Diese Arbeit beschreibt die Farb-Duplex-Sonographie bei Vaskulitiden, insbesondere bei der Arteriitis temporalis (AT), bei der Takayasu-Arteriitis und bei Vaskulitis-Overlap-Syndromen. Dabei wird die erstmals von uns beschriebene charakteristische echoarme Wandschwellung der Temporalarterien (Halo-Phänomen) bei akuter AT erläutert. Dieser Befund wird durch ein Arterienwandödem erklärt und verschwindet unter Therapie mit Kortikosteroiden innerhalb von durchschnittlich 16 Tagen. Zusätzlich lassen sich Stenosen und akute Verschlüsse der Temporalarterien in der Akutphase der Erkrankung darstellen. An den ersten 30 konsekutiven Patienten mit akuter AT führten wir eine kontrollierte, prospektive Studie durch. Diese ergab, dass das Halo-Phänomen bei 73 %, Stenosen und/oder Verschlüsse bei 80 %, und alle drei pathologischen Befunde bei 93 % der Patienten mit der klinischen Diagnose einer akuten AT nachweisbar waren. Die Sensitivität gegenüber der Temporalarterien-Histologie betrug jeweils 76 %, 86 % und 95 %. Die Spezifität des Halo-Phänomens betrug 100 % und von Stenosen/Verschlüssen 93 % gegenüber der klinischen Diagnose. Inzwischen hat der Autor dieser Arbeit 742 Untersuchungen an 630 Patienten durchgeführt. Davon hatten 80 Patienten eine akute AT und 104 weitere Patienten eine akute Polymyalgia rheumatica (PMR). Sensitivität und Spezifität sind vergleichbar mit den Ergebnissen der zuvor genannten kontrollierten Studie. Dabei liegt die Sensitivität der Sonographie sogar über derjenigen der Histologie, da längere Gefäßabschnitte untersucht werden. Bei eindeutigem klinischen und sonographischen Befund erscheint es möglich, auf die Biopsie zu verzichten. Außerdem wird der sonographische Befund der peripheren Riesenzellarteriits an der A. brachialis dargestellt. Zusätzlich fanden wir bei 10 von 33 konsekutiven Patienten mit akuter AT entzündliche Veränderungen an vielen anderen Arterien. Diese Befunde belegen, dass die akute AT stärker generalisiert ist, als bisher angenommen. Selbst bei einer Wegener`schen Granulomatose kann es zum Befall großer Gefäße, wie der Arteria carotis interna kommen, der sich sonographisch darstellen lässt, wie ein weiterer Patient zeigt. Die PMR kann gemeinsam mit der AT vorkommen. Umgekehrt war bei 7 von 102 Patienten mit PMR ohne klinische Zeichen einer AT die Sonographie der Temporalarterien wegweisend für die Diagnose einer begleitenden AT. Bei der Takayasu-Arteriitis finden sich ebenfalls charakteristische, allerdings hellere Wandschwellungen. Drei Patientinnen werden beschrieben, bei denen die Sonographie bereits im prästenotischen Frühstadium für die Diagnose wegweisend war. Die Duplex-Sonographie ist eine faszinierende Methode, wenn sie bei Patienten mit Verdacht auf eine Vaskulitis großer Gefäße angewandt wird, weil es mit ihr schnell, nicht-invasiv und mit vorhandener Technik gelingt, eine Diagnose zu stellen. / Color Duplex sonography is an excellent tool in the diagnosis of vasculitides, particularly for giant cell arteritis (GCA), for Takayasu`s artertis, and for vasculitis overlap syndromes. We described a characteristic dark wall-swelling of the temporal arteries (halo) in acute GCA that is due to an edema. It resolves within about 16 days with corticosteroid therapy. Additionally stenoses and occlusions of the temporal arteries are found in acute disease. A prospective, controlled study was performed on 30 patients with acute GCA. Sensitivity was 73 % (halo), 80 % (stenoses and/or occlusions), and 93 % (at least one of the three findings) for the clinical diagnosis, and 76 %, 86 %, and 95 % for positive histology. Specificity for the clinical diagnosis was 100 % (halo) and 93 % (stenoses, occlusions). Until now the author has performed 742 investigations in 630 patients including 80 patients with acute GCA and 104 more patients with acute polymyalgia rheumatica (PMR). Sensitivity and specificity are comparable to the results of the study. Sensitivity of sonography is even superior to that of histology because a longer segment of the artery can be investigated. In cases with typical clinical and ultrasound findings biopsy may not be necessary any more. Additionally we described the ultrasound image of large-vessel GCA in the brachial artery. In 10 of 33 consecutive patients with acute GCA we found inflammatory changes in many arteries other than the temporal arteries. Thus a generalized vasculitis occurs more frequently in GCA than assumed up to now. Even in Wegener`s granulomatosis large vessels like the internal carotid artery may be involved. We described the ultrasound image of one patient. In 102 patients with PMR and no clinical symptoms of GCA sonography of the temporal arteries delineated typical findings of GCA. In Takayasu`s arteritis sonography also shows a characteristic wall swelling which is brighter than in GCA. We described three patients in which sonography aided in establishing the diagnosis already in the early prestenotic stage of the disease. Duplex sonography is a fascinating method that can be used in the diagnosis of patients with suspected large vessel vasculitis like GCA and Takayasu`s arteritis. It is fast, non-invasive, and the equipment is widely available.

