[Large-vessel vasculitides]

Temporal arteritis (giant cell arteritis), and Takayasu's arteritis are the two primary large-vessel vasculitides. Both are characterized by activation of the adaptive immune system in the vessel wall and activation of the innate immune system, manifesting as systemic inflammatory symptoms and an acute phase reaction. The clinical findings in temporal arteritis commonly include visual loss, headache, scalp tenderness, jaw claudication and polymyalgia rheumatica. Takayasu's arteritis begins with non-specific symptoms followed by decreased perfusion of the extremities, internal organs and brain as the disease progresses to vessel narrowing. Temporal artery biopsy is the gold standard for diagnosing temporal arteritis, whereas the diagnosis of Takayasu's arteritis relies on magnetic angiography or computed tomography angiography of the aorta and its branches. Glucocorticoids are the cornerstone of treatment of both diseases. In selected cases of Takayasu's arteritis methotrexate and tumour necrosis factor inhibitors have proved useful.