Introduction. Giant cell arteritis (GCA) is a large vessel (LV) vasculitis, mainly affecting elder patients. Monitoring GCA activity during tocilizumab (TCZ) treatment is an unmet need, since low serum levels of C-reactive protein (CRP) during treatment may underestimate disease activity. To date, few data are available on the role of different imaging techniques in monitoring GCA activity and response to treatment. We report herein a cohort of GCA patients treated with TCZ and followed up with multimodal imaging. Patients and Methods. We collected clinical, laboratory, and imaging data of 11 GCA patients treated with TCZ 162 mg subcutaneously every week. Disease activity was assessed at baseline and within 12 months from the start of treatment using different imaging techniques such as color Doppler ultrasonography (CDUS), magnetic resonance imaging/angiography (MRI/MRA), computed tomography angiography (CTA), and/or positron emission tomography (PET). Results. Four patients were affected by cranial and 7 by LV-GCA. All patients were treated with oral glucocorticoids (GCs) (mean dose of prednisone or equivalent) in combination with TCZ. Treatment was preceded in 5 cases by 3 intravenous boluses of 1000 mg methylprednisolone. A significant decrease of the mean dose of oral GCs was observed between baseline and the last follow-up visit ( mg) (). TCZ treatment significantly decreased erythrocyte sedimentation rate () and CRP levels (). At follow-up (mean months), all patients were in clinical and serological remission. Moreover, PET, CDUS, MRI/MRA, and CTA did not show any LVV finding. Conclusions. Our study highlights TCZ efficacy in inducing GCA remission and its steroid-sparing effect. We highlighted a reliability of imaging procedures in the evaluation of disease activity and treatment response. A close disease monitoring with imaging techniques should be taken into account in GCA patients during TCZ treatment.

中文翻译：

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多模态成像在监测巨细胞动脉炎中托珠单抗的疾病活动和治疗反应中的作用

简介。巨细胞动脉炎 (GCA) 是一种大血管 (LV) 血管炎，主要影响老年患者。在托珠单抗 (TCZ) 治疗期间监测 GCA 活性是一项未满足的需求，因为治疗期间 C 反应蛋白 (CRP) 的低血清水平可能会低估疾病活动。迄今为止，关于不同成像技术在监测 GCA 活动和对治疗反应方面的作用的数据很少。我们在此报告了一组接受 TCZ 治疗并随后进行多模式成像的 GCA 患者。患者和方法. 我们收集了每周接受 162 mg TCZ 皮下注射治疗的 11 名 GCA 患者的临床、实验室和影像学数据。在基线和治疗开始后 12 个月内使用不同的成像技术评估疾病活动，例如彩色多普勒超声 (CDUS)、磁共振成像/血管造影 (MRI/MRA)、计算机断层扫描血管造影 (CTA) 和/或正电子发射断层扫描（PET）。结果。4 名患者受颅脑影响，7 名患者受 LV-GCA 影响。所有患者均接受口服糖皮质激素 (GCs) 治疗（平均剂量泼尼松或等效物）与 TCZ 联合使用。5 例患者在治疗前先静脉推注 3 次 1000 mg 甲基强的松龙。在基线和最后一次随访之间观察到口服 GC 的平均剂量显着降低（ 毫克) (）。TCZ 治疗显着降低红细胞沉降率 ()和 CRP 水平 (）。随访时（平均个月），所有患者的临床和血清学缓解。此外，PET、CDUS、MRI/MRA 和 CTA 未显示任何 LVV 发现。结论。我们的研究强调了 TCZ 在诱导 GCA 缓解方面的功效及其节省类固醇的作用。我们强调了成像程序在评估疾病活动和治疗反应方面的可靠性。在 TCZ 治疗期间，GCA 患者应考虑使用成像技术进行密切的疾病监测。