Diagnosis and management of giant cell arteritis: an Asia‐Pacific perspective

Abstract

Giant cell arteritis is the commonest primary vasculitis of the elderly. However, the prevalence does vary widely between populations with highest incidence amongst Northern Europeans and lowest amongst East Asians. Preliminary studies suggest that clinical manifestations may differ between different populations. Newer diagnostic approaches including ultrasound, MR angiography and PET imaging are under review. While there have been recent advances in the diagnosis of GCA particularly with regard to imaging, there is an urgent need for improvements in methods of diagnosis, treatment and requirement for screening. Glucocorticoid treatment remain the backbone of therapy. However, glucocorticoid therapy is associated with significant adverse effects. Conventional and novel immunosuppressive agents have only demonstrated modest effects in a subgroup of steroid refractory GCA due to the different arms of the immune system at play. However, recently a study of IL-6 blockade demonstrated benefit in GCA. Newer approaches such as fast-track pathways can also result in improvements in consequences of GCA including blindness.

Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series

“…Due to the considerably low temporal artery biopsy rate in China, GCA is rarely reported by ophthalmologists in this country; therefore, GCA remains underdiagnosed among the AION population, especially in the elderly. Temporal artery ultrasonography, which is non-invasive and cost-effective, is recommended by the European League Against Rheumatism as the first-line study for evaluating large-vessel vasculitis and has been widely utilized in our clinic recently for evaluating high-risk GCA patients ( 17 – 19 ). CDUS can detect the blood flow in ocular arteries, including the OA, CRA, and PCA, and the high-frequency linear probe can detect the superficial cutaneous temporal artery.…”

“…MRI is another non-invasive technique for evaluating arteries and determining a diagnosis ( 17 , 20 ). In addition to the cranial arteries, enhancement of the optic nerve sheath in orbit MRI has been reported as one characteristic of GCA, which was observed in our case series as well ( 20 , 21 ).…”

Diagnostic performance of the 2012 EULAR/ACR classification criteria for polymyalgia rheumatica in Korean patients

“…The prevalence of PMR is much lower in Asians when compared to Northern Europeans and individuals of Scandinavian descent 1 . According to Western studies, between 16% and 21% of patients with PMR are known to have giant cell arteritis (GCA), but the incidence of GCA is rare in Asian countries 18 . The clinical manifestations, US findings, and applications of the diagnostic/classification criteria for PMR may vary between different populations.…”

The diagnostic accuracy of temporal artery ultrasound and temporal artery biopsy in giant cell arteritis: A single center Australian experience over 10 years

“…A nationwide Japanese study identified an age‐adjusted prevalence of 1.47/100 000. 2 Visual symptoms are reported in up to 26% of patients, with the dreaded complication of permanent visual loss in 15% of such patients—mainly due to anterior ischemic optic neuropathy. 3 Early diagnosis and commencement of corticosteroids are crucial in preventing blindness.…”