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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
[Giant cell arteritis. Experience in 32 patients]
Pamela Wurmann1, Claudia Hernández1, Pedro Zamorano1
1Hospital Clínico, Universidad de Chile, Santiago, Chile.
Insights
Giant cell arteritis (GCA) diagnosis in patients over 50 often involves extracranial disease, and temporal artery biopsy (TAB) is a useful diagnostic tool. Many patients achieve remission with steroids and steroid-sparing agents like methotrexate.
Area of Science:
- Rheumatology
- Vasculitis Research
- Systemic Autoimmune Diseases
Context:
- Giant cell arteritis (GCA) is the most common systemic vasculitis affecting individuals over 50.
- Diagnosis relies on clinical, laboratory, imaging, and biopsy findings.
- Temporal artery biopsy (TAB) can be inconclusive in up to 40% of cases.
Purpose:
- To characterize the disease manifestations in patients diagnosed with GCA.
- To evaluate the utility of diagnostic tools, including TAB, in GCA management.
Summary:
- This study reviewed 32 patients diagnosed with GCA between 2000 and 2019, with a median age of 70.5 years (81% female).
- Frequent extracranial involvement (25%) was observed, alongside cranial symptoms (72%).
- Temporal artery biopsy confirmed the diagnosis in 65.4% of cases, with transmural inflammation being the most common finding. All patients received steroids, and 92% achieved remission within the first year, often with steroid-sparing agents like methotrexate.
Impact:
- Highlights the significant prevalence of extracranial involvement in GCA, underscoring the need for comprehensive diagnostic approaches.
- Reinforces the value of temporal artery biopsy as a key diagnostic modality in suspected GCA cases.
- Demonstrates the effectiveness of current treatment strategies, including steroids and steroid-sparing agents, in achieving clinical remission for GCA patients.
Background:
Giant cell Arteritis (GCA) is the most common systemic vasculitis in patients over 50 years. Diagnosis is based on clinical, laboratory, imaging and biopsy. Temporal artery biopsy (TAB) may be inconclusive in up to 40% of patients.
Aim:
To describe disease features of patients diagnosed with GCA.
Material And Methods:
Review of pathology reports of giant cell arteritis and clinical records of patients seen with the diagnosis between 2000 and 2019. Demographic, clinical, laboratory, histopathology, imaging, treatment and follow-up variables were analyzed.
Results:
We fetched 32 patients with a median age at diagnosis of 70.5 years (range 57-90), 81% women. Twenty eight percent had polymyalgia. 72% had only cranial symptoms, 12% had extracranial involvement and 13% exclusive extracranial involvement. The median time from onset of symptoms to diagnosis was two months (range 0.5-8). All had elevated erythrocyte sedimentation rate and c reactive protein. A TAB was performed in 27 patients and in 17 (65.4%) it confirmed the diagnosis. Transmural inflam- mation was the most frequent finding. All patients received steroids. Follow-up information was available from 25 patients and 92% received a steroid-spa- ring agent, usually methotrexate (74%). Ninety two percent achieved clinical remission in the first year and 59% had minor relapses during steroid tapering.
Conclusions:
Our patients showed frequent extracranial involvement and TAB was a useful diagnostic tool.
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