Relapses in giant cell arteritis: Updated review for clinical practice

IF 9.2 1区 医学 Q1 IMMUNOLOGY Autoimmunity reviews Pub Date : 2024-06-01 DOI:10.1016/j.autrev.2024.103580
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Abstract

Giant cell arteritis (GCA), the most common primary vasculitis in adults, is a granulomatous systemic vasculitis usually affecting the aorta and its major branches, particularly the carotid and vertebral arteries. Although remission can be achieved in most patients with GCA using high-dose glucocorticoids (GC), relapses are frequent, occurring in >40% of GC-only treated patients, mostly during the first two years after diagnosis. Relapsing courses lead to high GC exposure, increasing the risk of treatment-related adverse effects. Although tocilizumab is an efficacious GC-sparing therapy that allows increased sustained remission and reduced cumulative GC doses, relapses are common after drug discontinuation.

This narrative review examines the most relevant features of relapses in GCA, including its definition, classification, frequency, clinical, laboratory, and imaging characteristics, chronology, probable pathophysiology, and predictive factors. In addition, we discuss treatment options for relapsing patients and the effect of relapses on patient outcomes.

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巨细胞动脉炎复发:临床实践最新回顾。
巨细胞动脉炎(GCA)是成人中最常见的原发性血管炎,是一种肉芽肿性全身性血管炎,通常累及主动脉及其主要分支,尤其是颈动脉和椎动脉。尽管使用大剂量糖皮质激素(GC)可使大多数 GCA 患者的病情得到缓解,但复发却很频繁,在只接受 GC 治疗的患者中复发率大于 40%,且大多发生在确诊后的头两年。复发病程会导致大量糖皮质激素暴露,增加治疗相关不良反应的风险。尽管托西珠单抗是一种有效的节省 GC 的疗法,可提高持续缓解率并减少 GC 的累积剂量,但停药后复发仍很常见。这篇叙述性综述探讨了 GCA 复发的最相关特征,包括其定义、分类、频率、临床、实验室和影像学特征、时序、可能的病理生理学和预测因素。此外,我们还讨论了复发患者的治疗方案以及复发对患者预后的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Autoimmunity reviews
Autoimmunity reviews 医学-免疫学
CiteScore
24.70
自引率
4.40%
发文量
164
审稿时长
21 days
期刊介绍: Autoimmunity Reviews is a publication that features up-to-date, structured reviews on various topics in the field of autoimmunity. These reviews are written by renowned experts and include demonstrative illustrations and tables. Each article will have a clear "take-home" message for readers. The selection of articles is primarily done by the Editors-in-Chief, based on recommendations from the international Editorial Board. The topics covered in the articles span all areas of autoimmunology, aiming to bridge the gap between basic and clinical sciences. In terms of content, the contributions in basic sciences delve into the pathophysiology and mechanisms of autoimmune disorders, as well as genomics and proteomics. On the other hand, clinical contributions focus on diseases related to autoimmunity, novel therapies, and clinical associations. Autoimmunity Reviews is internationally recognized, and its articles are indexed and abstracted in prestigious databases such as PubMed/Medline, Science Citation Index Expanded, Biosciences Information Services, and Chemical Abstracts.
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