Giant cell arteritis: beyond temporal artery biopsy and steroids
Jem V Ninan1,2, Susan Lester1,3, Catherine L Hill1,3,4
1Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
Insights
Giant cell arteritis (GCA) diagnosis is challenging. Imaging aids diagnosis, while interleukin-6 blockade shows promise for effective, less toxic GCA treatments.
Area of Science:
- Rheumatology
- Internal Medicine
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is the most common vasculitis in the elderly.
- Untreated GCA can lead to severe complications like vision loss and stroke.
- Diagnosis is complicated by the variable sensitivity of the temporal artery biopsy.
Purpose of the Study:
- To review the evolving role of imaging in diagnosing GCA.
- To discuss current and novel therapeutic strategies for GCA.
- To highlight the need for less toxic treatment alternatives.
Main Methods:
- Review of current literature on GCA diagnosis and treatment.
- Discussion of imaging modalities for GCA detection.
- Analysis of conventional and novel immunosuppressive agents, including biologics.
Main Results:
- Imaging is increasingly important for GCA diagnosis.
- Glucocorticoids remain standard but have significant side effects.
- Interleukin-6 blockade has shown recent therapeutic benefits.
Conclusions:
- Advanced imaging improves GCA diagnosis accuracy.
- Novel therapies, particularly IL-6 blockade, offer promising alternatives to long-term steroid use.
- Further research into targeted immunosuppression is crucial for managing GCA effectively.
Abstract:
Giant cell arteritis is the most common primary vasculitis of the elderly. The acute complications of untreated giant cell arteritis, such as vision loss or occasionally stroke, can be devastating. The diagnosis is, however, not altogether straightforward due to variable sensitivities of the temporal artery biopsy as a reference diagnostic test. In this review, we discuss the increasing role of imaging in the diagnosis of giant cell arteritis. Glucocorticoid treatment is the backbone of therapy, but it is associated with significant adverse effects. A less toxic alternative is required. Conventional and novel immunosuppressive agents have only demonstrated modest effects in a subgroup of steroid refractory Giant cell arteritis due to the different arms of the immune system at play. However, recently a study of interleukin-6 blockade demonstrated benefits of giant cell arteritis. The current status of these immunosuppressive agents and novel therapies are also discussed in this review.
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