European Headache Federation recommendations for neurologists managing giant cell arteritis

Abstract

Background and aim: Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA. Methods: The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience. Results: Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA. Conclusion: The present article will outline recent advances made in the diagnosis and management of GCA.

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

“…expert opinion). It corresponds to other recommendations of 2018-2020 [31,34,36,40] on suspected GCA of large vessels as a primary indication for this test. For instance, the EULAR (2018) does not recommend CT or PET for the evaluation of cranial arteries' inflammation; however, it endorses its use (along with the ultrasound examination and MRI) "to detect the wall inflammation and/or alterations of extracranial arterial lumen, corroborating the LVV-GCA diagnosis" [34].…”

“…Although from an evidence-based medicine's perspective the risk factors of GCA complications should not be extrapolated directly on the PMR, they are nevertheless to be taken into account. It concerns, for instance, the key stroke predictor, namely in males, which is the "new" headache occurrence (temporal, occipital, frontal or generalized [31]), blindness predictors, i.e. jaw pain, dyslopia, anomaly of temporal arteries, and risk factors of aortic aneurism and death from its rupture, i.e.…”

“…Besides the specialized societies, such as the European League against Rheumatism (EULAR) and American College of Rheumatology (ACR) [32][33][34], the UK-based societies, namely the British Society for Rheumatology (BSR) and the British Health Professionals in Rheumatology (BHPR), the French Study Group for Large Vessel Vasculitis (Groupe d'étude français des artérites des gros vaisseaux, GEFA) [37], the German Society of Rheumatology (Deutsche Gesellschaft für Rheumatologie, DGRh), the Austrian Society of Rheumatology and Rehabilitation (Österreichische Gesellschaft für Rheumatologie, ÖGR), the Swiss Society of Rheumatology (Schweizerische Gesellschaft für Rheumatologie, SGR) [38], the Italian Society of Reumatology (Società Italiana di Reumatologia, SIR) [39]. The interdisciplinary issue of large-vessel vasculitis management was raised by the guidelines of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) [40] and the European Headache Federation (EHF) [31]. Furthermore, in 2020 there were 4 recommendations published, and in 2018 -there were three.…”

Fast-Track Ultrasound Clinic for the Diagnosis of Giant Cell Arteritis Changes the Prognosis of the Disease but Not the Risk of Future Relapse

“…It is possible that patients with a clinical presentation more easily resembling GCA would be referred more rapidly, however, increased attention to rarer or less specific symptoms of GCA is pivotal to optimize the clinical suspicion. To further improve the outcome of LVV, the expedited process allowing for early access to specialist evaluation and confirmatory investigational tests obtained with FTA should be paralleled by educational programmes and clear recommendations for fast-track referral offered to primary care and other relevant specialists to further reduced the symptom latency period ( 21 , 22 ). An improvement of the general public awareness of GCA could also be beneficial to reduce the diagnostic delay.…”

A Diagnostic Algorithm Based on a Simple Clinical Prediction Rule for the Diagnosis of Cranial Giant Cell Arteritis

“…Diagnostic imaging nowadays plays an important role in the diagnosis of GCA. For the diagnostic workup of suspected cranial GCA (cGCA), color duplex sonography (CDS) of the temporal arteries is recommended as the first line imaging test [ 2 , 3 , 4 , 5 ]. High-resolution sonography of the cranial arteries has been shown to accurately discriminate patients with and without cGCA [ 6 , 7 , 8 ].…”