Restuccia Giovanna, Cavazza Alberto, Boiardi Luigi, Pipitone Nicolò, Macchioni PierLuigi, Bajocchi GianLuigi, Catanoso Maria Grazia, Muratore Francesco, Ghinoi Alessandra, Magnani Luca, Cimino Luca, Salvarani Carlo
Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
Arthritis Rheum. 2012 Feb;64(2):549-56. doi: 10.1002/art.33362.
To evaluate the frequency and clinical characteristics of periadventitial small-vessel vasculitis (SVV) and isolated vasa vasorum vasculitis (VVV).
We identified 455 temporal artery biopsies performed in residents of Reggio Emilia, Italy between 1986 and 2003. Slides of temporal artery biopsy specimens were reviewed by a pathologist who was blinded with regard to clinical data. SVV was defined as inflammation of the small vessels external to the temporal artery adventitia, and VVV was defined as isolated inflammation of temporal artery vasa vasorum. Medical records of patients with SVV and/or VVV were reviewed, and demographic, clinical, laboratory, and followup data were collected. For comparison purposes, we collected the same data from an equal number of randomly selected patients with evidence of classic giant cell arteritis (GCA).
Sixteen patients had SVV, 18 had isolated VVV, and 5 had both SVV and VVV. Compared with patients with classic GCA, the frequencies of headache, scalp tenderness, abnormalities of temporal arteries, jaw claudication, anorexia, and weight loss, the levels of acute-phase reactant at diagnosis, and the initial and cumulative doses prednisone were significantly lower and the frequency of peripheral synovitis was higher in the patients with SVV, and the frequency of cranial ischemic events was similar in the 2 groups. In contrast, the clinical characteristics and erythrocyte sedimentation rate at diagnosis of patients with isolated VVV were similar to those of patients with classic GCA.
Our findings indicate that isolated VVV and SVV should be considered part of the histopathologic spectrum of GCA.
评估血管外膜小血管血管炎（SVV）和孤立性滋养血管血管炎（VVV）的发生率及临床特征。
我们确定了1986年至2003年间在意大利雷焦艾米利亚居民中进行的455例颞动脉活检。由一位对临床数据不知情的病理学家对颞动脉活检标本的切片进行复查。SVV被定义为颞动脉外膜外部小血管的炎症，VVV被定义为颞动脉滋养血管的孤立性炎症。对患有SVV和/或VVV的患者的病历进行复查，并收集人口统计学、临床、实验室和随访数据。为作比较，我们从数量相等的随机选择的有典型巨细胞动脉炎（GCA）证据的患者中收集相同的数据。
16例患者患有SVV，18例患有孤立性VVV，5例同时患有SVV和VVV。与典型GCA患者相比，SVV患者头痛、头皮压痛、颞动脉异常、颌跛行、厌食和体重减轻的发生率、诊断时急性期反应物水平以及泼尼松的初始剂量和累积剂量显著更低，外周滑膜炎的发生率更高，两组颅缺血事件的发生率相似。相比之下，孤立性VVV患者的临床特征和诊断时的红细胞沉降率与典型GCA患者相似。
我们的研究结果表明，孤立性VVV和SVV应被视为GCA组织病理学谱的一部分。
