Temporal Arteritis Revealing Antineutrophil Cytoplasmic Antibody-Associated Vasculitides: A Case-Control Study.

Aged Aged, 80 and over Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / diagnosis Arteritis / diagnosis Asthenia / physiopathology Case-Control Studies Cough / physiopathology Delayed Diagnosis Diagnosis, Differential Diplopia / physiopathology Female Fever / physiopathology France Giant Cell Arteritis / diagnosis Glucocorticoids / therapeutic use Headache / physiopathology Humans Jaw Male Middle Aged Pain / physiopathology Polymyalgia Rheumatica / physiopathology Proportional Hazards Models Retrospective Studies Scalp Sweating Temporal Arteries / pathology Treatment Failure Vision Disorders / physiopathology Weight Loss

Journal

Arthritis & rheumatology (Hoboken, N.J.)

ISSN: 2326-5205

Titre abrégé: Arthritis Rheumatol

Pays: United States

ID NLM: 101623795

Informations de publication

Date de publication:
02 2021

Historique:

received: 22 08 2019

accepted: 20 08 2020

pubmed: 21 9 2020

medline: 2 3 2021

entrez: 20 9 2020

Statut: ppublish

Résumé

Temporal arteritis (TA) is a typical manifestation of giant cell arteritis (GCA). Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are rarely revealed by TA manifestations, leading to a risk of misdiagnosis of GCA and inappropriate treatments. This study was undertaken to describe the clinical, biologic, and histologic presentations and outcomes in cases of TA revealing AAV (TA-AAV) compared to controls with classic GCA. In this retrospective case-control study, the characteristics of patients with TA-AAV were compared to those of control subjects with classic GCA. Log-rank test, with hazard ratios (HRs) and 95% confidence intervals (95% CIs), was used to assess the risk of treatment failure. Fifty patients with TA-AAV (median age 70 years) were included. Thirty-three patients (66%) presented with atypical symptoms of GCA (ear, nose, and throat involvement in 32% of patients, and renal, pulmonary, and neurologic involvement in 26%, 20%, and 16% of patients, respectively). Blood samples were screened for ANCAs at the time of disease onset in 33 patients, and results were positive in 88%, leading to a diagnosis of early TA-AAV in 20 patients. The diagnosis of AAV was delayed a median interval of 15 months in 30 patients. Compared to controls with GCA, patients with TA-AAV were younger (median age 70 years versus 74 years), were more frequently men (48% versus 30%), and had high frequencies of atypical manifestations and higher C-reactive protein levels (median 10.8 mg/dl versus 7.0 mg/dl). In patients with TA-AAV, temporal artery biopsy (TAB) showed fibrinoid necrosis and small branch vasculitis in 23% of patients each, whereas neither of these characteristics was evident in controls with GCA. Treatment failure-free survival was comparable between early TA-AAV cases and GCA controls, whereas those with delayed TA-AAV had a significantly higher risk of treatment failure compared to controls (HR 3.85, 95% CI 1.97-7.51; P < 0.0001). TA-AAV should be considered diagnostically in cases of atypical manifestations of GCA, refractoriness to glucocorticoid treatment, or early relapse. Analysis of TAB specimens for the detection of small branch vasculitis and/or fibrinoid necrosis could be useful. Detection of ANCAs should be performed in cases of suspected GCA with atypical clinical features and/or evidence of temporal artery abnormalities on TAB.

Identifiants

DOI: 10.1002/art.41527 PMID: 32951354

pubmed: 32951354

doi: 10.1002/art.41527

doi:

Substances chimiques

Glucocorticoids 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

286-294

Commentaires et corrections

Type : CommentIn

Informations de copyright

Références

Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Arthritis Rheum 2013;65:1-11.

Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990;33:1122-8.

Bloch DA, Michel BA, Hunder GG, McShane DJ, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis: patients and methods. Arthritis Rheum 1990;33:1068-73.

Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Gonzalez-Louzao C, Rodriguez-Ledo P. Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Semin Arthritis Rheum 2001;30:249-56.

Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet Lond Engl 2008;372:234-45.

Cavazza A, Muratore F, Boiardi L, Restuccia G, Pipitone N, Pazzola G, et al. Inflamed temporal artery: histologic findings in 354 biopsies, with clinical correlations. Am J Surg Pathol 2014;38:1360-70.

