Journal of Vasculitis

Vasculitis, a group of autoimmune disorders characterized by inflammation of blood vessels, poses significant challenges in management due to its heterogeneity and potential for organ damage. While traditional immunosuppressive therapies have been instrumental in controlling disease activity, emerging biologic therapies offer targeted interventions that hold promise in improving outcomes for patients with vasculitis. This article reviews the latest advancements in biologic therapies, including monoclonal antibodies, cytokine inhibitors, and targeted immunomodulators, focusing on their efficacy and safety profiles based on clinical evidence and real-world experience. Despite the progress made, challenges such as long-term safety, optimization of treatment strategies, and access barriers persist. Future research directions, including personalized treatment approaches and combination therapies, aim to address these challenges and further enhance the management of vasculitis. By understanding the evolving landscape of biologic therapies, healthcare providers can make informed decisions and improve outcomes for patients with this complex autoimmune condition.

Large Vessel Vasculitis (LVV) encompasses a group of inflammatory disorders primarily affecting the aorta and its major branches, including Giant Cell Arteritis (GCA) and Takayasu Arteritis (TA). Despite advancements in treatment, management of LVV remains challenging due to relapses, glucocorticoid dependency, and treatment-related adverse effects. This article explores novel therapeutic targets and emerging treatment strategies for LVV, including immunomodulatory agents, targeted biologic therapies, and small molecule inhibitors. By elucidating the underlying pathophysiological mechanisms and investigating innovative treatment approaches, healthcare providers can optimize outcomes and improve quality of life for patients with LVV.

Vasculitis encompasses a heterogeneous group of autoimmune disorders characterized by inflammation of blood vessels. While genetic predisposition is well-established in vasculitis, emerging evidence suggests a significant influence of environmental factors on disease development and progression. This article provides a comprehensive review of the current evidence linking various environmental factors, including infectious agents, pollutants, medications, and lifestyle factors, to vasculitis. Understanding the interplay between genetic susceptibility and environmental triggers is essential for elucidating the complex pathogenesis of vasculitis. Moreover, recognizing modifiable environmental factors holds promise for preventive strategies and targeted interventions to mitigate disease burden. Through an exploration of recent research findings and clinical observations, this article aims to enhance awareness among healthcare professionals regarding the role of environmental influences in vasculitis, ultimately guiding personalized approaches to patient care and management.

Coronary angioplasty can be complicated by pericarditis which can appear at distance or more rarely early after the procedure, especially in the event of a mechanical complication of this procedure such as coronary artery perforation.

Summary of the case: We report the case of a patient who presented with early pericarditis after angioplasty complicated by coronary perforation.

It is about a 58-year-old patient admitted for angioplasty of a chronic total occlusion of the right coronary artery; the angioplasty resulted in a coronary perforation through the guidewire 0.014. The patient remained asymptomatic and hemodynamically stable. Faced with the failure to exclude the perforation by balloon inflation, we decided to perform a distal fat embolization to seal the perforation.

Twelve hours after the procedure, the patient presented with intense chest pain with a concave elevation of the ST segment in the anterior and lateral leads with an increase in troponins level and a worsening of the pericardial effusion on echocardiography motivate an emergency coronary angiography which confirms the absence of an active perforation. An elevated C-reactive protein level confirmed the diagnosis of acute pericarditis leading to the start of anti-inflammatory treatment allowing sedation of the pain, normalization of the ECG and regression of the effusion thus authorizing the patient's discharge 5 days later.

Coronary perforation during angioplasty has, in addition to these immediate hemodynamic consequences, a risk of progression to so-called traumatic acute pericarditis and should prompt rigorous monitoring of inflammatory signs and the systematic initiation of anti-inflammatory treatment (Aspirin or non-steroidal anti-inflammatory drugs and Colchicine) after the acute management of the perforation in order to reduce the long-term morbidity and mortality of this complication and the progression towards constriction.

Advancements in imaging modalities have revolutionized the early diagnosis and monitoring of vasculitis, a group of inflammatory diseases affecting blood vessels. This article provides an overview of the latest developments in imaging techniques for the detection and assessment of vasculitis progression. Magnetic Resonance Imaging (MRI), Computed Tomography Angiography (CTA), Positron Emission Tomography (PET) imaging, ultrasound, and Optical Coherence Tomography (OCT) offer valuable insights into vascular inflammation, enabling clinicians to visualize vessel abnormalities, assess disease activity, and guide treatment decisions. Despite the unique advantages of each imaging modality, challenges remain, including radiation exposure, contrast agent use, and accessibility. Future directions include personalized imaging approaches, quantitative imaging biomarkers, multimodal imaging integration, artificial intelligence applications, patient-centered outcomes research, and efforts to address disparities in imaging access. By leveraging these advancements, healthcare professionals can enhance the early diagnosis, management, and monitoring of vasculitis, ultimately improving patient outcomes and quality of life.