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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Current understanding and management of giant cell arteritis and polymyalgia rheumatica
Parasar Ghosh1, Frances A Borg, Bhaskar Dasgupta
1Department of Rheumatology, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, SS0 0RY, UK.
Insights
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are inflammatory conditions affecting the elderly. Early recognition and management, including corticosteroid therapy, are crucial for preventing complications like vision loss.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common inflammatory conditions in older adults.
- GCA is a large-vessel vasculitis potentially leading to critical ischemia and neuro-ophthalmic complications, necessitating emergency intervention.
- PMR involves muscle pain and stiffness, sharing inflammatory pathways with GCA but with less vascular involvement.
Purpose of the Study:
- To review current guidelines for the early recognition, investigation, and management of GCA and PMR.
- To highlight recent advancements in imaging techniques for diagnosing and monitoring these conditions.
- To discuss the underlying pathogenesis involving immune cells and cytokines.
Main Methods:
- Review of recent clinical guidelines and literature.
- Analysis of pathogenic mechanisms involving dendritic cells, CD4(+) T cells, IFN-γ, and IL-6.
- Examination of diagnostic and therapeutic strategies, including imaging advancements.
Main Results:
- GCA and PMR share common inflammatory pathways, with CD4(+) T cells and cytokines like IFN-γ and IL-6 playing key roles.
- Corticosteroids are the primary treatment, with disease-modifying agents used for relapsing cases.
- Advances in imaging aid in the early diagnosis and management of these vasculitic and inflammatory conditions.
Conclusions:
- GCA and PMR require prompt diagnosis and management, primarily with corticosteroids.
- Understanding the shared pathogenesis offers potential targets for future therapies.
- Integrated approaches combining clinical guidelines and advanced imaging are essential for optimal patient outcomes.
Abstract:
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are linked conditions that occur in the elderly. GCA is a vasculitis of large- and medium-sized vessels causing critical ischemia. It is a medical emergency owing to the high incidence of neuro-ophthalmic complications. PMR is an inflammatory disease characterized by abrupt-onset pain and stiffness of the shoulder and pelvic girdle muscles. Both conditions are associated with a systemic inflammatory response and constitutional symptoms. The pathogeneses are unclear. The initiating step may be the recognition of an infectious agent by activated dendritic cells. The key cell type involved is CD4(+) T cells and the key cytokines are IFN-γ (implicated in granuloma formation) and IL-6 (key to the systemic response). The pathogenesis of PMR may be similar to that of GCA, however, PMR exhibits less clinical vascular involvement. The mainstay of therapy is corticosteroids, and disease-modifying therapy is indicated in relapsing disease. This article reviews recent guidelines on early recognition, investigations and management of these diseases, as well as advances in imaging.
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