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BSR/BHPR guideline

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doi:10.1093/rheumatology/keq039b is the British Guideline. JFW | T@lk 11:02, 4 April 2011 (UTC)[reply]

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Queen's Student Editing Initiative

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To Whom it may concern, We are a group of medical students at Queen's University, and we are editing this page as part of a class assignment. We are working to improve this article over the next month and will be posting our planned changes on this talk page in the upcoming week. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence that we have gathered. We are excited to engage in any discussions and welcome suggestions as we learn to edit a Wikipedia article. Thank you. FIONARAYMOND (talk) 20:37, 11 November 2019 (UTC)[reply]


Hello All,

We have compiled a list of suggestions to improve this article (as alluded to in my previous talk post) and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

Adding information describing the pathophysiological and biochemical mechanism of action of giant cell arteritis. (Section 2). The sentences will now read:

"The pathological mechanism is the result of an inflammatory cascade that is triggered by an as of yet determined cause resulting in dendritic cells in the vessel wall recruiting T cells and macrophages to form granulomatous infiltrates.[1] These infiltrates erode the middle and inner layers of the arterial tunica media leading to conditions such as aneurysm and dissection. Activation of T helper 17 (Th17) cells involved with interleukin (IL) 6, IL-17, IL-21 and IL-23 play a critical part; specifically, Th17 activation leads to further activation of Th17 through IL-6 in a continuous, cyclic fashion.[1] This pathway is suppressed with glucocorticoids, and more recently it has been found that IL-6 inhibitors also play a suppressive role.[1]

Adding two sentences that will include information briefly describing relapse of GCA. The sentences read as follows:

“While studies vary as to the exact relapse rate of giant cell arteritis, relapse of this condition does occur. It most often happens at low doses of prednisone (<20mg/day), during the first year of treatment, and the most common signs of relapse are headache and polymyalgia rheumatica.[citation needed]" There is no section that directly corresponds with relapse so we are proposing adding this information at the end of the ‘treatment’ paragraph within the abstract section.

Adding information about the potential side effects of prednisone as a treatment. (Section 4). “Short-term side effects of prednisone use are uncommon but can include mood changes, avascular necrosis, and an increased risk on infection[1]. Some of the side effects associated with long-term use include weight gain, diabetes mellitus, osteoporosis, avascular necrosis, glaucoma, cataracts, cardiovascular disease, and increased risk of infection, but side-effects in most organ systems can occur[2][3].”

Adding descriptive information about the alternative treatment which is a biological agent called Tocilizumab, specifically successes of the treatment, mechanism, dosage, side effects, and long term effects (Section 4). The sentences will read as follows:

"The active component of Tocilizumab is a humanized antibody that targets the interleukin-6 receptor, which is a key cytokine involved in the progression of GCA. Tocilizumab has been found to be highly effective at minimizing both recurrence, and flares of GCA when used on its own or concurrently with corticosteroids.[2] Since Tocilizumab has only been used in GCA since 2016, widespread instructions about the use of Tocilizumab have not been established.[3] Treatment is highly specific to each individual and the success and safety of Tocilizumab in treating GCA over long periods of time requires further investigation.[2][3] Tocilizumab may relate to an increase in risk of the formation of holes in the walls of the lower parts of the digestive system (gastrointestinal perforation) and infections, however it does not appear that there are more risks than using corticosteroids.[citation needed]“

References

  1. ^ a b c Yoshifuji, Hajime (2019-03-04). "Pathophysiology of large vessel vasculitis and utility of interleukin-6 inhibition therapy". Modern Rheumatology. 29 (2): 287–293. doi:10.1080/14397595.2018.1546358. ISSN 1439-7595.
  2. ^ a b Mariano, Vincent J.; Frishman, William H. (2018). "Tocilizumab in Giant Cell Arteritis:". Cardiology in Review: 1. doi:10.1097/CRD.0000000000000204. ISSN 1061-5377.
  3. ^ a b Rinden, T.; Miller, E.; Nasr, R. (2019-07-01). "Giant cell arteritis: An updated review of an old disease". Cleveland Clinic Journal of Medicine. 86 (7): 465–472. doi:10.3949/ccjm.86a.18103. ISSN 0891-1150.

Adding/clarifying information describing some co-existing/similar conditions with giant cell arteritis, as well as adding a citation that was missing in this section’s last sentence. (Section 1.1)

Under the “Associated Conditions” section, the second paragraph will be replaced with: “The disorder may coexist (in a half of cases)[12] with polymyalgia rheumatica (PMR), which is characterized by sudden onset of pain and stiffness in muscles (pelvis, shoulder) of the body and is seen in the elderly. GCA and PMR are so closely linked that they are often considered to be different manifestations of the same disease process. However, although they can co-exist, PMR usually lacks the cranial symptoms including headache, pain in the jaw while chewing, and vision symptoms that are present in GCA.[27] Other diseases that resemble temporal arteritis are systemic lupus erythematosus, rheumatoid arthritis, many severe infections as well as cancers and haematological malignancies among others.[27]

Reference #27 (number subject to change): "BMJ Best Practice". bestpractice.bmj.com. Retrieved 2019-11-11.

References

Please provide more information on this reference. Article name etc. and insert using the citation tool as we practiced in class so it will work when you edit it into Wikipedia. Great work so far!JenOttawa (talk) 13:41, 20 November 2019 (UTC)[reply]

Providing a reference to describe the link between giant cell arteritis and aortic aneurysm (Section 1.1). Under "Associated conditions", replacing the third point with: "Giant-cell arteritis can affect the aorta and lead to aortic aneurysm and aortic dissection, with up to 66.7% of people with GCA having evidence of an inflamed aorta, which can increase the risk of aortic aneurysm and dissection.[1] There are arguments for the routine screening of each person with GCA for this possible life-threatening complication by imaging the aorta. Screening should be done on a case-by-case basis based on the signs and symptoms of people with GCA.[1]"

References

  1. ^ Chen, John J.; Warrington, Kenneth J.; Garrity, James A.; Prasad, Sashank (2017). "Is Routine Imaging of the Aorta Warranted in Patients With Giant Cell Arteritis?". Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society. 37 (3): 314–319. doi:10.1097/WNO.0000000000000538. ISSN 1536-5166. PMID 28614098.

Alyshapelley (talk • contribs) 22:04, 19 November 2019 (UTC)[reply]

Thank you for sharing these improvements. I re-added your citation by pasting the PMID into the citation tool as we did in class on Nov 11. Please make sure that you can do this (you can practice in your sandbox) before editing the article live on the 25th. I am also happy to help anytime. JenOttawa (talk) 13:41, 20 November 2019 (UTC)[reply]

We welcome any comments or discussion regarding these proposed changes. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. Thank you! FIONARAYMOND (talk) 00:57, 19 November 2019 (UTC)[reply]

Thanks for sharing this @FIONARAYMOND:. Looks great so far! Do you mind re-adding your references? They did not come through when pasting from your sandbox. If you can add them with the citation tool (pasting PMID) that would be great. I also added a few citation needed tags. You can reuse the same citation, and it is best to have a citation after each sentence to support the evidence presented. JenOttawa (talk) 01:02, 19 November 2019 (UTC)[reply]
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