Photo Credit: carlesmiro

The following is a summary of “Magnetic resonance imaging to monitor disease activity in giant cell arteritis treated with ultra-short glucocorticoids and tocilizumab,” published in the July 2024 issue of Rheumatology by Christ et al.

Magnetic resonance imaging (MRI) is well-established for diagnosing giant cell arteritis (GCA), but its effectiveness in monitoring disease activity remains to be determined.

Researchers conducted a retrospective study assessing the usefulness of MRI in monitoring disease activity by examining vascular and musculoskeletal inflammation in patients from the GUSTO trial.

They involved 18 patients with newly diagnosed GCA who were treated with 500 mg intravenous methylprednisolone for 3 consecutive days, followed by tocilizumab monotherapy starting from day 3 through week 52. The MRI exams of the cranial, thoracic, and abdominal regions were conducted at baseline (active, new-onset disease), as well as at weeks 24, 52 (remission on-treatment), and 104 (remission off-treatment). The MRI findings were evaluated for characteristics typical of polymyalgia rheumatica (PMR) and assessed for the extent and severity of vasculitic disease.

The result showed 673 vascular segments and 943 musculoskeletal regions from 55 thoracic/abdominal MRI scans, along with 490 vascular segments from 49 cranial MRI scans of 18 patients, were analyzed. At week 24, vasculitic vessels remained in 1-quarter of cranial segments. By weeks 52 and 104, no cranial vascular segments exhibited vasculitic manifestations. Large vessels, except the ascending aorta and PMR, showed minimal or no reduction in inflammatory findings over time.

Investigators concluded that after 52 weeks of treatment, vasculitic manifestations in cranial vessels normalized, while large vessel and PMR findings persisted despite full remission, indicating that MRI of cranial arteries could be a useful tool for monitoring disease activity and detecting relapse.

Source: academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/keae378/7717971