• Giant cell arteritis: a new perspective on investigations and diagnostic criteria

      Sagdeo, Amol; Askari, Ayman; Morrissey, Hana; Ball, Patrick (Research Trends, 2020-08-13)
      Giant cell arteritis (GCA) is a common form of granulomatous inflammation of large blood vessels. It can cause irreversible blindness in nearly 20% of untreated cases. It has an incidence of 15-30 per 100,000 persons aged 50 years and over in North American and European countries. GCA is a medical emergency and requires early confirmation of diagnosis and initiation of treatment. Recent development in non-invasive imaging modalities, with higher sensitivities and specificities than temporal artery biopsy (TAB), improved the standard for GCA diagnosis. The recent updates on British Society for Rheumatology guidelines elaborated on the role of ultrasound (US) in the diagnosis of GCA and use of the guidelines provides a new approach for GCA confirmatory diagnosis. A search was conducted using EMBASE and Medline databases to identify recent published research on the diagnosis of GCA. Only human studies published in English between 2010 to 2020 were considered in this systematic narrative review. This review also summarises the evidence available for non-invasive imaging and recommends an approach combining the recently published algorithm for diagnosis decision making of cranial GCA using scoring system. This review proposes a combined approach to use a clinical diagnostic decision making in suspected cranial GCA and use the scoring system based on the clinical history, examination findings, laboratory results and the imaging results combined to give a score to diagnose GCA from other vasculitides. The approach to investigate a case of GCA needs to be modified and should include newer imaging techniques available and new diagnostic criteria should be used in combination with the rapid access pathways for clinical decision.
    • Secukinumab efficacy and safety: Reporting on the experiences of clinicians and patients

      Al Abadie, Mohammed; Ayaz, Ambreen; Adcock, Lyn; Elston, Georgina; Beswick, Samantha; Cartwright, Peter; Ibrahim, Rangeen; Ball, Patrick; Morrissey, Hana (Research Trends, 2019-09-07)
      Secukinumab (SEC) is a human monoclonal antibody that selectively neutralizes IL-17A, a key cytokine involved in the development of psoriasis. Superior efficacy has been demonstrated in clinical trials with up to 79% of moderate-to-severe psoriasis patients achieving a PASI 90 at week 16 and 75% achieving a PASI 90 at week 52. However, the population recruited into clinical trials are different to the real-world population. The aim of this paper is to discuss the safety and efficacy of SEC based on ‘real-world data’ when used in patients with multiple co-morbidities and concomitant medications. Two clinical audits conducted were based on a clinical audit checklist, which was adopted and included in all patients’ usual care as the patient-management model for biological therapies. Patients on SEC were identified from our pharmacy database and data was collected from electronic patient records between September 2015 and May 2018. The psoriasis area severity index (PASI) and dermatology life quality index (DLQI) were extracted at baseline and at 16 weeks. The results from the rheumatology departments of the two hospitals were then compared. A total of 135 patients’ data was analysed. SEC was found to offer an efficacious real-world treatment option with response rates generally higher than observed in pivotal Phase III clinical trials. Response rates were higher in biologic naïve patients than non-naïve patients. There were no unusual safety signals; however, long-term efficacy and sustainability are yet to be established.