Large-vessel giant cell arteritis: diagnosis, monitoring and management
Matthew J Koster1, Eric L Matteson1, Kenneth J Warrington1
1Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.
Insights
Large-vessel GCA (LV-GCA) requires early diagnosis and effective treatment. While imaging aids diagnosis, its role in assessing disease activity and outcomes for LV-GCA is still unclear, with limited data on advanced therapies.
Area of Science:
- Rheumatology
- Vascular Medicine
- Immunology
Background:
- Giant cell arteritis (GCA) is a chronic vasculitis affecting medium and large arteries.
- It presents as cranial arteritis or large-vessel GCA (LV-GCA), with potential for severe vascular complications.
- Delayed diagnosis in LV-GCA underscores the need for early identification and treatment.
Purpose of the Study:
- To review current understanding of large-vessel GCA (LV-GCA) diagnosis and management.
- To explore the evolving role of advanced imaging in LV-GCA assessment.
- To discuss current and emerging therapeutic strategies for LV-GCA.
Main Methods:
- Review of recent literature on GCA, focusing on LV-GCA phenotypes.
- Analysis of advancements in diagnostic imaging modalities for LV-GCA.
- Evaluation of therapeutic options, including glucocorticoids and biologics.
Main Results:
- Imaging techniques like MRA, CTA, PET, and ultrasound have improved LV-GCA diagnosis.
- The utility of imaging in assessing disease activity and long-term outcomes requires further clarification.
- Glucocorticoids remain primary therapy, but carry significant adverse effects.
- Biologics like tocilizumab show promise as steroid-sparing agents, but specific LV-GCA data is limited.
Conclusions:
- Early diagnosis and prompt treatment are crucial for managing LV-GCA and preventing vascular complications.
- Further research is needed to define the role of imaging in monitoring LV-GCA activity and outcomes.
- Exploring novel therapeutic approaches, including biologics, is essential for optimizing LV-GCA management and minimizing steroid-related toxicity.
Abstract:
GCA is a chronic, idiopathic, granulomatous vasculitis of medium and large arteries. It comprises overlapping phenotypes including classic cranial arteritis and extra-cranial GCA, otherwise termed large-vessel GCA (LV-GCA). Vascular complications associated with LV-GCA may be due, in part, to delayed diagnosis, highlighting the importance of early identification and prompt initiation of effective therapy. Advancements in imaging techniques, including magnetic resonance angiography, CT angiography, PET and colour duplex ultrasonography, have led to improvements in the diagnosis of LV-GCA; however, the role imaging modalities play in the assessment of disease activity and long-term outcomes remains unclear. Glucocorticoids are the mainstay of therapy in LV-GCA, but their prolonged use is associated with multiple, sometimes serious, adverse effects. Recent data suggest that biologic therapies, such as tocilizumab, may be effective and safe steroid-sparing options for patients with GCA. However, data specifically evaluating the management of LV-GCA are limited.
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