease. Factors affecting a decrease in renal function were assessed using Cox proportional hazards models.
RESULTS: Rates of hypertension, impaired renal function, hypoalbuminemia and crescentic glomerulonephritis were significantly higher among the elderly, than the adult patients. About 80% and 60% of the patients in both groups were respectively treated with corticosteroid and a renin-angiotensin system (RAS) blockade. Both groups had favorable renal survival rates for nine years (93.6% and 91.4% of the adult and elderly patients, respectively). Significantly more elderly than adult patients developed a 50% increase in sCr during a mean observation period of 3.9 years (21.7% vs. 4.7%, p = 0.012), and significantly fewer elderly, than adult patients achieved clinical remission (23.9% vs. 46.2%, p = 0.016). Multivariate analysis selected advanced age (≥65 years) and lower serum albumin values as independent prognostic factors for a decline in renal function, whereas steroid pulse therapy helped to preserve renal function.
CONCLUSIONS: The renal prognosis of adult and elderly patients with IgAV-N was favorable when treated aggressively with corticosteroid and RAS blockade. However, the course of renal function should be carefully monitored in patients aged over 65 years and those with hypoalbuminemia.

PMID: 29738576 [PubMed - indexed for MEDLINE]

Potential predictors for frequent relapse in human leukocyte antigen-B27-associated uveitis.

jeu, 26/07/2018 - 06:52
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Potential predictors for frequent relapse in human leukocyte antigen-B27-associated uveitis.

Graefes Arch Clin Exp Ophthalmol. 2018 Aug;256(8):1543-1549

Authors: Kim M, Sim YS, Choi SY, Park YH

Abstract
PURPOSE: To identify potential predictors for frequent relapse in a cohort of patients with human leukocyte antigen (HLA)-B27-associated uveitis in a tertiary referral center at the initial visit.
METHODS: This retrospective cohort study comprised 130 patients diagnosed with HLA-B27-associated uveitis. Subjects were divided into two groups according to the frequency of uveitis attacks (number/year): frequent relapse (FR) (who relapsed more than twice a year, 38) and infrequent relapse (IR) group (who relapsed twice or less than twice a year, 92).
RESULTS: The FR group presented more often with hypopyon or posterior synechiae at the initial presentation. Interestingly, posterior segment involvements including vitritis, vasculitis, or cystoid macular edema were not significantly different between the groups. In terms of laboratory findings, the erythrocyte sedimentation rate (ESR) was higher in the FR group. Multivariate Cox hazards analysis showed male sex, the presence of hypopyon, and ESR to be potential predictive factors for frequent relapse.
CONCLUSION: We found that male sex, hypopyon at presentation, and high ESR are potential predictors for frequent relapse in HLA-B27-associated uveitis. Identifying patients at higher risk of relapse could provide important information for patients, allowing patients to understand their condition and increase their acceptance of strict management.

PMID: 29705838 [PubMed - indexed for MEDLINE]

The Acupuncture Therapeutic Approach in Temporal Arteritis Vasculitis: A Case Report.

jeu, 26/07/2018 - 06:52
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The Acupuncture Therapeutic Approach in Temporal Arteritis Vasculitis: A Case Report.

J Acupunct Meridian Stud. 2018 Jun;11(3):116-118

Authors: Sezgin Y

Abstract
Temporal arteritis is a form of vasculitis that involves the large- and medium-diameter arteries and leads to progressive headache. Symptoms may be accompanied by vision disorder, subfebrile temperature, fatigue, lack of appetite, weight loss, sweating, and joint pains. While cortisone therapy reduces the symptoms, its effects in terms of improving quality of life are limited. We opted to benefit from the effects of acupuncture to reduce symptoms and increase quality of life in a case of temporal arteritis, a chronic disease. A 75-year-old woman presented with pain on both sides of the head. The pain occurred in the form of agonizing attacks 2-3 times a week. Accompanying neck pain was present, together with continuous lethargy and fatigue. Physical examination revealed decreased cutaneous elasticity and muscle mass, and a depressive mood state was present. The patient was first administered six sessions of acupuncture therapy directed toward the migraine etiology. When no response was achieved, we investigated temporal and parietal region points associated with headache in the literature. Points GB1,8,18, ST8, SI19, and BL8 were added to the treatment. The pain attacks and their frequency decreased following acupuncture therapy. In conclusion, while cortisone is the first preference in the treatment of temporal arteritis, we think that acupuncture aimed at the cause of accompanying symptoms can also be useful.

PMID: 29436372 [PubMed - indexed for MEDLINE]

Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body.

ven, 20/07/2018 - 01:44
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Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body.

