Purchase this article with an account.
Harris C Sultan, Patricia Chevez-Barrios, Andrew G Lee; Histologic markers for determining prognosis in patients with treated or healing giant cell arteritis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3854.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Recent advances in the understanding of the immunology of giant cell arteritis (GCA) have suggested that chemokines expressed by vascular endothelium attract CD68+ macrophages to infiltrate the vessel wall and to contribute to the vaso-occlusive disease of GCA. We hypothesize that the presence of these cells along the internal elastic lamina (IEL) of temporal artery biopsies (TAB) predict the prognosis for patients with treated or healing disease.
This is a retrospective, observational clinical study, correlating clinical data with pathology specimens. The patients were seen at the Blanton Eye Institute in Houston, TX and TABs were reviewed at Houston Methodist Hospital. Only TABs from patients with treated or healing arteritis were reviewed. The primary outcome measure was to define the number of CD68+ macrophages at the level of the IEL per histologic section with relation to clinical outcomes (referral to rheumatology, need for further immunomodulators, and recurrence of disease). Interval data was compared using one-way-ANOVA, while nominal data was compared using Chi-square analysis.
A total of 42 patients were reviewed, 15 male and 27 female. Average age of diagnosis was 72 with a mean follow up of 57 weeks. Seventeen patients had recurrence of disease during their steroid taper, 25 were referred to rheumatology, and 11 were placed on immunomodulators including methotrexate, azathioprine, and tocilizumab among others.When controlling for number of days on steroids prior to TAB, the number of disease recurrences were directly correlated to the number of CD68+ cells per histologic section (p=0.037, One-way ANOVA). Sections with greater than 2-CD68+ cells per slice were correlated with a greater chance of being placed on immunomodulators (p=0.038), however referral to rheumatology was not (p=0.713, Chi-square with Fisher's Exact test).
The CD68+ macrophage marker and the location of these cells on the IEL can be a useful way to prognosticate clinical course in patients with treated or healing GCA. Patients refractory to initial steroid tapers were found to have increased number of CD68+ cells per section. Although referral to rheumatology was not found to be significant likely due to provider preferences, identifying an average of 2 or more CD68+ cells per section may predict likelihood of being placed on immunomodulator treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only