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巨细胞动脉炎诊断与治疗的当前进展

Current developments in the diagnosis and treatment of giant cell arteritis.

作者信息

Szekeres Denes, Al Othman Bayan

机构信息

School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, United States.

Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States.

出版信息

Front Med (Lausanne). 2022 Dec 13;9:1066503. doi: 10.3389/fmed.2022.1066503. eCollection 2022.

Abstract

Giant cell arteritis is the most common vasculitis in adults above 50 years old. The disease is characterized by granulomatous inflammation of medium and large arteries, particularly the temporal artery, and is associated acutely with headache, claudication, and visual disturbances. Diagnosis of the disease is often complicated by its protean presentation and lack of consistently reliable testing. The utility of color doppler ultrasound at the point-of-care and FDG-PET in longitudinal evaluation remain under continued investigation. Novel techniques for risk assessment with Halo scoring and stratification through axillary vessel ultrasound are becoming commonplace. Moreover, the recent introduction of the biologic tocilizumab marks a paradigm shift toward using glucocorticoid-sparing strategies as the primary treatment modality. Notwithstanding these developments, patients continue to have substantial rates of relapse and biologic agents have their own side effect profile. Trials are underway to answer questions about optimal diagnostic modality, regiment choice, and duration.

摘要

巨细胞动脉炎是50岁以上成年人中最常见的血管炎。该病的特征是中、大动脉,尤其是颞动脉的肉芽肿性炎症,急性期伴有头痛、间歇性跛行和视觉障碍。该疾病的诊断常常因其表现多样且缺乏始终可靠的检测方法而变得复杂。即时护理时彩色多普勒超声和氟代脱氧葡萄糖正电子发射断层扫描(FDG-PET)在纵向评估中的效用仍在持续研究中。通过Halo评分进行风险评估以及通过腋窝血管超声进行分层的新技术正变得越来越普遍。此外,生物制剂托珠单抗的近期引入标志着向以糖皮质激素节省策略作为主要治疗方式的范式转变。尽管有这些进展,但患者的复发率仍然很高,而且生物制剂也有其自身的副作用。目前正在进行试验,以回答有关最佳诊断方式、治疗方案选择和疗程的问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32cf/9792614/72b2185b565d/fmed-09-1066503-g001.jpg

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