Management of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA)

Bienvenu, Boris; Ly, Kim-Heang; Lambert, Marc; Agard, C.; André, M.; Benhamou, Y.; Bonnotte, Bernard; Boysson, Hubert de; Espitia, O.; Fau, G.; Fauchais, Anne-Laure; Galateau-Sallé, Françoise; Haroche, Julien; Héron, Emmanuel; Lapébie, François-Xavier; Liozon, É.; Nguyen, Leanne; Magnant, Julie; Manrique, Alain; Matt, M.; Menthon, Mathilde de; Mouthon, Luc; Puéchal, Xavier; Pugnet, G.; Quéméneur, T.; Régent, Alexis; Saadoun, David; Samson, M.; Sène, Damien; Smets, P.; Yelnik, C.; Sailler, L.; Mahr, Alfred

doi:10.1016/j.revmed.2015.12.015

Cited by 172 publications

(139 citation statements)

References 144 publications

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“…The early administration of hydroxychloroquine did not improve the outcome in noncomplicated GCA with no difference in cumulative glucocorticoid use or effect on risk of relapse [79].…”

Section: Hydroxychloroquinementioning

confidence: 81%

“…However, existing guidelines only recommend IV glucocorticoid in those with transient or permanent vision loss [79e81]. Once GCA disease activity is suppressed, the daily dose of prednisolone can be reduced by 10 mg/ month, followed by 5 mg/month, and once the daily dose is 10e15 mg/day, it is reduced further by 1 mg/month, with aim of cessation by 18e24 months [79].…”

Section: Glucocorticoid Regimens and Deliverymentioning

confidence: 99%

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Giant cell arteritis

Ninan

Lester

Hill

2016

Best Practice & Research Clinical Rheumatology

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“…The early administration of hydroxychloroquine did not improve the outcome in noncomplicated GCA with no difference in cumulative glucocorticoid use or effect on risk of relapse [79].…”

Section: Hydroxychloroquinementioning

confidence: 81%

Section: Glucocorticoid Regimens and Deliverymentioning

confidence: 99%

Giant cell arteritis

Ninan

Lester

Hill

2016

Best Practice & Research Clinical Rheumatology

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“…[9] Between November 2013 and August 2015, all patients in whom a TAB was performed for suspected GCA were considered for participation in the study. Patients who had received glucocorticoid treatment for >7 days were excluded.…”

Section: Methodsmentioning

confidence: 99%

Positron emission tomography and computed tomography angiography for the diagnosis of giant cell arteritis

Larivière¹,

et al. 2016

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The use of 18F-fluoro-deoxyglucose positron emission tomography scan (FDG-PET) and computed tomography angiography (CTA) to improve accuracy of diagnosis of giant cell arteritis (GCA) is a very important clinical need. We aimed to compare the diagnostic performance of FDG-PET and CTA in patients with GCA.FDG-PET and CTA were acquired in all consecutive patients suspected for GCA. Results of FDG-PET and CTA were compared with the final diagnosis based on clinical judgment, temporal artery biopsy (TAB) findings, and ACR criteria. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for each method.Twenty-four patients suspected for GCA were included. Fifteen (62.5%) were ultimately diagnosed as having GCA. Among them, all fulfilled ACR criteria and 6 had biopsy-proven GCA. Strong FDG uptake in large vessels was found in 10 patients who all had GCA. Mean maximal standard uptake values (SUVmax) per patient measured at all the arterial territories were of 3.7 (range: 2.8–4.7). FDG uptake was negative in 14 patients including 9 and 5 patients without and with GCA, respectively. Mural thickening suggestive of aortitis or branch vessel arteritis was observed on CTA in 11 patients with and 2 patients without GCA. No mural thickening was observed in 11 patients including 7 patients without and 4 patients with GCA. Overall, sensitivity was 66.7% and 73.3%, specificity was 100% and 84.6%, NPV was 64.3% and 64.6%, and PPV was 100% and 84.6% of FDG-PET and CTA, respectively.Both FDG-PET and CTA have a strong diagnostic yield for the diagnosis of GCA. FDG-PET appeared to have a higher PPV as compared to CTA and may be the preferred noninvasive technique to explore patients with suspected GCA.

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“…For those patients who had already developed visual impairment, early treatment (within 24 h) was the only predictor of recovery of visual impairment. Existing guidelines recommend intravenous glucocorticoid therapy for those with permanent or transient visual loss . However, the evidence for use of IV over oral glucocorticoids in other GCA patients has been contradictory .…”

Section: Advances In Therapymentioning

confidence: 99%

Giant cell arteritis: beyond temporal artery biopsy and steroids

Ninan

Lester

Hill

2017

Internal Medicine Journal

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Giant cell arteritis is the most common primary vasculitis of the elderly. The acute complications of untreated giant cell arteritis, such as vision loss or occasionally stroke, can be devastating. The diagnosis is, however, not altogether straightforward due to variable sensitivities of the temporal artery biopsy as a reference diagnostic test. In this review, we discuss the increasing role of imaging in the diagnosis of giant cell arteritis. Glucocorticoid treatment is the backbone of therapy, but it is associated with significant adverse effects. A less toxic alternative is required. Conventional and novel immunosuppressive agents have only demonstrated modest effects in a subgroup of steroid refractory Giant cell arteritis due to the different arms of the immune system at play. However, recently a study of interleukin-6 blockade demonstrated benefits of giant cell arteritis. The current status of these immunosuppressive agents and novel therapies are also discussed in this review.

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Management of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA)

Cited by 172 publications

References 144 publications

Giant cell arteritis

Giant cell arteritis

Positron emission tomography and computed tomography angiography for the diagnosis of giant cell arteritis

Giant cell arteritis: beyond temporal artery biopsy and steroids

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