Treating cytomegalocyte arteritis, these dynamics and progressions to understand! EULAR 2020.

EULAR 2020, let's listen! On June 3, 2020, the European annual meeting on rheumatism (EULAR) officially opened.due to the impact of the covid-19 epidemic, this meeting was held online.in order to grasp the latest and hottest international frontier trends in the field of rheumatic immunology, Liu Tian, deputy chief physician of Department of Rheumatology and immunology, Peking University People's Hospital, was specially invited by the "medical rheumatism and nephropathy channel" to present a wonderful report on the meeting! In the first day and the next day of this EULAR vasculitis clinical research branch, there are a number of studies worthy of attention, mainly focusing on the treatment and evaluation of giant cell arteritis (GCA) and the application of IL-6 receptor antagonist tochizumab (TCZ).01il-6 inhibitors, how are they performed in the treatment of vasculitis? First of all, from the Department of Rheumatology, Massachusetts General Hospital John.Stone The professor introduced the results of giacta study on TCZ treatment of GCA in the following two years, focusing on the recurrence of the disease.in this study, patients with new symptoms or recurrent GCA were divided into three groups: TCZ 162 mg once a week (QW) subcutaneous injection group, TCZ once every 2 weeks (q2w) subcutaneous injection group and placebo group.throughout the three-year study, the proportion of patients without relapse in TCZ QW group (47% in new symptom group, 49% in recurrence group) was significantly higher than that in TCZ q2w group (27% in new symptom group, 35% in recurrence group) and placebo group (28% in new symptom group and 31% in recurrence group).this study shows that tcz162mgqw treatment is more effective in reducing disease recurrence and hormone use in patients with recurrent and emerging symptoms of giant cell arteritis.Dr. M. Calderon goercke introduced a multicenter real world study in Spain on optimal maintenance of GCA with TCZ.a total of 134 patients with GCA who were ineffective or intolerant to previous treatment were enrolled in the study. Patients received intravenous TCZ 8 mg / kg every 4 weeks or subcutaneous injection of TCZ 162 mg once a week. Br / kg / kg, and the time to complete remission was extended from 1 mg / kg to 2 mg / kg per week. Br / > there were 18 cases with complete relapse in the TCZ < 5 months follow-up group.this real study suggests that patients with GCA who have achieved clinical remission with TCZ may choose to maintain remission by optimizing the maintenance regimen, which can be achieved by reducing the intravenous TCZ dose or prolonging the subcutaneous TCZ injection time.an 8-year single center observational study from Switzerland evaluated the role of TCZ in preventing blindness in GCA.Dr. J. Amsler, from the Department of allergy, rheumatology and immunology, University of Bern, introduced a total of 192 GCA patients treated with TCZ. During the baseline period, 71 (37%) patients had visual impairment and 21 (7.8%) patients had blindness. Br / > among the new patients, visual acuity was improved in only 2 patients (2%) with visual impairment.this study suggests that TCZ is another possible drug choice to prevent GCA blindness in addition to hormones.02gca treatment and evaluation, what is the progress? What else can we do about the assessment of GCA in addition to inflammatory markers and clinical symptoms? Dr. K. Quinn of the National Institutes of health has brought an interesting study.in this study, 18-FDG pet was used to evaluate vascular wall inflammation after TCZ treatment of GCA.in this prospective study, 22 patients were followed up for 2 years. Pet was performed every 6-12 months, and pet VAS score (petvas, score 0-27) was used for evaluation.the mean baseline petvas score of these patients was 24.5, which gradually decreased with the remission of the disease during the 2-year follow-up (Figure 1). this study suggests that pet can be used as one of the disease evaluation indicators in future clinical studies of GCA. Fig. 1 Comparison of petvas scores before and after treatment for GCA patients with tumor risk? Dr. n. Ben shabat from Israel and others brought the results of their national study. this study included 7213 GCA patients and 32987 age - and gender matched healthy controls from the Israeli health database. They were followed up for 8 years to assess tumor incidence in both groups. the results showed that GCA patients had a higher overall cancer risk than healthy controls (HR 1.29,95% CI 1.20-1.39), and the risk of renal cell carcinoma, sarcoma, acute and chronic leukemia, lymphoma, and multiple myeloma was higher in the GCA group (Figure 2). Figure 2 Comparison of tumor free km survival curves between GCA patients and healthy controls. Finally, Dr. y. ferfar from France shared the long-term outcomes and prognosis of isolated aortoarteritis (IA). This retrospective study included 353 patients with noninfectious aortoarteritis, including 136 patients with GCA, 96 patients with Takayasu arteritis (TKA) and 73 patients with IA. the median follow-up time was 52 months. 32.3% of patients had new vascular events, including 58% of IA, 20% of GCA and 19% of TKA patients. in multivariate regression analysis, IA (HR 1.85, P = 0.017) and male (HR 1.77, P < 0.0001) were independent risk factors for new vascular events. the proportion of IA patients who did not need surgical intervention within 5 years was also the lowest, only 45%, while the TKA and GCA patients were 71% and 76%, respectively. this study indicates that IA has a worse vascular prognosis than TKA and GCA. due to the difference of regional and ethnic prevalence, the research focus of eular2020 on macrovasculitis is GCA, but there are few reports on TKA. we are looking forward to more studies on TKA published in China and Asia in the future.