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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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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]

Magnetic resonance angiography in giant cell arteritis: results of a randomized controlled trial of tocilizumab in giant cell arteritis.

ven, 20/07/2018 - 01:44
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Magnetic resonance angiography in giant cell arteritis: results of a randomized controlled trial of tocilizumab in giant cell arteritis.

Rheumatology (Oxford). 2018 06 01;57(6):982-986

Authors: Reichenbach S, Adler S, Bonel H, Cullmann JL, Kuchen S, Bütikofer L, Seitz M, Villiger PM

Abstract
Objective: To analyse magnetic resonance angiographic (MRA) vessel wall signals from a randomized controlled trial of tocilizumab (TCZ) to treat GCA.
Methods: Participants were assigned in a 2:1 ratio to receive either TCZ + glucocorticoids (GCs) or placebo + GC infusions at 4-week intervals for 52 weeks. GCs were started at 1 mg/kg/day, then tapered to 0.1 mg/kg/day at week 12 and thereafter down to zero. Patients with initial positive MRA findings underwent control MRA at weeks 12 and 52. Vessel wall signals were scored from 0 (normal) to 3 (intense late enhancement). Outcomes were the number of patients with complete MRA remission at weeks 12 and 52, and changes in vasculitis score, vessel anatomy and atherosclerosis.
Results: Of the 30 randomized participants, nine TCZ and two placebo patients had no vessel wall enhancement on initial MRA. At week 12, MRAs were performed in nine TCZ and four placebo patients (nine and three in clinical remission, respectively). Three (33%) TCZ patients showed normalization of vessel wall signals compared with one (25%) placebo patient. At week 52, there was additional MRA improvement in some TCZ patients, but one-third showed persistent or increased late vessel wall enhancement. There was no formation of aneurysms or stenosis and no increase in atherosclerosis.
Conclusions: Although TCZ resulted in complete clinical and laboratory remission of GCA over 52 weeks, MRA signals in vessel walls normalized in only one-third of patients. Whether these signals are of prognostic importance remains to be determined.

PMID: 29529280 [PubMed - indexed for MEDLINE]

mTOR pathway is activated in endothelial cells from patients with Takayasu arteritis and is modulated by serum immunoglobulin G.

ven, 20/07/2018 - 01:44
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mTOR pathway is activated in endothelial cells from patients with Takayasu arteritis and is modulated by serum immunoglobulin G.

Rheumatology (Oxford). 2018 06 01;57(6):1011-1020

Authors: Hadjadj J, Canaud G, Mirault T, Samson M, Bruneval P, Régent A, Goulvestre C, Witko-Sarsat V, Costedoat-Chalumeau N, Guillevin L, Mouthon L, Terrier B, French Vasculitis Study Group

Abstract
Objectives: Takayasu arteritis (TA) and GCA are large-vessel vasculitides characterized by vascular remodelling involving endothelial cells (ECs) and vascular smooth muscle cells. Mammalian target of rapamycin (mTOR) pathway has been involved in vascular remodelling. We hypothesized that the mTOR pathway was involved in the pathogenesis of large-vessel vasculitis.
Methods: We used IF analysis on aortic and temporal artery biopsies from patients with TA and GCA to assess the involvement of the mTOR pathway and searched for antibodies targeting ECs in serum by IIF and cellular ELISA. We evaluated in vitro the effect of purified IgG from patients on mTOR pathway activation and cell proliferation.
Results: IF analyses on tissues revealed that both mTORC1 and mTORC2 are activated specifically in ECs from TA patients but not in ECs from GCA patients and healthy controls (HCs). Using IIF and ELISA, we observed higher levels of antibodies binding to ECs in TA patients compared with GCA patients and HCs. Using western blot, we demonstrated that purified IgG from TA patients caused mTORC1 activation in ECs, whereas this effect was not observed with purified IgG from GCA patients or HCs. Purified IgG from TA patients induced a significant EC proliferation compared with to GCA and HC IgG, and this effect was decreased after EC exposure with sirolimus, a specific mTOR inhibitor and PI3K inhibitor.
Conclusion: Our results suggest that antibodies targeting ECs drive endothelial remodelling in TA through activation of the mTOR pathway, but not in GCA. Inhibition of the mTOR pathway could represent a therapeutic option in TA.

PMID: 29506143 [PubMed - indexed for MEDLINE]

Neuro-Behcet's disease in a patient with thrombotic thrombocytopenic purpura.

ven, 20/07/2018 - 01:44
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Neuro-Behcet's disease in a patient with thrombotic thrombocytopenic purpura.

