Advances in diagnosing and treating giant cell arteritis: New hope for arteritic anterior ischemic optic neuropathy

Giant cell arteritis (GCA) is an autoimmune disease of medium and large sized vessels. It is the most prevalent form of primary vasculitis in the western world. Vascular inflammation in GCA can lead to vascular occlusion. Severe neuro-ophthalmological complications, such as arteritic anterior ischemic optic neuropathy (AAION), may present with sudden partial or complete vision loss or diplopia. Visual impairment is often refractory to corticosteroid therapy, underscoring the critical importance of early diagnosis. Delayed diagnosis and initiation of high-dose corticosteroids can lead to contralateral eye involvement and bilateral irreversible vision loss. Recent advances in expedited diagnostics have significantly improved outcomes in GCA patients, particularly by reducing ischemic neuro-ophthalmological events. Thus, a key factor has been the introduction of Fast-Track Clinics that have successfully decreased the incidence of permanent blindness in GCA patients. In these clinics, imaging modalities such as vascular ultrasound, magnetic resonance imaging, and positron emission tomography-computed tomography play a critical role in both diagnosis and disease monitoring, enabling timely and accurate intervention. On the therapeutic front, cytokine-specific inhibitors have improved GCA management, enhancing remission rates and reducing glucocorticoid use. Tocilizumab, an IL-6 receptor (IL-6R) inhibitor, has become a cornerstone of GCA treatment; however, since some patients do not respond to IL-6R inhibition, ongoing research is exploring alternative disease-modifying therapies. These new approaches aim to reduce glucocorticoid dependency, mitigate side effects, enhance visual outcomes, and improve patient outcomes, highlighting a shift towards more individualized treatment approaches.