Objetivo: Avaliar marcadores de reserva ovariana e a presença de anticorpo anti-corpo lúteo (anti-CoL) em pacientes com arterite de Takayasu (AT) e possível associação com parâmetros clínicos, laboratoriais e uso de imunossupressores. Métodos: 20 pacientes com AT e 24 controles saudáveis foram avaliados para anti-CoL (immunoblot). A reserva ovariana foi avaliada por: hormônio folículo estimulante (FSH), hormônio luteinizante (LH), estradiol, hormônio anti-Mülleriano (HAM) e contagem de folículos antrais (CFA). HAM foi dosado por ELISA utilizando dois diferentes testes. Dados demográficos, obstétricos, alterações menstruais, aspectos clínicos, imagens vasculares e tratamento foram também analisados. Resultados: A média da idade atual foi similar em pacientes e controles (31,2 ± 6,1 vs. 30,4 ± 6,9 anos, p = 0,69). As frequências de HAM baixo foram idênticas em pacientes com AT com ambos os testes de ELISA e maiores quando comparadas ao grupo controle (50% vs.17%, p=0,02, 50% vs. 19%, p=0,048). Observou-se uma correlação positiva entre os dois testes de ELISA em pacientes (r=0,93, p < 0,0001) e em controles saudáveis (r=0,93, p < 0,0001). Pacientes com AT apresentaram menor CFA (11 vs. 16, p=0,13) e maior frequência de CFA reduzida (41% vs. 22%, p=0,29), contudo sem significância estatística. Não foram encontradas diferenças entre os dois grupos em relação às outras características demográficas e clínicas, dados obstétricos e demais parâmetros da reserva ovariana (p > 0,05). Anti-CoL foi observado apenas em uma paciente com AT (5% vs. 0%, p = 0,45). Avaliação adicional das mulheres com AT comparando as com baixos níveis de HAM ( < 1,0 ng/mL) versus aquelas com níveis de HAM QRUPD ng/mL) não mostrou diferença entre os dois grupos em relação a duração da doença, atividade de doença, provas de fase aguda, exames de imagem vascular e tratamento (p > 0,05). Conclusão: O presente estudo foi o primeiro a sugerir que as pacientes com AT podem apresentar reserva ovariana diminuída / Objective: To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in Takayasu arteritis (TA) patients and a possible association with clinical and laboratory parameters and the use of immunosuppressive drugs. Methods: 20 TA and 24 healthy controls were evaluated for anti-CoL (immunoblot). Ovarian reserve was assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, antiMüllerian hormone (AMH) and antral follicle count (AFC). AMH was measured by ELISA using two different kits. Demographical data, menstrual abnormalities, obstetric data, clinical features, vascular imaging and treatment were also analyzed. Results: The mean current age was similar in TA patients and controls (31.2 6.1 vs. 30.4 6.9 years, p=0.69). The frequencies of decreased levels of AMH in TA patients were identical using both kits and higher when compared to controls (50% vs. 17%, p=0.02; 50% vs. 19%, p=0.048). A positive correlation was observed between the two kits in TA patients (r=+0.93; p < 0.0001) and in healthy controls (r=+0.93; p < 0.0001). The apparent lower AFC (11 vs. 16, p=0.13) and the higher frequency of low AFC (41% vs. 22%, p=0.29) in TA compared to controls did not reach statistical significance. No differences between the two groups were found concerning other demographic and clinical characteristics, obstetric data and other parameters of ovarian reserve (p > 0.05). Anti-CoL was solely observed in TA patients (5% vs. 0%, p=0.45). Further evaluation of TA patients comparing patients with low AMH levels ( < 1.0ng/mL) versus normal AMH levels (.- 1.0ng/mL) revelead no differences regarding disease duration, disease activity, acute phase reactants, vascular imaging and treatment between these two groups (p > 0.05). Conclusions: The present study was the first to suggest that TA patients may have diminished ovarian reserve

