The IL-6 axis in vascular inflammation: effects of IL-6 receptor blockade on vascular lesions from patients with giant-cell arteritis.

Objectives: Blocking interleukin (IL)-6-receptor with tocilizumab has been a major advance in the treatment of giant-cell arteritis (GCA), supporting a crucial role of IL-6 receptor signalling. However, nearly half of the patients are not able to maintain glucocorticoid- free remission with tocilizumab. The impact of tocilizumab on vascular lesions of GCA is largely unknown since conflicting results have been obtained by imaging.

Biopsy vs imaging for the diagnosis of giant cell arteritis. Viewpoint 2: in favour of biopsy.

Objectives: Both temporal artery biopsy (TAB) and imaging are widely used to support the diagnosis of giant cell arteritis (GCA). The objective of this study was to compare the use of TAB and imaging.

Methods: This article was based on a debate presented at the 21st Vasculitis Meeting, discussing the advantages and disadvantages of using TAB with histology vs imaging for the diagnosis of suspected GCA.

Highlights from the plenary session: end-organ damage and repair.

The plenary session on "End organ damage and repair" at the 21st International Vasculitis Workshop Congress featured two lectures and three studies addressing the pathogenesis, diagnosis, and management of fibrosis in vasculitis. The studies presented at the session demonstrate the importance of cellular interplay in driving inflammation and fibrosis, like the B cell-fibroblast interactions in the aorta of giant cell arteritis patients and the potential fibrotic role of specific infiltrating macrophage subtypes in ANCA-associated glomerulonephritis. Moreover, organ damage, such as the presence of interstitial lung disease in ANCA-associated vasculitis, may impact on long-term outcome, and need a personalized treatment approach.

Characterizing Protracted Febrile Myalgia: Fasciitis and Vasculitis of the Fascia and Muscle as Novel Histopathological Features.

: Protracted febrile myalgia (PFM) is a rare but severe form of myalgia mainly occurring in pediatric patients with familial Mediterranean fever (FMF). PFM imaging and histopathological data remain scarce. : A comprehensive clinical, imaging, and histopathological characterization of PFM was performed by retrospectively analyzing a reference center cohort of adult patients with FMF and myalgia, and by a PubMed search of well-described cases with PFM.

Expert Perspective: Management of Relapses in Giant Cell Arteritis.

Giant cell arteritis (GCA) is a relapsing large vessel vasculitis with risk of serious ischemic manifestations, including vision loss and vascular damage in the form of large artery stenosis, aneurysms, and dissections. Approximately 50% of patients treated with glucocorticoid (GC) monotherapy and 30% of patients receiving adjunctive therapy with tocilizumab experience disease relapses, often during the first 2 years after diagnosis. Although most relapses in GCA do not involve life- or organ-threatening presentations and can be controlled successfully, frequent relapses may lead to increased prescription of GC and consequent treatment-related morbidity, in addition to risk of further vascular damage.