Sustained remission in large-Vessel vasculitis: Do they ever burn out?
Drug-free remission is the ideal end point for any chronic disease. Although there are data on drug-free remission in rheumatoid arthritis and lupus, such data are limited for most vasculitis. Notably, there is less evidence for disease-modifying agents in large-vessel vasculitis (LVV). Thus, we exp...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-01-01
|
| Series: | Indian Journal of Rheumatology |
| Subjects: | |
| Online Access: | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=4;spage=304;epage=311;aulast=Ahmed |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841561321365045248 |
|---|---|
| author | Sakir Ahmed Padmanabha Shenoy Debashish Danda Ramnath Misra |
| author_facet | Sakir Ahmed Padmanabha Shenoy Debashish Danda Ramnath Misra |
| author_sort | Sakir Ahmed |
| collection | DOAJ |
| description | Drug-free remission is the ideal end point for any chronic disease. Although there are data on drug-free remission in rheumatoid arthritis and lupus, such data are limited for most vasculitis. Notably, there is less evidence for disease-modifying agents in large-vessel vasculitis (LVV). Thus, we explored the literature about sustained remission in LVV. MEDLINE and SCOPUS were searched for outcomes in LVV, and the results were manually screened for studies with at least 1-year follow-up. Isolated polymyalgia rheumatica was not included. In giant cell arteritis (GCA), histological and clinical remissions were discordant. Histology could not predict relapse rate. Various imaging techniques exhibit vessel wall inflammation in clinically quiescent disease. Relapse rate seems to correlate with the rate of steroid reduction. Relapse was rare when on higher steroid doses. Emerging evidence suggests that tocilizumab and methotrexate may prevent relapse. In Takayasu arteritis (TA), histology specimens are difficult to obtain. Remission on imaging does not mirror clinical remission. While magnetic resonance imaging and positron emission tomography are sensitive tools, these cannot differentiate smouldering disease from vascular repair. The best predictor of relapse is the extent of disease. Approximately half of the TA patients relapsed by 5 years. In patients undergoing intravascular procedures, restenosis occurred in around a third. Even for patients on anti- Tumour necrosis factor necrosis factor, sustained remission was in 20% only. LVV seems to be steroid dependent, and the efficacy of various steroid-sparing agents cannot be established unless the natural history of the disease is known. Both TA and GCA can have grumbling courses with relapse rates increasing over time. |
| format | Article |
| id | doaj-art-399b5d36261148ccb20380d30490b599 |
| institution | Kabale University |
| issn | 0973-3698 0973-3701 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Indian Journal of Rheumatology |
| spelling | doaj-art-399b5d36261148ccb20380d30490b5992025-01-03T01:45:19ZengSAGE PublishingIndian Journal of Rheumatology0973-36980973-37012019-01-0114430431110.4103/injr.injr_182_19Sustained remission in large-Vessel vasculitis: Do they ever burn out?Sakir AhmedPadmanabha ShenoyDebashish DandaRamnath MisraDrug-free remission is the ideal end point for any chronic disease. Although there are data on drug-free remission in rheumatoid arthritis and lupus, such data are limited for most vasculitis. Notably, there is less evidence for disease-modifying agents in large-vessel vasculitis (LVV). Thus, we explored the literature about sustained remission in LVV. MEDLINE and SCOPUS were searched for outcomes in LVV, and the results were manually screened for studies with at least 1-year follow-up. Isolated polymyalgia rheumatica was not included. In giant cell arteritis (GCA), histological and clinical remissions were discordant. Histology could not predict relapse rate. Various imaging techniques exhibit vessel wall inflammation in clinically quiescent disease. Relapse rate seems to correlate with the rate of steroid reduction. Relapse was rare when on higher steroid doses. Emerging evidence suggests that tocilizumab and methotrexate may prevent relapse. In Takayasu arteritis (TA), histology specimens are difficult to obtain. Remission on imaging does not mirror clinical remission. While magnetic resonance imaging and positron emission tomography are sensitive tools, these cannot differentiate smouldering disease from vascular repair. The best predictor of relapse is the extent of disease. Approximately half of the TA patients relapsed by 5 years. In patients undergoing intravascular procedures, restenosis occurred in around a third. Even for patients on anti- Tumour necrosis factor necrosis factor, sustained remission was in 20% only. LVV seems to be steroid dependent, and the efficacy of various steroid-sparing agents cannot be established unless the natural history of the disease is known. Both TA and GCA can have grumbling courses with relapse rates increasing over time.http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=4;spage=304;epage=311;aulast=Ahmeddrug taperingdrug-free remissionfollow-upgiant cell arteritisremissiontakayasu arteritis |
| spellingShingle | Sakir Ahmed Padmanabha Shenoy Debashish Danda Ramnath Misra Sustained remission in large-Vessel vasculitis: Do they ever burn out? Indian Journal of Rheumatology drug tapering drug-free remission follow-up giant cell arteritis remission takayasu arteritis |
| title | Sustained remission in large-Vessel vasculitis: Do they ever burn out? |
| title_full | Sustained remission in large-Vessel vasculitis: Do they ever burn out? |
| title_fullStr | Sustained remission in large-Vessel vasculitis: Do they ever burn out? |
| title_full_unstemmed | Sustained remission in large-Vessel vasculitis: Do they ever burn out? |
| title_short | Sustained remission in large-Vessel vasculitis: Do they ever burn out? |
| title_sort | sustained remission in large vessel vasculitis do they ever burn out |
| topic | drug tapering drug-free remission follow-up giant cell arteritis remission takayasu arteritis |
| url | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2019;volume=14;issue=4;spage=304;epage=311;aulast=Ahmed |
| work_keys_str_mv | AT sakirahmed sustainedremissioninlargevesselvasculitisdotheyeverburnout AT padmanabhashenoy sustainedremissioninlargevesselvasculitisdotheyeverburnout AT debashishdanda sustainedremissioninlargevesselvasculitisdotheyeverburnout AT ramnathmisra sustainedremissioninlargevesselvasculitisdotheyeverburnout |