Objetivo: Avaliar marcadores de reserva ovariana e a presença de anticorpo anti-corpo lúteo (anti-CoL) em pacientes com arterite de Takayasu (AT) e possível associação com parâmetros clínicos, laboratoriais e uso de imunossupressores. Métodos: 20 pacientes com AT e 24 controles saudáveis foram avaliados para anti-CoL (immunoblot). A reserva ovariana foi avaliada por: hormônio folículo estimulante (FSH), hormônio luteinizante (LH), estradiol, hormônio anti-Mülleriano (HAM) e contagem de folículos antrais (CFA). HAM foi dosado por ELISA utilizando dois diferentes testes. Dados demográficos, obstétricos, alterações menstruais, aspectos clínicos, imagens vasculares e tratamento foram também analisados. Resultados: A média da idade atual foi similar em pacientes e controles (31,2 ± 6,1 vs. 30,4 ± 6,9 anos, p = 0,69). As frequências de HAM baixo foram idênticas em pacientes com AT com ambos os testes de ELISA e maiores quando comparadas ao grupo controle (50% vs.17%, p=0,02, 50% vs. 19%, p=0,048). Observou-se uma correlação positiva entre os dois testes de ELISA em pacientes (r=0,93, p < 0,0001) e em controles saudáveis (r=0,93, p < 0,0001). Pacientes com AT apresentaram menor CFA (11 vs. 16, p=0,13) e maior frequência de CFA reduzida (41% vs. 22%, p=0,29), contudo sem significância estatística. Não foram encontradas diferenças entre os dois grupos em relação às outras características demográficas e clínicas, dados obstétricos e demais parâmetros da reserva ovariana (p > 0,05). Anti-CoL foi observado apenas em uma paciente com AT (5% vs. 0%, p = 0,45). Avaliação adicional das mulheres com AT comparando as com baixos níveis de HAM ( < 1,0 ng/mL) versus aquelas com níveis de HAM QRUPD ng/mL) não mostrou diferença entre os dois grupos em relação a duração da doença, atividade de doença, provas de fase aguda, exames de imagem vascular e tratamento (p > 0,05). Conclusão: O presente estudo foi o primeiro a sugerir que as pacientes com AT podem apresentar reserva ovariana diminuída / Objective: To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in Takayasu arteritis (TA) patients and a possible association with clinical and laboratory parameters and the use of immunosuppressive drugs. Methods: 20 TA and 24 healthy controls were evaluated for anti-CoL (immunoblot). Ovarian reserve was assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, antiMüllerian hormone (AMH) and antral follicle count (AFC). AMH was measured by ELISA using two different kits. Demographical data, menstrual abnormalities, obstetric data, clinical features, vascular imaging and treatment were also analyzed. Results: The mean current age was similar in TA patients and controls (31.2 6.1 vs. 30.4 6.9 years, p=0.69). The frequencies of decreased levels of AMH in TA patients were identical using both kits and higher when compared to controls (50% vs. 17%, p=0.02; 50% vs. 19%, p=0.048). A positive correlation was observed between the two kits in TA patients (r=+0.93; p < 0.0001) and in healthy controls (r=+0.93; p < 0.0001). The apparent lower AFC (11 vs. 16, p=0.13) and the higher frequency of low AFC (41% vs. 22%, p=0.29) in TA compared to controls did not reach statistical significance. No differences between the two groups were found concerning other demographic and clinical characteristics, obstetric data and other parameters of ovarian reserve (p > 0.05). Anti-CoL was solely observed in TA patients (5% vs. 0%, p=0.45). Further evaluation of TA patients comparing patients with low AMH levels ( < 1.0ng/mL) versus normal AMH levels (.- 1.0ng/mL) revelead no differences regarding disease duration, disease activity, acute phase reactants, vascular imaging and treatment between these two groups (p > 0.05). Conclusions: The present study was the first to suggest that TA patients may have diminished ovarian reserve

A Arterite de Takayasu (AT) é uma vasculite granulomatosa de aorta e grandes vasos associada a elevado risco cardiovascular. A velocidade de onda de pulso (VOP) é um método de avaliação indireta de diminuição da distensibilidade arterial, e valores elevados de VOP correlacionam-se com maior morbimortalidade cardiovascular. A avaliação da VOP em pacientes com arterite de Takayasu é complexa devido a muitos fatores de confusão. O objetivo do presente estudo foi avaliar a rigidez arterial, por meio da velocidade de onda de pulso carótido-femoral (VOP-CF) em pacientes do sexo feminino com arterite de Takayasu e controles saudáveis com variáveis clínicas e antropométricas comparáveis, e sua possível associação com os parâmetros da doença. Método: Pacientes com arterite de Takayasu (n = 27) foram avaliados consecutivamente e foram selecionados controles saudáveis com idade, pressão arterial, peso e altura comparáveis (n = 27). Os critérios de exclusão foram menopausa, tabagismo, diabetes, insuficiência renal, hipertensão mal controlada, arritmias cardíacas, obesidade, comorbidades