Steroid-sparing agents in giant cell arteritis

Background: Giant cell arteritis is the commonest form of medium-to-large vessel vasculitis, requiring long-term corticosteroid therapy. The short- and long-term side effects of corticosteroids are many, including weight gain, psychological effects, osteoporosis, cardiometabolic complications, and infections. Materials and Methods: Various agents used in place of or in combination with corticosteroids to reduce corticosteroid-related side effects were reviewed. However, considerable variation in practice was identified giving unclear guidance. This review included the most recent evidence on methotrexate, mycophenolate mofetil, azathioprine, cyclophosphamide, abatacept, and tocilizumab Results and Discussion: Also discussed are encouraging results with tocilizumab in GCA patients. Amongst the agents available for steroid-sparing effects, tocilizumab demonstrated the most robust data and is consequently recommended as the agent of choice for steroid-sparing, for remission induction, remission maintenance, and treating relapsing and refractory cases of GCA.Published versio

Comorbid Forms of Psychopathology: Key Patterns and Future Research Directions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63093/1/cerda_comorbid psychopathology review_2008.pd

Strain-induced first-order orbital flip transition and coexistence of charge-orbital ordered phases in Pr<SUB>0.5</SUB>Ca<SUB>0.5</SUB>MnO<SUB>3</SUB>

Low-temperature transmission electron microscopy and X-ray diffraction (XRD) studies have been carried out on pellet and powder samples of Pr0.5Ca0.5MnO3. These studies have revealed appearance of a different type of charge-orbital ordered (COO) phase, resulting due to flipping of eg orbitals from d3x2&#8722;r2/d3y2&#8722;r2 to d3x2&#8722;r2/d3z2&#8722;r2 configuration. This orbital flip results in a changeover of the COO superlattice-ordering vector from (&#189;,0,0) to (&#188;,&#189;,&#188;) in the Pnma phase. This COO phase coexists with the conventional COO phase. Low-temperature XRD studies show that the COO phase appears only in pellet sample and not in the corresponding powder sample. The powder sample shows only conventional COO phase. Volume fractions of conventional and the other type COO phases in pellet sample of Pr0.5Ca0.5MnO3 is estimated to be ~55% and 45%, respectively. The occurrence of orbital flip has been attributed to local strain building up in the pellet sample. The strain builds up during cooling because manganite has anisotropic thermal expansion coefficients