Summary
Giant cell arteritis (GCA) was considered a rare disease 50 years ago; however, it is now known to be an important and significant cause of morbidity and mortality in elderly people. GCA is a generalised arteritis, although the aetiology and pathogenesis of this disorder are poorly understood. It is likely that there are environmental or genetic factors that significantly influence the risk for the disease in different populations.
Epidemiological studies have shown the highest incidence in Northern Europe and in Minnesota, US; which are populations of the same descent. Much lower incidence figures have been reported from more Southern regions of Europe and elsewhere. Possibly, the incidence of the disease is increasing as suggested by recent surveys.
Glucocorticosteroids are the drugs of choice in all clinical types of GCA. Most studies have been performed with prednisolone. There is no general agreement concerning the initial dosage, but 10 to 40 mg/day is commonly recommended. After a few months the majority of patients can be treated with a low maintenance dosage of prednisolone 5 to 7.5 mg/day. Because of the low dosage required, the frequency of corticosteroid-related adverse effects is relatively low. The median duration of treatment is about 5 years.
Nonsteroidal anti-inflammatory drugs, in contrast to corticosteroids, have no proven preventive effect on vascular complications of GCA, and cannot be recommended.
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References
Alestig K, Barr J. Giant-cell arteritis. A biopsy study of polymyalgia rheumatica, including one case of Takayasu’s disease. Lancet 1: 1228–1230, 1963
Amstrong RD, Panayi GS, Welsh KI. Polymyalgia rheumatica and rheumatoid arthritis. Similarity of HLA antigen frequencies. Correspondence. Arthritis and Rheumatism 27: 1438–1439, 1984
Andersson R, Malmvall BE, Bengtsson BÅ. Long-term corticosteroid treatment in giant cell arteritis. Acta Medica Scandinavica 220: 465–469, 1986a
Andersson R, Malmvall BE, Bengtsson BÅ. Acute phase reactants in the initial phase of giant cell arteritis. Acta Medica Scandinavica 220: 365–367, 1986b
Andersson R. Giant cell arteritis — immunology, long-term corticosteroid treatment and mortality. PhD Thesis, University of Göteborg, Göteborg, 1988
Andersson R, Rundgren A, Rosengren K, Bengtsson BÅ, Malmvall BE, et al. Osteoporosis after long-term corticosteroid treatment of giant cell arteritis. Journal of Internal Medicine 227: 391–395, 1990
Ayoub WT, Franklin CM, Torretti D. Polymyalgia rheumatica. Duration of therapy and long-term outcome. American Journal of Medicine 79: 309–315, 1985
Barber S. Myalgic syndrome with constitutional effects. Annals of the Rheumatic Diseases 16: 230, 1967
Bacon PA, Doherty SM, Zuckerman AJ. Hepatitis B antibody in polymyalgia rheumatica. Lancet 2: 476–478, 1975
Barrier J, Pion P, Massari R, Peltier P, Rojouan J, et al. Approche epidemiologique de la maladie de Horton dans la departement de Loire-Atlantique: 110 cas en 10 ans (1970–1979). Revue de Medicine Interne 1: 13–20,1982
Behn AR, Perra T, Myles AB. Polymyalgia rheumatica and corticosteroids: how much for how long? Annals of the Rheumatic Diseases 42: 374–378, 1983
Bengtsson BÅ, Malmvall BE. An alternate-day corticosteroid regimen in maintenance therapy of giant arteritis. Acta Medica Scandinavica 209: 347–360, 1981a
Bengtsson BÅ, Malmvall BE. The epidemiology of giant cell arteritis including temporal arteritis and polymyalgia rheumatica. Arthritis and Rheumatism 24: 899–904, 1981b
Bengtsson BÅ, Malmvall BE. Giant cell arteritis. Incidence of giant cell arteritis. Acta Medica Scandinavica 658 (Suppl.): 15–17, 1982
Bengtsson BÅ. Epidemiology of giant cell arteritis. Bailliere’s Clinical Rheumatology 5: 379–385, 1991
Bielory L, Ogunkoya A, Frohman LP. Temporal arteritis in blacks. American Journal of Medicine 86: 707–708, 1989
Birkhead NC, Wagener HP, Shick RM. Treatment of temporal arteritis with adrenal corticosteroids. Journal of the American Medical Association 163: 821–827, 1957
Boesen P, Sörensen SF. Giant cell arteritis, temporal arteritis and polymyalgia rheumatica in a Danish County. A prospective investigation 1982–1985. Arthritis and Rheumatism 30: 294–299, 1987
Bogden DR, Glaser JS. Ischemic optic neuropathy. Brain 98: 689–708, 1975
