Need and value of targeted immunosuppressive therapy in giant cell arteritis

Despite the heterogeneity of the giant cell arteritis (GCA) at the level of clinical manifestations and the cellular and molecular players involved in its pathogenesis, GCA is still treated with standardised regimens largely based on glucocorticoids (GC). Long-term use of high dosages of GC as required in GCA are associated with many clinically relevant side effects. In the recent years, the interleukin-6 receptor blocker tocilizumab has become available as the only registered targeted immunosuppressive agent in GCA. However, immunological heterogeneity may require different pathways to be targeted in order to achieve a clinical, immunological and vascular remission in GCA. The advances in the targeted blockade of various molecular pathways involved in other inflammatory and autoimmune diseases have catalyzed the research on targeted therapy in GCA. This article gives an overview of the studies with targeted immunosuppressive treatments in GCA, with a focus on their clinical value, including their effects at the level of vascular inflammation

Visual and semiquantitative assessment of cranial artery inflammation with FDG-PET/CT in giant cell arteritis

BACKGROUND AND AIM: Assessing cranial artery inflammation plays an important role in the diagnosis of cranial giant cell arteritis (C-GCA). However, current diagnostic tests are limited. The use of fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging is an established tool for assessing large vessel inflammation but is currently not used for assessment of the cranial arteries. This study aimed to evaluate the accuracy of FDG-PET/CT in the diagnosis of biopsy proven C-GCA and its relation to clinical presentation. METHODS: This retrospective case control study included temporal artery biopsy (TAB) positive C-GCA patients and age- and sex-matched controls. FDG-PET/CT scans were performed according to EANM/EARL guidelines, visually assessed by an experienced nuclear medicine physician, and semiquantitatively assessed using the maximum standardised uptake value (SUVmax). The visual and semiquantitative assessments were performed on the temporal arteries, maxillary arteries, vertebral arteries, and occipital arteries. Clinical signs and symptoms were scored for comparison. RESULTS: A total of 24 C-GCA patients and 24 controls were included in the study. Visual analysis revealed an 83% sensitivity and a 75% specificity. Receiver operating characteristic (ROC) analysis of the semiquantitative assessment revealed a 79% sensitivity and a 92% specificity when measuring SUVmax in the cranial arteries. Visual and semiquantitative assessments showed moderate agreement (Fleiss kappa 0.55). There was a positive correlation between the number of cranial symptoms and the SUVmax in the vertebral artery. CONCLUSION: FDG-PET/CT can reliably diagnose C-GCA by assessing cranial artery inflammation using SUVmax. Extending the use of FDG-PET/CT to include assessment of the cranial arteries may improve its diagnostic value in GCA and provide a suitable alternative to TAB. Moderate agreement between visual and semiquantitative assessment methods suggest diagnostic accuracy may be improved by further standardisation

A man with a remarkable nodular lesion on his penis

A 59-year-old patient presented with an asymptomatic, nodular lesion on his penis. He had a history of hypertension and destructive tophaceous gout. A painless yellow multinodal plaque of 4 by 2 centimeters was observed on the penile shaft. A punch biopsy confirmed the diagnosis of tophaceous gout.</p

A man with a remarkable nodular lesion on his penis

A 59-year-old patient presented with an asymptomatic, nodular lesion on his penis. He had a history of hypertension and destructive tophaceous gout. A painless yellow multinodal plaque of 4 by 2 centimeters was observed on the penile shaft. A punch biopsy confirmed the diagnosis of tophaceous gout.</p

A man with a remarkable nodular lesion on his penis

A 59-year-old patient presented with an asymptomatic, nodular lesion on his penis. He had a history of hypertension and destructive tophaceous gout. A painless yellow multinodal plaque of 4 by 2 centimeters was observed on the penile shaft. A punch biopsy confirmed the diagnosis of tophaceous gout.</p