Current developments in the diagnosis and treatment of giant cell arteritis

Abstract

Giant cell arteritis is the most common vasculitis in adults above 50 years old. The disease is characterized by granulomatous inflammation of medium and large arteries, particularly the temporal artery, and is associated acutely with headache, claudication, and visual disturbances. Diagnosis of the disease is often complicated by its protean presentation and lack of consistently reliable testing. The utility of color doppler ultrasound at the point-of-care and FDG-PET in longitudinal evaluation remain under continued investigation. Novel techniques for risk assessment with Halo scoring and stratification through axillary vessel ultrasound are becoming commonplace. Moreover, the recent introduction of the biologic tocilizumab marks a paradigm shift toward using glucocorticoid-sparing strategies as the primary treatment modality. Notwithstanding these developments, patients continue to have substantial rates of relapse and biologic agents have their own side effect profile. Trials are underway to answer questions about optimal diagnostic modality, regiment choice, and duration.

Antiplatelet Therapy to Prevent Ischemic Events in Giant Cell Arteritis: protocol for a systematic review and meta-analysis

“…(1) Depending on the clinical phenotype, additional immunosuppressive therapy is sometimes required. (7,8) Symptomatic relapses are common and occur in 40-80% of patients during glucocorticoid tapering or discontinuation. (9,10) Complications of GCA can be severe.…”

Increased vertebral canal diameter measured by ultrasonography as a sign of vasculitis in patients with giant cell arteritis

“…It is a granulomatous arteritis of large and medium-sized vessels, mainly affecting the supra-aortic trunks and their branches. Superficial temporal artery involvement is characteristic and is responsible for most of the typical symptoms associated with this disease (2,3).…”

“…Those uncommon symptoms can be the only presenting clinical picture. Thus, there are situations in which patients may present with a clinical picture that in most cases is very clear, allowing the diagnosis by the established diagnostic criteria; but also, others with very nonspecific symptoms in which the initial clinical suspicion may be, in some cases, low (3). According to some case series of GCA patients affecting the vertebral arteries, all patients presenting with stroke.…”

“…Most of them did not have the classical symptoms of GCA associated with stroke (11). This subgroup of patients with VA involvement resulting from GCA is associated with increased mortality rates (3,4,7,11). In these latter patients, the diagnosis becomes a challenge, since the detection of the disease, its treatment, and the speed of its onset and the swiftness of treatment can influence mark the appearance of complications and therefore the short and long term prognosis.…”

“…Meta-analyses indicate high reliability for this sign in the diagnosis of GCA (15,17,(20)(21)(22)(23). Since ultrasonography is an easy and accessible technique and reproducible with good reliability, it has been postulated in different guidelines as the first diagnostic test for suspected GCA (3,17).…”