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Published on: February 8, 2019
European Headache Federation recommendations for neurologists managing giant cell arteritis
S P Mollan1, K Paemeleire2, J Versijpt3
1Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Insights
Giant cell arteritis (GCA) is a medical emergency. New guidelines offer evidence-based recommendations for diagnosis and management, including the use of Tocilizumab, an IL-6 receptor antagonist, as a new treatment option.
Area of Science:
- Neurology
- Rheumatology
- Ophthalmology
Background:
- Giant cell arteritis (GCA) is a critical condition with risks of sight loss and stroke.
- Headache is a primary symptom, necessitating up-to-date knowledge for neurologists.
- The European Headache Federation (EHF) developed these recommendations.
Purpose of the Study:
- To provide evidence-based and expert recommendations on GCA diagnosis and management.
- To update neurologists on recent advances in GCA investigation and treatment.
- To address the risks associated with GCA and its current treatment.
Main Methods:
- Systematic literature review and evidence quality assessment.
- Development of recommendations by a multidisciplinary group (neurology, ophthalmology, rheumatology).
- Incorporation of clinical experience for best practice where high-level evidence was lacking.
Main Results:
- Advanced imaging and fast-track pathways are improving GCA diagnosis and patient outcomes.
- High-dose glucocorticoids are standard first-line treatment, but long-term toxicity is a concern.
- Tocilizumab, an IL-6 receptor antagonist, is now approved as a licensed drug for GCA treatment.
Conclusions:
- The article details recent advancements in GCA diagnosis.
- It outlines updated management strategies for GCA.
- It highlights the introduction of Tocilizumab as a significant therapeutic advance.
Background And Aim:
Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA.
Methods:
The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience.
Results:
Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA.
Conclusion:
The present article will outline recent advances made in the diagnosis and management of GCA.
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