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Extracranial giant cell arteritis: A narrative review.
K D F Lensen1, A E Voskuyl, E F I Comans
1Departments of Internal Medicine and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, the Netherlands.
The Netherlands Journal of Medicine
|June 22, 2016
Summary
Extracranial giant cell arteritis (GCA) is increasingly recognized, affecting large arteries with or without cranial GCA. Diagnosis relies on advanced imaging due to non-specific symptoms and biopsy limitations.
Area of Science:
- Rheumatology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Giant cell arteritis (GCA) traditionally focuses on cranial involvement.
- Extracranial GCA, affecting large arteries, is increasingly diagnosed.
- Pathogenesis and histopathology of extracranial GCA are not well-defined but presumed similar to cranial GCA.
Purpose of the Study:
- To summarize current knowledge on extracranial GCA.
- To review diagnostic modalities and treatment strategies for extracranial GCA.
- To highlight extracranial complications associated with GCA.
Main Methods:
- Systematic literature search.
- Review of diagnostic imaging techniques including 18F-FDG-PET, MRI, CT angiography, and ultrasound.
- Analysis of clinical presentations and treatment approaches.
Main Results:
- Extracranial GCA is recognized in patients with and without cranial GCA.
- Diagnosis often relies on imaging due to non-specific symptoms and low temporal artery biopsy sensitivity.
- Complications include aortic aneurysm/dissection and arm claudication.
Conclusions:
- Optimal diagnostic strategy for extracranial GCA is undetermined, guided by clinical suspicion and resource availability.
- Treatment generally mirrors that of cranial GCA, though criteria for intervention are debated.
- Surgical intervention may be indicated, requiring optimal medical management beforehand.
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