Large-vessel involvement in giant cell arteritis and polymyalgia rheumatica

Area of Science:

• Rheumatology
• Vascular Medicine
• Internal Medicine

Background:

• Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are inflammatory conditions affecting older adults.
• Large-vessel involvement (LVI) is increasingly recognized in GCA, with potential for severe vascular complications.
• Vascular complications are rare in PMR, but overlap between GCA and PMR is common.

Purpose of the Study:

• To review current understanding of large-vessel involvement (LVI) in GCA and PMR.
• To address controversies in the diagnosis, monitoring, and management of LVI in these conditions.
• To highlight the clinical significance of LVI in GCA versus PMR.

Main Methods:

• Literature review of recent studies on LVI in GCA and PMR.
• Analysis of diagnostic modalities for LVI.
• Discussion of management strategies for vascular complications.

Main Results:

• LVI is increasingly detected in GCA using advanced imaging, leading to complications like aortic aneurysms and dissections.
• Limb artery stenosis is a recognized complication of LVI in GCA.
• Vascular complications directly attributed to PMR are exceedingly rare.

Conclusions:

• LVI is a significant concern in GCA, necessitating careful diagnosis and management.
• The role and management of LVI in PMR require further clarification.
• Distinguishing LVI in GCA from PMR is crucial for appropriate patient care.