From the Systemic Autoimmunity Branch, US National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Bethesda, Maryland; Division of Rheumatology, Georgetown University, Washington, DC; National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Bethesda, Maryland; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
S. Banerjee, MD, Systemic Autoimmunity Branch, NIH, NIAMS; K.A. Quinn, MD, Systemic Autoimmunity Branch, NIH, NIAMS, and Division of Rheumatology, Georgetown University; K.B. Gribbons, BS, Systemic Autoimmunity Branch, NIH, NIAMS; J.S. Rosenblum, BS, Systemic Autoimmunity Branch, NIH, NIAMS; A.C. Civelek, MD, NIH, Clinical Center, Radiology and Imaging Sciences; E. Novakovich, BSN, Systemic Autoimmunity Branch, NIH, NIAMS; P.A. Merkel, MD, MPH, Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; M.A. Ahlman, MD, NIH, Clinical Center, Radiology and Imaging Sciences; P.C. Grayson, MD, MSc, Systemic Autoimmunity Branch, NIH, NIAMS.
J Rheumatol. 2020 Jan;47(1):99-107. doi: 10.3899/jrheum.181222. Epub 2019 Mar 15.
Disease activity in large-vessel vasculitis (LVV) is traditionally assessed by clinical and serological variables rather than vascular imaging. This study determined the effect of treatment on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) vascular activity in relation to clinical- and serologic-based assessments.
Patients with giant cell arteritis (GCA) or Takayasu arteritis (TA) were prospectively evaluated at 6-month intervals in an observational cohort. Treatment changes were made at least 3 months before the followup visit and categorized as increased, decreased, or unchanged. Imaging (FDG-PET qualitative analysis), clinical, and serologic (erythrocyte sedimentation rate, C-reactive protein) assessments were determined at each visit and compared over interval visits.
Serial assessments were performed in 52 patients with LVV (GCA = 31; TA = 21) over 156 visits. Increased, decreased, or unchanged therapy was recorded for 36-, 23-, and 32-visit intervals, respectively. When treatment was increased, there was significant reduction in disease activity by imaging, clinical, and inflammatory markers (p ≤ 0.01 for each). When treatment was unchanged, all 3 assessments of disease activity remained similarly unchanged over 6-month intervals. When treatment was reduced, PET activity significantly worsened (p = 0.02) but clinical and serologic activity did not significantly change. Treatment of GCA with tocilizumab and of TA with tumor necrosis factor inhibitors resulted in significant improvement in imaging and clinical assessments of disease activity, but only rarely did the assessments both become normal.
In addition to clinical and serologic assessments, vascular imaging has potential to monitor disease activity in LVV and should be tested as an outcome measure in randomized clinical trials.
传统上，大血管血管炎（LVV）的疾病活动通过临床和血清变量而不是血管成像来评估。本研究旨在确定治疗对 18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）血管活性的影响与基于临床和血清学的评估相关。
在观察性队列中，前瞻性评估巨细胞动脉炎（GCA）或 Takayasu 动脉炎（TA）患者，每 6 个月评估一次。在随访前至少 3 个月进行治疗改变，并分为增加、减少或不变。在每次就诊时确定影像学（FDG-PET 定性分析）、临床和血清学（红细胞沉降率、C 反应蛋白）评估，并在间隔就诊时进行比较。
在 156 次就诊中对 52 例 LVV 患者（GCA = 31；TA = 21）进行了连续评估。分别记录了 36、23 和 32 个就诊间隔的增加、减少或不变的治疗。当治疗增加时，影像学、临床和炎症标志物均显示疾病活动显著减少（每个 p ≤ 0.01）。当治疗不变时，6 个月间隔内所有 3 项疾病活动评估均保持不变。当治疗减少时，PET 活性显著恶化（p = 0.02），但临床和血清学活性没有显著变化。托珠单抗治疗 GCA 和肿瘤坏死因子抑制剂治疗 TA 导致影像学和疾病活动的临床评估显著改善，但评估两者均正常的情况很少见。
除了临床和血清学评估外，血管成像还有助于监测 LVV 的疾病活动，并且应该作为随机临床试验的疗效测量指标进行测试。
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