The different clinical patterns of giant cell arteritis

Area of Science:

• Rheumatology
• Internal Medicine
• Vasculitis Research

Background:

• Giant-cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium-sized arteries.
• Understanding the diverse clinical presentations of GCA is crucial for timely diagnosis and management.
• Previous studies have highlighted various GCA manifestations, but a comprehensive frequency analysis of distinct clinical patterns is needed.

Purpose of the Study:

• To determine the frequency of different clinical patterns at the onset of giant-cell arteritis.
• To investigate the characteristics and treatment duration associated with various GCA clinical phenotypes.

Main Methods:

• Retrospective analysis of 693 patients with biopsy-proven GCA or imaging-confirmed large-vessel vasculitis (LVV).
• Patients were recruited from two referral centers.
• Clinical patterns were categorized, and imaging was used to detect silent LVV in a subset of patients.

Main Results:

• The most common clinical pattern was isolated cranial GCA (80%).
• Other patterns included symptomatic LVV (9%), isolated fever/inflammatory response (9%), and isolated polymyalgia rheumatica with vasculitis (2%).
• A significant proportion (45%) of patients without overt LVV symptoms had silent LVV detected on imaging; symptomatic LVV was associated with longer glucocorticoid dependency and treatment duration.

Conclusions:

• Approximately 80% of GCA patients present with typical cranial symptoms, while 20% exhibit less common clinical manifestations.
• Symptomatic large-vessel vasculitis in GCA necessitates prolonged treatment courses compared to other phenotypes.