inflamatórias, gravidez e história de procedimentos cirúrgicos que envolvessem a aorta. A atividade da doença foi determinada por parâmetros clínicos e laboratoriais. As medições de VOP-CF foram obtidas pelo Sistema Complior. Resultados: A média de VOP-CF foi maior em pacientes com arterite de Takayasu do que em controles (9,77 ± 3,49 vs. 7,83 ± 1.06 m/s, p = 0,009). Apesar dos rigorosos xv critérios de seleção, os pacientes com arterite de Takayasu ainda apresentavam, em média, pressão arterial sistólica de 8 mmHg maior do que os controles (p > 0,05), e os valores de pressão de pulso significativamente mais elevados. O modelo de regressão linear múltipla mostra que 93,8% da variabilidade da VOP é explicada pelas variáveis idade, pressão arterial média (PAM) e pela própria doença (R2 ajustado = 0,938). A análise logística stepwise usando como variável dependente o valor de corte de VOP estabelecido pela curva ROC (> 8,34 m/s) e, como variáveis independentes, os parâmetros com significância na análise univariada, revelou que arterite de Takayasu (OR: 4,69, IC 95% 1,31 - 16,72; p = 0,017) e PAM (OR: 1,06, IC 95% 1,00 - 1,12, p = 0,048) foram independentemente associados a maior VOP. Uma análise mais aprofundada dos parâmetros de doença revelou que os valores de VOP não foram correlacionados com velocidade de hemossedimentação, proteína C-reativa, dose cumulativa de glicocorticoides e fração de ejeção (p > 0,05). Conclusão: Nesta coorte de pacientes do sexo feminino com arterite de Takayasu, a própria doença e a pressão arterial média foram os determinantes mais fortemente associados com elevada rigidez arterial e não houve correlação dos valores de VOP com parâmetros de atividade da doença / Takayasu arteritis (TA) is a granulomatous vasculitis that affects the aorta and large vessels and is associated with higher cardiovascular risk. Pulse wave velocity (PWV) is a method of indirect evaluation of decreased arterial distensibility, and elevated PWV correlates with increased cardiovascular morbidity and mortality. The assessment of PWV in patients with Takayasu arteritis is complex due to many confounding factors. The aim of this study was to evaluate arterial stiffness, assessed by carotid-femoral pulse wave velocity (CF-PWV) in female patients with TA and healthy controls with comparable anthropometric and clinical variables, and the possible association with parameters of the disease. Method: Patients with TA (n = 27) were consecutively evaluated and healthy controls were selected with comparable age, blood pressure, weight and height (n = 27). Exclusion criteria were menopause, smoking, diabetes, renal insufficiency, poorly controlled hypertension, cardiac arrhythmias, obesity, inflammatory comorbidities, pregnancy and history of surgical procedures involving the aorta. Disease activity was determined by clinical and laboratory parameters. The CF-PWV measurements were obtained by the Complior System. Results: The mean CF-PWV was higher in patients with TA than in controls (9.77 ± 3.49 vs. 7.83 ± 6.1 m / s, p = 0.009). Despite the strict selection criteria, TA patients still had, on average, systolic blood pressure of 8 mmHg greater than controls (p > 0.05), and pulse pressure values significantly higher. The multiple linear regression model showed that 93.8% of the variability in PWV is explained by the variables age, mean arterial pressure (MAP) and the disease itself (adjusted R2 = 0.938). A stepwise logistic analysis using as the dependent variable the cutoff value of VOP established by the ROC curve (> 8.34 m/s) and, as independent variables, parameters with significance in the univariate analysis, revealed that Takayasu arteritis (OR: 4.69 95% CI 1.31 - 16.72, p = 0.017) and MAP (OR: 1.06, 95% CI 1.00 - 1.12, p = 0.048) were independently associated with increased PWV. Further analysis of disease parameters revealed that PWV values were not correlated with erythrocyte sedimentation rate, C-reactive protein, cumulative dose of glucocorticoids or ejection fraction (p > 0.05). Conclusion: In this cohort of female patients with Takayasu arteritis, the disease itself and mean arterial pressure were determinants most strongly associated with elevated arterial stiffness and no correlation of PWV values and parameters of disease activity was found

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