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  1. Article ; Online: Fast-track pathway for early diagnosis and management of giant cell arteritis: the combined role of vascular ultrasonography and [18F]-fluorodeoxyglucose PET-computed tomography imaging.

    Ludwig, Dalia R / Vöö, Stefan / Morris, Vanessa

    Nuclear medicine communications

    2023  Volume 44, Issue 5, Page(s) 339–344

    Abstract: Giant cell arteritis (GCA) is a medical emergency, which can lead to irreversible blindness and other ischaemic vascular events if left untreated. Prompt access to specialist assessment, diagnostics in the form of a fast-track pathway (FTP) and access to ...

    Abstract Giant cell arteritis (GCA) is a medical emergency, which can lead to irreversible blindness and other ischaemic vascular events if left untreated. Prompt access to specialist assessment, diagnostics in the form of a fast-track pathway (FTP) and access to appropriate treatment are key factors in preventing morbidity associated with this disease. Recent developments in vascular imaging prompted review of our management of GCA patients. Here, we present the newly implemented FTP in GCA at the University College London Hospital, with added vascular imaging in the form of temporal artery ultrasound (TAUS) and [18F]-fluorodeoxyglucose PET-computed tomography ( 18 F-FDG PET-CT) with temporal artery biopsy. The initial pilot data on the FTP showed a significant negative predictive value of the combined TAUS and 18 F-FDG PET-CT, and the vast majority of cases positive on imaging were confirmed by biopsy. Through the new FTP in GCA, the diagnosis was completed within 48-72 h, compared with the conventional pathway time of up to 2-3 weeks awaiting biopsy results. Prompt and accurate diagnosis of GCA enables commencement of corticosteroid (prednisolone) treatment in the appropriate patient population while avoiding unnecessary steroid exposure and toxicity in GCA-negative patients.
    MeSH term(s) Humans ; Giant Cell Arteritis/diagnostic imaging ; Giant Cell Arteritis/pathology ; Positron Emission Tomography Computed Tomography/methods ; Fluorodeoxyglucose F18 ; Positron-Emission Tomography ; Early Diagnosis
    Chemical Substances Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2023-02-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 758141-5
    ISSN 1473-5628 ; 0143-3636
    ISSN (online) 1473-5628
    ISSN 0143-3636
    DOI 10.1097/MNM.0000000000001670
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 1577: Show issues Location:
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  2. Article ; Online: Suspected systemic rheumatic diseases in adults presenting with fever.

    Ludwig, Dalia R / Amin, Tara N / Manson, Jessica J

    Best practice & research. Clinical rheumatology

    2019  Volume 33, Issue 4, Page(s) 101426

    Abstract: A significant proportion of patients with pyrexia of unknown origin (PUO) are found to have a rheumatological cause. The mainstay of treatment for rheumatic disease is immunosuppression, and therefore, accurate diagnosis is crucial given the risks ... ...

    Abstract A significant proportion of patients with pyrexia of unknown origin (PUO) are found to have a rheumatological cause. The mainstay of treatment for rheumatic disease is immunosuppression, and therefore, accurate diagnosis is crucial given the risks associated with these drugs. In this review, we analyse the rheumatological conditions that most commonly present with fever and illustrate clinical cases demonstrating some of the challenges in the workup of these patients. With this in mind, we propose an evidence-based algorithm for investigating PUO from a rheumatological perspective, with the aim that it will aid clinicians when approaching these clinical scenarios.
    MeSH term(s) Adult ; Fever of Unknown Origin/etiology ; Humans ; Rheumatic Diseases/complications ; Rheumatic Diseases/diagnosis
    Language English
    Publishing date 2019-08-29
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 2052323-3
    ISSN 1532-1770 ; 1521-6942
    ISSN (online) 1532-1770
    ISSN 1521-6942
    DOI 10.1016/j.berh.2019.06.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The role of ANCA in the management of cocaine-induced midline destructive lesions or ENT pseudo-granulomatosis with polyangiitis: a London multicentre case series.

    Pendolino, Alfonso Luca / Benshetrit, Guy / Navaratnam, Annakan V / To, Caroline / Bandino, Fabrizio / Scarpa, Bruno / Kwame, Ivor / Ludwig, Dalia R / McAdoo, Stephen / Kuchai, Romana / Gane, Simon / Saleh, Hesham / Pusey, Charles D / Randhawa, Premjit S / Andrews, Peter J

    The Laryngoscope

    2023  Volume 134, Issue 6, Page(s) 2609–2616

    Abstract: Objective: In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may ... ...

