PT  - JOURNAL ARTICLE
AU  - Shubhasree Banerjee
AU  - Kaitlin A. Quinn
AU  - K. Bates Gribbons
AU  - Joel S. Rosenblum
AU  - Ali Cahid Civelek
AU  - Elaine Novakovich
AU  - Peter A. Merkel
AU  - Mark A. Ahlman
AU  - Peter C. Grayson
TI  - Effect of Treatment on Imaging, Clinical, and Serologic Assessments of Disease Activity in Large-vessel Vasculitis
AID  - 10.3899/jrheum.181222
DP  - 2020 Jan 01
TA  - The Journal of Rheumatology
PG  - 99--107
VI  - 47
IP  - 1
4099  - http://www.jrheum.org/content/47/1/99.short
4100  - http://www.jrheum.org/content/47/1/99.full
SO  - J Rheumatol2020 Jan 01; 47
AB  - Objective. Disease activity in large-vessel vasculitis (LVV) is traditionally assessed by clinical and serological variables rather than vascular imaging. This study determined the effect of treatment on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) vascular activity in relation to clinical- and serologic-based assessments.Methods. Patients with giant cell arteritis (GCA) or Takayasu arteritis (TA) were prospectively evaluated at 6-month intervals in an observational cohort. Treatment changes were made at least 3 months before the followup visit and categorized as increased, decreased, or unchanged. Imaging (FDG-PET qualitative analysis), clinical, and serologic (erythrocyte sedimentation rate, C-reactive protein) assessments were determined at each visit and compared over interval visits.Results. Serial assessments were performed in 52 patients with LVV (GCA = 31; TA = 21) over 156 visits. Increased, decreased, or unchanged therapy was recorded for 36-, 23-, and 32-visit intervals, respectively. When treatment was increased, there was significant reduction in disease activity by imaging, clinical, and inflammatory markers (p ≤ 0.01 for each). When treatment was unchanged, all 3 assessments of disease activity remained similarly unchanged over 6-month intervals. When treatment was reduced, PET activity significantly worsened (p = 0.02) but clinical and serologic activity did not significantly change. Treatment of GCA with tocilizumab and of TA with tumor necrosis factor inhibitors resulted in significant improvement in imaging and clinical assessments of disease activity, but only rarely did the assessments both become normal.Conclusion. In addition to clinical and serologic assessments, vascular imaging has potential to monitor disease activity in LVV and should be tested as an outcome measure in randomized clinical trials.