Indian J Ophthalmol. 2018 07;66(7):1031-1033

Authors: Madanagopalan VG, Nagesha CK, Velis G, Devulapally S, Balamurugan S

Abstract
A 54-year-old male sustained ocular trauma with a projectile. Examination of the right eye revealed an intraocular foreign body (IOFB) adjacent to the optic nerve head, vitritis, vitreous hemorrhage, and translucent perivascular sheathing of the retinal vessels in all quadrants suggesting frosted branch angiitis (FBA). The patient underwent vitrectomy with removal of the IOFB and silicone oil tamponade under steroid cover. With continued use of systemic and topical steroids after surgery, complete resolution of FBA and improvement in vision were noted in a week. Prompt resolution of FBA after IOFB removal points toward a strong association between the presence of IOFB and FBA.

PMID: 29941765 [PubMed - indexed for MEDLINE]

Assessment of a topical product based on polysulfated galactosaminoglycan as an adjuvant in the treatment of acute STP and stasis dermo-hypodermitis.

ven, 20/07/2018 - 01:44
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Assessment of a topical product based on polysulfated galactosaminoglycan as an adjuvant in the treatment of acute STP and stasis dermo-hypodermitis.

Minerva Med. 2018 Aug;109(4):276-279

Authors: Santoliquido A

Abstract
BACKGROUND: Superficial thrombophlebitis (STP) is a relatively frequent pathology characterized by possible extension to the deep venous circulation, with notable local inflammatory reaction which is treated by subcutaneous administration of Fondaparinux. Stasis dermo-hypodermitis is characterized by cutaneous hyperpigmentation and eczema, treatment for which consists of the use of drugs targeting endothelial cells (mesoglycan, FFPM, sulodexide). In this study we evaluated the impact of local application of a mixture of semi-synthetic polysulfated galactosaminoglycans on the regression rate of STP and dermo-hypodermitis in patients treated with best medical therapy (BMT).
METHODS: Thirty patients (20 F and 10 M) were enrolled from May to December 2017, 20 with dermo-hypodermitis due to stasis secondary to post-thrombotic syndrome (PTS) and 10 with acute STP of the great saphenous vein or its collaterals. Topical administration of the galactosaminoglycan-based product was added to the BMT of 10 pts with PTS and 5 pts with STP for 45-60 days. In all patients a Visual Analogical Scale (VAS) was used to assess the intensity of spontaneous and induced pain at 0, 15, 30, 45 and 60 days.
RESULTS: With regard to PTS, VAS values at time 0 were comparable between the two groups, while at later times there was a progressive reduction in the score, with values of ≤2 at 30 days for patients treated with the topical product based on galactosaminoglycans vs. 60 days for the other control subjects. With regard to STP, the values of VAS at time 0 between the two groups were comparable, while at time 15 the VAS value was lower in subjects treated with the topical product.
CONCLUSIONS: This pilot study on the efficacy of a local formulation of a mixture of semi-synthetic polysulfated galactosaminoglycans highlighted the role of this product in accelerating the recovery of patients at the most advanced stages of chronic venous disease (CVD) and in the management of its complications. In the future, studies of larger series will be needed with the use of placebo to substantiate their effectiveness in these conditions and in other classes of CVD.

PMID: 29696940 [PubMed - indexed for MEDLINE]

Diagnostic positron emission tomography-computed tomography in clinically elusive giant cell arteritis.

ven, 20/07/2018 - 01:44
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Diagnostic positron emission tomography-computed tomography in clinically elusive giant cell arteritis.

Indian J Ophthalmol. 2018 05;66(5):693-694

Authors: Mohamed R, Djama D, Ayoub T

PMID: 29676318 [PubMed - indexed for MEDLINE]

Mortality causes and trends associated with giant cell arteritis: analysis of the French national death certificate database (1980-2011).

ven, 20/07/2018 - 01:44
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Mortality causes and trends associated with giant cell arteritis: analysis of the French national death certificate database (1980-2011).

Rheumatology (Oxford). 2018 Jun 01;57(6):1047-1055

Authors: Aouba A, Gonzalez Chiappe S, Eb M, Delmas C, de Boysson H, Bienvenu B, Rey G, Mahr A

Abstract
Objectives: Comprehensive analyses of cause-specific death patterns in GCA are sparse. We studied the patterns and time trends in GCA-related mortality using a large death certificate database.
Methods: We obtained multiple-cause-of-death data from the French national death certificate database for 1980-2011. GCA-associated deaths were defined as decedents ⩾55 years old with GCA listed as an underlying or non-underlying cause of death. Time trends of death rates were analysed and the mean age at death with GCA and in the general population ⩾55 years old were calculated. Standardized mortality odds ratios (SMORs) were calculated for 17 selected causes of death (based on 2000-11 data).
Results: The analyses pertained to approximately 15 000 death certificates listing GCA (including approximately 6300 for 2000-11). Annual standardized death rates for GCA increased to a peak in 1997 and then decreased (Spearman's correlation test, both P < 0.0001). Mean age at death was higher for GCA than for general population decedents (Student's t-test, P < 0.0001). GCA deaths were frequently or strongly associated with aortic aneurysm and dissection (1.85% of death certificates, SMOR: 3.09, 95% CI: 2.48, 3.82), hypertensive disease (20.78%, SMOR: 2.22, 95% CI: 1.97, 2.50), diabetes mellitus (11.27%, SMOR: 1.96, 95% CI: 1.72, 2.23), certain infectious and parasitic diseases (12.12%, SMOR: 1.76, 95% CI: 1.55, 2.00) and ischaemic heart disease (16.54%, SMOR: 1.45, 95% CI: 1.35, 1.64).
Conclusion: GCA is associated with increased risk of dying from large-vessel disease, other cardiovascular diseases and potentially treatment-related co-morbidities. These findings help provide better insights into the outcomes of GCA.

