Ciccia Francesco, Macaluso Federica, Mauro Daniele, Nicoletti Giovanni Francesco, Croci Stefania, Salvarani Carlo
Department of Precision Medicine, Section of Rheumatology, Università della Campania L Vanvitelli, Naples, Italy.
Department of Precision Medicine, Section of Rheumatology, Università della Campania L Vanvitelli, Naples, Italy; Dipartimento Specialità Mediche, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Lancet Rheumatol. 2021 Dec;3(12):e874-e885. doi: 10.1016/S2665-9913(21)00253-8. Epub 2021 Oct 28.
Giant cell arteritis is a primary granulomatous vasculitis characterised by a strict tissue tropism for large and medium-size vessels, occurring in people older than 50 years. Although considerable progress in understanding some of the pathophysiological mechanisms involved in the pathogenesis of giant cell arteritis has been made in the past 10 years, specific triggers of disease and mechanisms of chronic damage have not yet been identified. The definition of a specific pro-inflammatory hierarchy between the multiple cell types and the different cytokines or chemokines involved in the inflammatory process are still unexplored areas of study. The overall goal of precision medicine is to identify the best possible therapeutic approach for an individual or group of individuals with a given disease. The fundamental prerequisite of this approach is the identification, at baseline, of clinical and imaging findings and of molecular biomarkers that allow a precise stratification of patients and an adequate prediction of the therapeutic response. In this regard, the possibility of obtaining temporal artery biopsies for diagnostic purposes offers incredible exploratory possibilities to define different disease pathotypes potentially susceptible to different therapeutic interventions. In this Series paper, we will describe the most recent evidence relating to the pathogenesis of giant cell arteritis, trying to define, if possible, a new pathogenetic-centred approach to patients with giant cell arteritis.
巨细胞动脉炎是一种原发性肉芽肿性血管炎，其特征是对大中型血管具有严格的组织嗜性，发生于50岁以上人群。尽管在过去10年里，人们对巨细胞动脉炎发病机制中涉及的一些病理生理机制的理解取得了相当大的进展，但疾病的具体触发因素和慢性损伤机制尚未明确。炎症过程中多种细胞类型与不同细胞因子或趋化因子之间特定促炎层级的定义仍是尚未探索的研究领域。精准医学的总体目标是为患有特定疾病的个体或个体群体确定最佳治疗方法。这种方法的基本前提是在基线时识别临床和影像学表现以及分子生物标志物，以便对患者进行精确分层并充分预测治疗反应。在这方面，为诊断目的获取颞动脉活检的可能性为定义可能对不同治疗干预敏感的不同疾病病理类型提供了令人难以置信的探索可能性。在本系列论文中，我们将描述与巨细胞动脉炎发病机制相关的最新证据，尽可能尝试为巨细胞动脉炎患者定义一种新的以发病机制为中心的方法。
