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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
[Large-vessel vasculitis-giant cell and Takayasu arteritis]
1Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Universität Bern, 3010, Bern, Schweiz. peter.villiger@insel.ch.
Insights
Giant cell arteritis (GCA) and Takayasu arteritis (TA) are large-vessel vasculitides. Tocilizumab (TCZ) shows promise in treating GCA and TA, offering effective therapeutic options.
Area of Science:
- Rheumatology
- Immunology
Background:
- Large-vessel vasculitis encompasses giant cell arteritis (GCA) and Takayasu arteritis (TA).
- GCA typically affects individuals over 50, predominantly women, presenting with acute symptoms like headaches.
- TA usually manifests in younger populations with systemic inflammation affecting the aorta and its branches.
Purpose of the Study:
- To outline the diagnostic and therapeutic strategies for GCA and TA.
- To highlight recent advancements in treatment, including novel biologic agents.
Main Methods:
- Diagnosis of GCA relies on imaging, with histology as an optional confirmation.
- Treatment of GCA involves initial oral prednisone, with tocilizumab (TCZ) demonstrating high efficacy.
- TA management includes steroids, disease-modifying antirheumatic drugs, and biologics like infliximab or TCZ.
Main Results:
- Tocilizumab (TCZ) is highly effective for GCA treatment, offering an alternative to or adjunct with steroids.
- Methotrexate can be used as a steroid-sparing agent in GCA.
- TA treatment involves a combination of therapies, including TCZ and infliximab.
Conclusions:
- Prompt diagnosis and treatment are crucial for GCA to prevent complications like blindness.
- Both GCA and TA require tailored treatment approaches, with biologics like TCZ offering new therapeutic avenues.
- Understanding the distinct clinical presentations and treatment responses is key for managing these large-vessel vasculitides.
Abstract:
Large-vessel vasculitis includes giant cell arteritis (GCA) and Takayasu arteritis (TA). GCA can affect persons from the age of 50 years and is more frequent among women. The disease course generally begins with an acute phase, with patients feeling very unwell and experiencing temporal headaches. Rapid diagnosis and treatment are necessary to reduce the risk of blindness. A suspected diagnosis must be confirmed by imaging, histology is optional. Initial treatment comprises oral prednisone. Recent studies have demonstrated inhibition of interleukin‑6 with tocilizumab (TCZ) to be highly effective. Alternatively, methotrexate can be administered in a steroid-sparing approach. In contrast, TA onset is generally during childhood or adolescence, and begins with moderate systemic inflammation. The aorta and its main branches are affected. Treatment comprises steroids, disease-modifying antirheumatic drugs, and the tumor necrosis factor inhibitor infliximab or TCZ.
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