Rheumatology (Oxford). 2018 Jun 01;57(6):1117-1118

Authors: Karaivanov S, Krueger A, Bethke N, Radbruch H, Eckardt KU, Schreiber A

PMID: 29444324 [PubMed - indexed for MEDLINE]

Central retinal vein occlusion in temporal arteritis: red sign or red herring?

ven, 20/07/2018 - 01:44
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Central retinal vein occlusion in temporal arteritis: red sign or red herring?

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

Authors: Kaly L, Slobodin G, Rimar D, Rozenbaum M, Boulman N, Ginsberg S, Awisat A, Zilber K, Hussein H, Rosner I

PMID: 29361164 [PubMed - indexed for MEDLINE]

Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease.

ven, 20/07/2018 - 01:44
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Immediate and late outcomes of endovascular therapy for lower extremity arteries in Buerger disease.

J Vasc Surg. 2018 06;67(6):1769-1777

Authors: Kim DH, Ko YG, Ahn CM, Shin DH, Kim JS, Kim BK, Choi D, Hong MK, Jang Y

Abstract
OBJECTIVE: Buerger disease is a rare inflammatory vasculopathy presenting with severe claudication or critical limb ischemia. In this study, we sought to evaluate the feasibility and clinical outcomes of endovascular therapy for Buerger disease involving arteries in the lower extremities.
METHODS: Between January 2006 and May 2016, there were 44 Buerger disease patients (43 men; mean age, 40.4 ± 9.6 years) with 50 target limbs treated by endovascular therapy at the Severance Cardiovascular Hospital. Baseline characteristics as well as both immediate and late clinical outcomes were retrospectively analyzed.
RESULTS: The majority (86.4%) of patients presented with critical limb ischemia. A total of 88 target lesions in 50 limbs were treated with endovascular procedures. All limbs showed infrapopliteal artery occlusions, and multilevel diseases involving the iliac or femoropopliteal artery were found in 31 patients (62%). Technical success was achieved in 80% of subjects. We found that a lower serum level of C-reactive protein, specifically the log C-reactive protein value (odds ratio, 0.03; 95% confidence interval [CI], 0.00-0.71; P = .030), was an independent predictor of technical failure. The median follow-up duration was 29 months. Major adverse limb event-free survival and reintervention- and amputation-free survival were 83.3% and 67.9% at 3 years, respectively. In a multivariate Cox proportional hazards analysis, previous endovascular treatment (hazard ratio, 3.70; 95% CI, 1.20-11.31; P = .022) and previous amputation (hazard ratio, 4.68; 95% CI, 1.37-15.96; P = .014) were identified as independent risk factors for reintervention- and amputation-free survival.
CONCLUSIONS: In patients with Buerger disease, endovascular treatment achieved technical success in the majority of the cases and was associated with favorable immediate and late clinical outcomes. These findings indicate that endovascular therapy may be considered a first-line treatment option for severe symptomatic patients with Buerger disease.

PMID: 29157680 [PubMed - indexed for MEDLINE]

An Unusual Case of Abdominal Pain.

ven, 20/07/2018 - 01:44
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An Unusual Case of Abdominal Pain.

Gastroenterology. 2018 06;154(8):e1-e2

Authors: Zhao Q, Zhang S, Dong A

PMID: 28870529 [PubMed - indexed for MEDLINE]

Severe ischemic cytomegalovirus proctocolitis with multiple perforation.

mar, 10/07/2018 - 21:02
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Severe ischemic cytomegalovirus proctocolitis with multiple perforation.

Arch Virol. 2018 Jul;163(7):1927-1931

Authors: D'cruz RT, Lau CC, Thamboo TP

Abstract
Cytomegalovirus (CMV) typically causes gastrointestinal infections in immunocompetent patients. Colonic perforations secondary to CMV are exceeding rare. We describe a 88-year-old male presenting with a week-long history of intractable abdominal discomfort, bloating, nausea and diarrhea. Flexible sigmoidoscopy revealed significant ulceration with yellowish slough. Emergency surgery was performed subsequently in view of multiple perforations in the rectosigmoid junction. CMV gastrointestinal infections demonstrated an ischemic process secondary to vasculitis, which accelerated the pathway to colonic perforation. CMV gastrointestinal infection should be considered as a differential diagnosis in patients with colonoscopy findings similar to ischemic colitis and Clostridium difficile infections.

PMID: 29532267 [PubMed - indexed for MEDLINE]

Cataract surgery combined with micro-incision vitrectomy in patients with behcet's disease uveitis.

sam, 07/07/2018 - 20:15
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Cataract surgery combined with micro-incision vitrectomy in patients with behcet's disease uveitis.

