[Large vessel vasculitis : pathogenesis, diagnostic and medical management]

Area of Science:

• Rheumatology
• Immunology
• Internal Medicine

Background:

• Large vessel vasculitis encompasses giant cell arteritis (GCA) and Takayasu arteritis (TA).
• Understanding their distinct yet overlapping features is crucial for effective management.
• Recent advances in understanding pathogenesis and diagnostics are transforming patient care.

Purpose of the Study:

• To compare the epidemiology, pathogenesis, diagnostic criteria, and medical management of GCA and TA.
• To review the role of T helper cell responses, genetics, and infections in their development.
• To discuss current and emerging treatment strategies for large vessel vasculitis.

Main Methods:

• Comparative review of epidemiological data.
• Analysis of current understanding of disease pathogenesis, including immunological and infectious triggers.
• Evaluation of diagnostic criteria, inflammatory biomarkers, and advanced imaging techniques.
• Review of established and novel therapeutic approaches, including corticosteroids, aspirin, and biologics.

Main Results:

• Detailed comparison of GCA and TA epidemiology and clinical presentations.
• Exploration of shared and distinct pathogenetic mechanisms involving Th1/Th17 responses, genetic factors, and specific infections.
• Overview of updated classification criteria and the utility of biomarkers and imaging in diagnosis.
• Summary of current treatment guidelines and emerging biological therapies.

Conclusions:

• Effective management of large vessel vasculitis requires a comprehensive understanding of both GCA and TA.
• Advances in pathogenesis research are paving the way for targeted therapies.
• Multidisciplinary approaches integrating diagnostics and therapeutics are essential for improving patient outcomes.