PMID: 29554340 [PubMed - indexed for MEDLINE]

Using serum troponins to screen for cardiac involvement and assess disease activity in the idiopathic inflammatory myopathies.

ven, 20/07/2018 - 01:44
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Using serum troponins to screen for cardiac involvement and assess disease activity in the idiopathic inflammatory myopathies.

Rheumatology (Oxford). 2018 06 01;57(6):1041-1046

Authors: Lilleker JB, Diederichsen ACP, Jacobsen S, Guy M, Roberts ME, Sergeant JC, Cooper RG, Diederichsen LP, Chinoy H

Abstract
Objectives: Limitations in the methods available for identifying cardiac involvement and accurately quantifying disease activity in the idiopathic inflammatory myopathies (IIMs) may contribute to poor outcomes. We investigated the utility of different serum muscle damage markers [total creatine kinase (CK), cardiac troponin T (cTnT) and cardiac troponin I (cTnI)] to address these issues.
Methods: We assessed disease activity and cardiac involvement using the International Myositis Assessment and Clinical Studies Group core set measures in 123 participants with confirmed adult-onset IIM from the UK and Denmark. Total CK, cTnT and cTnI were measured. Associations were assessed using logistic regression and Spearman's ranked correlation.
Results: Cardiac involvement (n = 18) was associated with higher cTnI levels, independent of overall disease activity [adjusted odds ratio 1.03 (95% CI 1.01, 1.05); P = 0.002]. An abnormal cTnI had the highest specificity and positive predictive value for cardiac involvement (95% and 62%, respectively). In those with a normal CK but elevated cTnT or cTnI, an association with increased disease activity scores was observed. Serum cTnT correlated with the physician (ρ = 0.39) and patient-assessed (ρ = 0.28) global visual analogue scales and HAQ (ρ = 0.41) more strongly than CK or cTnI levels. cTnT was the only marker to correlate with manual muscle testing scores (ρ = -0.24).
Conclusion: Serum cTnI testing may have a role in screening for cardiac involvement in IIMs. Abnormal levels of serum cTnT and cTnI are associated with increased disease activity, including in those with a normal CK.

PMID: 29538753 [PubMed - indexed for MEDLINE]

Novel insights into the aetiology of granulomatosis with polyangiitis-a case-control study using the Clinical Practice Research Datalink.

ven, 20/07/2018 - 01:44
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Novel insights into the aetiology of granulomatosis with polyangiitis-a case-control study using the Clinical Practice Research Datalink.

Rheumatology (Oxford). 2018 06 01;57(6):1002-1010

Authors: Pearce FA, Lanyon PC, Watts RA, Grainge MJ, Abhishek A, Hubbard RB

Abstract
Objectives: We aimed to provide insights into the aetiology of granulomatosis with polyangiitis (GPA), by conducting a large case-control study using a general population-based, prospectively collected database of healthcare records.
Methods: We compared all incident cases of GPA in the Clinical Practice Research Datalink 1990-2014, with up to 10 age-, sex- and general practice-matched controls. We identified potential risk factors, recorded numbers of cases and controls exposed to each, and calculated odds ratios (ORs) using conditional logistic regression. Our main analysis excluded data recorded during 1 year before diagnosis, to prevent early symptoms being mistaken for risk factors.
Results: We identified 757 people with GPA and matched 7546 controls. People with GPA were five times more likely to have a previous diagnosis of bronchiectasis (OR = 5.1, 95% CI: 2.7, 9.4; P < 0.0001), and these effects remained stable in diagnoses recorded >5 years prior to diagnosis. People with GPA were two to three times more likely than controls to have previous diagnoses of autoimmune diseases or chronic renal impairment, and these effects also remained stable >5 years prior to diagnosis. People with GPA were more likely to have a diagnosis of pulmonary fibrosis (OR = 5.7, 95% CI: 1.7, 19.5; P = 0.01) and sinus infections (OR = 2.7, 95% CI: 1.8, 4.2; P < 0.0001) recorded in the 3 years before diagnosis, but not before this. We also found former smoking, some medications and higher socio-economic status significantly, but less strongly, associated.
Conclusion: We found novel long-term associations between GPA and pre-existing bronchiectasis and autoimmune diseases.

PMID: 29529281 [PubMed - indexed for MEDLINE]

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