    Abstract Objective: In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management.
    Methods: A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected.
    Results: Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups.
    Conclusions: A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern was not associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term "cocaine-induced ENT pseudo-GPA" instead of CIMDL.
    Level of evidence: IV Laryngoscope, 134:2609-2616, 2024.
    MeSH term(s) Humans ; Male ; Antibodies, Antineutrophil Cytoplasmic/blood ; Antibodies, Antineutrophil Cytoplasmic/immunology ; Female ; Adult ; Retrospective Studies ; Granulomatosis with Polyangiitis/drug therapy ; Granulomatosis with Polyangiitis/immunology ; Granulomatosis with Polyangiitis/diagnosis ; London ; Middle Aged ; Cocaine-Related Disorders/complications ; Cocaine/adverse effects ; Nose Deformities, Acquired/etiology ; Nose Deformities, Acquired/chemically induced ; Otorhinolaryngologic Diseases/etiology ; Otorhinolaryngologic Diseases/immunology
    Chemical Substances Antibodies, Antineutrophil Cytoplasmic ; Cocaine (I5Y540LHVR)
    Language English
    Publishing date 2023-12-12
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ZDB-ID 80180-x
    ISSN 1531-4995 ; 0023-852X
    ISSN (online) 1531-4995
    ISSN 0023-852X
    DOI 10.1002/lary.31219
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Relapse after cessation of weekly tocilizumab for giant cell arteritis: a multicentre service evaluation in England.

    Quick, Vanessa / Abusalameh, Mahdi / Ahmed, Sajeel / Alkoky, Hoda / Bukhari, Marwan / Carter, Stuart / Coath, Fiona L / Davidson, Brian / Doddamani, Parveen / Dubey, Shirish / Ducker, Georgina / Griffiths, Bridget / Gullick, Nicola / Heaney, Jonathan / Holloway, Amelia / Htut, Ei Ei Phyu / Hughes, Mark / Irvine, Hannah / Kinder, Alison /
    Kurshid, Asim / Lim, Joyce / Ludwig, Dalia R / Malik, Mariam / Mercer, Louise / Mulhearn, Ben / Nair, Jagdish R / Patel, Rikesh / Robson, Joanna / Saha, Pratyasha / Tansley, Sarah / Mackie, Sarah L

    Rheumatology (Oxford, England)

    2023  

    Abstract: Objectives: The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. ...

    Abstract Objectives: The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ.
    Methods: Multicentre service evaluation of relapse after stopping qwTCZ for GCA. The log-rank test was used to identify significant differences in time to relapse.
    Results: 336 GCA patients were analysed from 40 centres, treated with qwTCZ for a median (interquartile range, IQR) of 12 (12-17) months. At time of stopping qwTCZ, median (IQR) prednisolone dose was 2 (0-5) mg/day. By 6, 12 and 24 months after stopping qwTCZ, 21.4%, 35.4% and 48.6% respectively had relapsed, requiring an increase in prednisolone dose to a median (IQR) of 20 (10-40) mg/day. 33.6% of relapsers had a major relapse as defined by EULAR. Time to relapse was shorter in those that had previously also relapsed during qwTCZ treatment (P = 0.0017); in those not in remission at qwTCZ cessation (P = 0.0036); and in those with large vessel involvement on imaging (P = 0.0296). Age ≥65, gender, GCA-related sight loss, qwTCZ treatment duration, TCZ taper, prednisolone dosing, and conventional synthetic DMARD use were not associated with time to relapse.
    Conclusion: Up to half our patients with GCA relapsed after stopping qwTCZ, often requiring a substantial increase in prednisolone dose. One third of relapsers had a major relapse. Extended use of TCZ or repeat treatment for relapse should be considered for these patients.
    Language English
    Publishing date 2023-11-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 1464822-2
    ISSN 1462-0332 ; 1462-0324
    ISSN (online) 1462-0332
    ISSN 1462-0324
    DOI 10.1093/rheumatology/kead604
    Database MEDical Literature Analysis and Retrieval System OnLINE

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