BMC Ophthalmol. 2018 Jun 28;18(1):158

Authors: Fan F, Jia Z, Li K, Zhao X, Ma Q

Abstract
BACKGROUND: This study sought to report the outcomes of a combined cataract extraction, intraocular lens (IOL) insertion and micro-incision vitrectomy (MIVS) procedure for the treatment of Behcet uveitis.
METHODS: This investigation involved the retrospective evaluation of a case series of patients with Behcet uveitis who underwent cataract extraction, IOL insertion and MIVS in a single surgical session at the same institution between January 2013 and November 2016. Outcome measures included visual acuity, inflammatory reaction, systemic anti-inflammatory medications, intraocular pressure (IOP) and complications.
RESULTS: Seven eyes of seven patients with a mean age of 39.00 ± 5.54 years (range, 32 to 48 years) and a mean follow-up duration of 13.57 ± 5.83 months (range, 6 to 24 months) were studied; five patients with a history of well-controlled uveitis were included. All patients underwent cataract extraction and IOL implantation combined with MIVS. All patients received postoperative steroids, which were slowly tapered during the weeks after surgery. There were no significant complications related to the surgery. Overall, best-corrected visual acuity (BCVA) was improved from log MAR (logarithm of the minimum angle of resolution) 1.67 ± 0.67 preoperatively to log MAR 0.74 ± 0.35 postoperatively; this improvement was statistically significant (p < 0.05). All eyes were deemed quiet at follow-up, and no patients required the escalation of therapy for long-term uveitis control.
CONCLUSIONS: This retrospective series indicates that a procedure that combines phacoemulsification, IOL implantation and MIVS is a feasible technique for the removal of cataracts and pathologic vitreous in eyes with Behcet uveitis. This approach can restore vision without obvious complications.

PMID: 29954349 [PubMed - indexed for MEDLINE]

The co-existence of Lemierre's syndrome and Bezold's abscesses due to Streptococcus constellatus: A case report.

sam, 07/07/2018 - 20:15
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The co-existence of Lemierre's syndrome and Bezold's abscesses due to Streptococcus constellatus: A case report.

Medicine (Baltimore). 2018 Jun;97(26):e11228

Authors: Yaita K, Sugi S, Hayashi M, Koga T, Ebata T, Sakai Y, Kaieda S, Ida H, Watanabe H

Abstract
RATIONALE: The ancient infectious diseases, Lemierre's Syndrome and Bezold's Abscesses are rare.
PATIENT CONCERNS: A 70-year-old Japanese woman with a 15-year history of Parkinson's disease was referred to our hospital due to fever, occipital headache and bilateral shoulder pain that had continued for three months. She had been prescribed prednisolone due to a diagnosis of polymyalgia rheumatica.
DIAGNOSES: A blood culture revealed bacteremia of Streptococcus constellatus. In addition, computed tomography revealed Bezold's abscesses and Lemierre's syndrome.
INTERVENTIONS: We administered ceftriaxone for 31 days, followed by oral amoxicillin.
OUTCOMES: The patient recovered and the abscesses improved.
LESSONS: This case underscores the importance of blood culture tests and cross-referencing with radiological imagings in the diagnoses of these rare critical infectious diseases that mimic polymyalgia rheumatica.

PMID: 29952983 [PubMed - indexed for MEDLINE]

Behçet disease associated with gastrointestinal amyloidosis manifested as hematochezia: A case report.

sam, 07/07/2018 - 20:15
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Behçet disease associated with gastrointestinal amyloidosis manifested as hematochezia: A case report.

Medicine (Baltimore). 2018 Jun;97(26):e11153

Authors: Sato S, Yashiro M, Matsuoka N, Kawana S, Asano T, Kobayashi H, Tasaki K, Watanabe H, Hashimoto Y, Migita K

Abstract
RATIONALE: Behçet disease (BD) is an inflammatory disorder characterized by recurrent oral aphthous ulcers, genital ulcers, ocular lesions, and skin lesions. Complication of amyloidosis in patients with BD is rare. Here, we report a case of BD with immunoglobulin light chain (AL)-amyloidosis manifested as hematochezia.
PATIENT CONCERNS: A 61-year-old man developed sudden hematochezia due to bleeding from multiple small colonic ulcers; AL-amyloid deposition was found on immunohistochemical examination of biopsy specimen of colonic ulcer. Systemic investigation revealed cardiac disfunction with cardiomegaly and progressive renal dysfunction, which indicated the presence of systemic AL-amyloidosis.
DIAGNOSES: Based on the findings of colonic ulcers with cardiac and renal involvement, a diagnosis of systemic AL-amyloidosis complicated by incomplete BD was established.
INTERVENTIONS: He was treated with increased dose of oral prednisolone (20 mg/day), colchicine and mesalazine, because he was reluctant to receive aggressive chemotherapy (melphalan and dexamethasone) or autologous stem cell transplantation.
OUTCOMES: Colonic ulcers completely diminished after treatment, however, he died because of severe urinary tract infection and progressive renal failure after one year of gastrointestinal (GI) manifestations.
LESSONS: Our case shows that patients with BD may have GI manifestations due not only to entero-BD but also due to GI amyloidosis.