Généreau T, Lortholary O, Pottier MA, Michon-Pasturel U, Ponge T, de Wazières B, et al. Temporal artery biopsy: a diagnostic tool for systemic necrotizing vasculitis. Arthritis Rheum 1999;42:2674-81.

Vermeulen JP, Mahowald ML. A case of Wegener’s granulomatosis presenting with jaw claudication. J Rheumatol 1984;11:707-9.

Garrouste C, Sailler L, Astudillo L, Lavayssière L, Cointault O, Borel C, et al. Fulminant alveolar hemorrhage: evolution of giant cell arteritis to ANCA-positive vasculitis? Rev Med Interne 2008;29:232-5. In French.

McCarthy A, Farrell M, Hedley-Whyte T, McGuone D, Kavanagh E, McNally S, et al. Granulomatosis with polyangiitis masquerading as giant cell arteritis [letter]. J Neurol 2013;260:1661-3.

Fujii K, Tsutsumi T, Takaoka K, Osugi Y, Ando S, Koyama Y. A concomitant case of giant cell arteritis and microscopic polyangiitis with hemoperitoneum by rupture of the gastroepiploic artery. Mod Rheumatol 2012;22:934-8.

Chirinos JA, Tamariz LJ, Lopes G, Carpio FD, Zhang X, Milikowski C, et al. Large vessel involvement in ANCA-associated vasculitides: report of a case and review of the literature. Clin Rheumatol 2004;23:152-9.

Morinaga A, Ono K, Komai K, Yamada M. Microscopic polyangitis presenting with temporal arteritis and multiple cranial neuropathies. J Neurol Sci 2007;256:81-3.

Endo T, Katsuta Y, Kimura Y, Kikuchi A, Aramaki T, Takano T, et al. A variant form of Churg-Strauss syndrome: initial temporal non-giant cell arteritis followed by asthma. Is this a distinct clinicopathologic entity? Hum Pathol 2000;31:1169-71.

Amato MB, Barbas CS, Delmonte VC, Carvalho CR. Concurrent Churg-Strauss syndrome and temporal arteritis in a young patient with pulmonary nodules. Am Rev Respir Dis 1989;139:1539-42.

Buhaescu I, Williams A, Yood R. Rare manifestations of Churg-Strauss syndrome: coronary artery vasospasm, temporal artery vasculitis, and reversible monocular blindness - a case report. Clin Rheumatol 2009;28:231-3.

Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsnes W, et al. Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007;66:222-7.

Comarmond C, Cacoub P. Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment [review]. Autoimmun Rev 2014;13:1121-5.

Damoiseaux J, Csernok E, Rasmussen N, Moosig F, van Paassen P, Baslund B, et al. Detection of antineutrophil cytoplasmic antibodies (ANCAs): a multicentre European Vasculitis Study Group (EUVAS) evaluation of the value of indirect immunofluorescence (IIF) versus antigen-specific immunoassays. Ann Rheum Dis 2017;76:647-53.

Bossuyt X, Tervaert JW, Arimura Y, Blockmans D, Flores-Suárez LF, Guillevin L, et al. Position paper: revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis [review]. Nat Rev Rheumatol 2017;13:683-92.

Lie JT, on behalf of the American College of Rheumatology Subcommittee on Classification of Vasculitis. Illustrated histopathologic classification criteria for selected vasculitis syndromes. Arthritis Rheum 1990;33:1074-87.

Jones RB, Furuta S, Tervaert JW, Hauser T, Luqmani R, Morgan MD, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis: 2-year results of a randomised trial. Ann Rheum Dis 2015;74:1178-82.

Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med 2010;363:221-32.

Stone JH, Tuckwell K, Dimonaco S, Klearman M, Aringer M, Blockmans D, et al. Trial of tocilizumab in giant-cell arteritis. N Engl J Med 2017;377:317-28.

Villiger PM, Adler S, Kuchen S, Wermelinger F, Dan D, Fiege V, et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet Lond Engl 2016;387:1921-7.

Hoffman GS, Cid MC, Hellmann DB, Guillevin L, Stone JH, Schousboe J, et al. A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum 2002;46:1309-18.

Gil H, Mauny F, Meaux-Ruault N, Magy-Bertrand N, Roncato-Saberan M, Hafsaoui C, et al. Valeur des anticorps anticytoplasme des polynucléaires neutrophiles dans la maladie de Horton. Rev Med Interne 2008;29:780-4.