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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Recent Advances in Giant Cell Arteritis
1Division of Rheumatology Louisiana State University, 1542 Tulane Ave., Box T4M-2, New Orleans, LA, 70112, USA. mgueva@lsuhsc.edu.
Insights
Giant cell arteritis (GCA), a common vasculitis, is increasingly diagnosed early, preventing vision loss. New insights into its pathogenesis have led to targeted therapies like Tocilizumab, offering improved treatment options.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Giant cell arteritis (GCA) is the most prevalent systemic vasculitis, affecting large and medium-sized vessels.
- Symptoms often stem from cranial and aortic involvement, making early diagnosis crucial for preventing vision loss.
Purpose of the Study:
- To review recent advancements in the understanding of GCA pathogenesis.
- To discuss progress in diagnosis, treatment, and prognosis of GCA.
Main Methods:
- Review of current literature on GCA pathogenesis and treatment.
- Analysis of new diagnostic modalities and therapeutic targets.
Main Results:
- Significant progress in understanding GCA pathogenesis, particularly the role of interleukin-6 (IL-6).
- IL-6 inhibition has led to the first FDA-approved treatment, Tocilizumab, for GCA.
- Other potential therapies like Abatacept and Ustekinumab show promise for large vessel vasculitis (LVV).
Conclusions:
- Early diagnosis of GCA is vital for preventing irreversible vision loss.
- Targeted therapies, especially IL-6 inhibition, represent a major breakthrough in GCA management.
- Ongoing research into novel therapeutic targets holds promise for future GCA and LVV treatments.
Purpose Of Review:
Giant cell arteritis (GCA) is the most common systemic vasculitis. GCA is categorized as a granulomatous vasculitis of large and medium size vessels. Majority of the symptoms and signs of GCA result from involvement of the aorta and its branches intra- and extracranial. Temporal artery biopsy continues to be the cardinal diagnostic procedure despite new imaging modalities for diagnosing GCA with cranial involvement. Great advances in awareness have led to improvement in preventing irreversible vision loss due to early diagnosis.
Recent Findings:
The cause of GCA has not been elucidated but major progress has been made in the knowledge of its pathogenesis leading to new therapeutic targets, particularly inhibition of interleukin 6. IL 6 plays a key role in the regulation of TH17/Tregs imbalance in GCA and appears to correlate with clinical disease activity in GCA. All of this has led to the first FDA (food and drug administration) approved treatment for GCA, Tocilizumab. Abatacept and Ustekinumab are promising targets for therapy in LVV but still need further research. This paper is a review of the recent progress in the understanding of GCA pathogenesis, diagnosis, treatment, and prognosis.
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