PMID: 29952963 [PubMed - indexed for MEDLINE]

Tongue Necrosis in Giant-Cell Arteritis.

sam, 07/07/2018 - 20:15
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Tongue Necrosis in Giant-Cell Arteritis.

N Engl J Med. 2018 Jun 28;378(26):2517

Authors: Truffaut L, Lefebvre P

PMID: 29949496 [PubMed - indexed for MEDLINE]

Case 20-2018: A 64-Year-Old Man with Fever, Arthralgias, and Testicular Pain.

sam, 07/07/2018 - 20:15
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Case 20-2018: A 64-Year-Old Man with Fever, Arthralgias, and Testicular Pain.

N Engl J Med. 2018 Jun 28;378(26):2518-2529

Authors: Sacks CA, Kilcoyne A, Wallace ZS, Glomski K

PMID: 29949483 [PubMed - indexed for MEDLINE]

Adalimumab therapy in hepatitis B virus-negative polyarteritis nodosa: A case report.

dim, 01/07/2018 - 17:05
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Adalimumab therapy in hepatitis B virus-negative polyarteritis nodosa: A case report.

Medicine (Baltimore). 2018 Jun;97(25):e11053

Authors: Wang CR, Yang CC

Abstract
INTRODUCTION: Polyarteritis nodosa (PAN) is a difficult-to-treat rheumatology disorder, and biologic agents have been used in such patients with a treatment failure or the disease relapse.
CASE PRESENTATION: We report a 42-year-old male Han Chinese who received adalimumab (ADA) alone during his vasculitis relapse, manifesting with weight loss, ankle arthritis, testicular inflammation and new-onset hypertension. Under the ADA 40 mg biweekly subcutaneous injection, there were the disappearance of clinical activity and no disease flares with a follow-up period of 26 months.
CONCLUSION: The clinical observation in this patient suggests a potential efficacy of ADA therapy in controlling the disease activity of PAN.

PMID: 29923995 [PubMed - indexed for MEDLINE]

Large-vessel vasculitis in human immunodeficiency virus-infected patients.

jeu, 28/06/2018 - 14:38
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Large-vessel vasculitis in human immunodeficiency virus-infected patients.

J Vasc Surg. 2018 05;67(5):1501-1511

Authors: Ferfar Y, Savey L, Comarmond C, Sadaghianloo N, Garrido M, Domont F, Valantin MA, Pourcher-Martinez V, Cluzel P, Fouret P, Chiche L, Gaudric J, Koskas F, Cacoub P, Saadoun D

Abstract
OBJECTIVE: The objective of this study was to describe large-vessel vasculitis (LVV) in patients with human immunodeficiency virus (HIV) infection. It is a retrospective single-center study conducted between 2000 and 2015 through a university hospital of 11 HIV-infected patients with LVV.
METHODS: The characteristics and outcome of 11 HIV-infected patients with LVV (7 patients fulfilled international criteria for Takayasu arteritis, 5 patients had histologic findings of vasculitis, and 5 patients had imaging features of aortitis) were analyzed and compared with those of 82 patients with LVV but without HIV infection.
RESULTS: Concerning the HIV-infected patients with LVV (n = 11), the mean age was 40 years (range, 36-56 years), and 55% of patients were female. At diagnosis of LLV, the mean initial CD4 cell count was 455 cells/mm3 (range, 166-837 cells/mm3), and the median HIV viral load was 9241 copies. Vascular lesions were located in the aorta (n = 7), in supra-aortic trunks (n = 7), and in digestive arteries (n = 3). Inflammatory aorta infiltrates showed a strong expression of interferon-γ and interleukin 6. In HIV-negative LVV patients (n = 82), the median age was 42 years, and 88% of the patients were women. Thirty patients had an inflammatory syndrome. Seventy patients had been treated with glucocorticosteroids and 57 with immunosuppressive treatments. Compared with their negative counterparts, HIV-positive patients with LVV were more frequently male (P = .014), had more vascular complications (ie, Ishikawa score; P = .017), and had more frequent revascularization (P = .047). After a mean follow-up of 96 months, four relapses of vasculitis were reported, and one patient died. Regardless of the HIV virologic response, antiretroviral therapy improved LVV in only one case.
CONCLUSIONS: LVV in HIV-infected patients is a rare and severe entity.

PMID: 29242069 [PubMed - indexed for MEDLINE]

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