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Giant Cell Arteritis

  • Abid Awisat
  • Raashid Luqmani
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  • 46 Downloads

Abstract

Giant cell arteritis (GCA) is a granulomatous vasculitis involving medium and large-size vessels occurring in adults and is almost exclusive to individuals above 50 years with an age-dependent pattern peaking at the age of 70–80. The pathophysiology of this distinct disease involves activation of local T-cells and macrophages leading to the production of pro-inflammatory cytokines including IL-6 and IFN-γ, resulting in the formation of giant cells, granulomata and subsequently damage to the arterial wall.

Although new onset headache is the hallmark symptom of GCA, It often presents indolently with constitutional symptoms. Less frequently it presents dramatically as visual loss or cerebrovascular accidents.

Color Doppler Ultrasonography (CDUS) is a non-invasive modality which is more sensitive although less specific than temporal artery biopsy in the diagnosis of GCA. The typical finding seen in CDUS suggestive of active vasculitis is the “halo” sign which represents edema of the vessel wall caused by inflammation.

Computed tomographic angiography (CTA) and (MRA) are useful noninvasive modalities for screening of involvement of large vessels presenting as luminal changes (stenosis, wall thickening, dilations and aneurysms) in CTA or oedema and wall contrast enhancement using more sensitive, comparably specific MRA.

Apart from high dose glucocorticoid treatment, novel emerging biologic therapies targeting interleukin 6 have proven long term efficacy and should be considered.

Overall, GCA is not associated with increased mortality compared to general population but is associated with an increase in morbidity, mainly cardiovascular and steroid associated metabolic disorders (osteoporosis, hypertension, diabetes mellitus). Patients with suspected GCA should be referred to fast track GCA clinics for rapid evaluation and diagnosis to minimize the incidence of complications.

Keywords

Giant cell arteritis Large vessel vasculitis Temporal artery color Doppler Anti IL-6 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Abid Awisat
    • 1
  • Raashid Luqmani
    • 2
  1. 1.Rheumatology UnitBnai Zion Medical CenterHaifaIsrael
  2. 2.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal ScienceNuffield Orthopaedic Centre, University of OxfordOxfordUK

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