Chuang TY, Hunder GG, Iistrup DM, Kurland LT. Polymyalgia rheumatica. A 10-year epidemiologic and clinical study. Annals of Internal Medicine 97: 672–680, 1982
Cid MC, Ercilla G, Vilaseca J, Sanmarti R, Villa1ta J, et al. Po1ymyalgia rheumatica — a syndrome associated with HLA-DR4 antigen. Arthritis and Rheumatism 31: 678–682, 1988
Coomes EN, Ellis RM, Kay AG. A prospective study of 102 patients with the polymya1gia syndrome. Rheumatology and Rehabilitation 15: 270–276, 1976
Dasgupta B, Gray J, Fernandes L, Olliff C. Treatment of polymyalgia rheumatica with intramuscular injections of depot methylprednisolone. Annals of the Rheumatic Diseases 50: 942–945, 1991
de Silva M, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatic a: a double-blind study. Annals of the Rheumatic Diseases 45: 136–138, 1986
de Vita S, Tavoni A, Jeracitano G, Gemignani G, Dolcher MP, et al. Treatment of giant cell arteritis with cyclophosphamide pulses. Correspondence. Journal ofInternal Medicine 232: 373–375, 1992
Doury P, Pattin S, Eulry F, Thabaut A. The use of dapsone in the treatment of giant cell arteritis and polymyalgia rheumatica. Arthritis and Rheumatism 26: 689–690, 1983
Elling H, Skinhoj P, Elling P. Hepatitis B virus and polymyalgia rheumatic a: a search for HBsAG, HBsAB, HBcAB, HBeAG, HBeAB. Annals of the Rheumatic Diseases 39: 511–513, 1980
Esselinckx W, Doherthy SM, Dixon AStJ. Polymyalgia rheumatica. Abrupt and gradual withdrawal of prednisolone treatment, clinical and laboratory observations. Annals of the Rheumatic Diseases 36: 219–224, 1977
Fauchald P, Rygvold O, Oystese B. Temporal arteritis and polymyalgia rheumatica. Clinical and biopsy findings. Annals of Internal Medicine 77: 845–852, 1972
Fernandez-Herlihy L. Duration of corticosteroid therapy in giant cell arteritis. Journal of Rheumatology 7: 361–364, 1980
Fessel WJ. Polymyalgia rheumatica, temporal arteritis and contact with birds. Lancet 2: 1249–1250, 1969
Franzen P, Suttinen S, von Knorring J. Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study 1984–1988. Journal of Rheumatology 19: 273–276, 1992
Friedlander AH, Runyon C. Polymyalgia rheumatica and temporal arteritis. Oral Surgery, Oral Medicine and Oral Pathology 69: 317–321, 1990
Friedman G, Friedman B, Bombassat J. Epidemiology of temporal arteritis in Israel. Israel Journal of Medical Sciences 18: 241–244, 1982
Gilmour JR. Giant cell chronic arteritis. Journal of Pathology 53: 263–277, 1941
Gonzalez-Gay MA, Alonso MD, Aguero JJ, Bal M, Fernandez-Camblor B, et al. Temporal arteritis in a northwestern area of Spain: study of 57 biopsy-proven patients. Journal of Rheumatology 9 (2): 277–280, 1992
Goodman BJ. Temporal arteritis. American Journal of Medicine 67: 839–862, 1979
Granato JE, Abben RP, May WS. Familial association of giant cell arteritis: a case report and brief review. Achives of Internal Medicine 141: 115–117, 1981
Gray RES, Doherty SM, Galloway J, Coulton L, deBroe M, et al. A double-blind study of deflazacort and prednisolone in patients with chronic inflammatory disorders. Arthritis and Rheumatism 34 (3): 287–295, 1991
Hamilton CR, Shelley WM, Tumulty PA. Giant cell arteritis, including temporal arteritis and poly myalgia rheumatica. Medicine 50: 1, 1971
Hamrin B. Poly myalgia arteritica. Acta Medica Scandinavica 192 (Suppl.): 86–99, 1972
Hayreh SS. Ophthalmic features of giant cell arteritis. Bailliere’s Clinical Rheumatology 5 (3): 431–469, 1991
Healey LA. Long-term follow-up of poly myalgia rheumatica: evidence for synovitis. Seminars in Arthritis and Rheumatism 13: 322–328, 1984
Horton BT, Magath TB. Arteritis of the temporal vessels; report on seven cases. Proceedings of Star Meetings of Mayo Clinic 12: 548, 1937
Hunder GG, Allen GL. The relationship between polymyalgia rheumatic a and temporal arteritis. Geriatrics 27: 134, 1973
Hunder GG. More on polymyalgia rheumatica and giant cell arteritis. Western Journal of Medicine 141: 68–70, 1984
Hunder GG, Michet CJ. Giant cell arteritis and polymyalgia rheumatica. Clinics in Rheumatic Diseases 11: 471–483, 1985
Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, et al. The American College of Rheumatology 1990. Criteria for classification of giant cell arteritis. Arthritis and Rheumatism 33: 1122–1128, 1990
Huston KA, Hunder GG. Temporal arteritis. A 25-year epidemiologic, clinical and pathologic study. Annals of Internal Medicine 88: 162–167, 1978
Hutchinson J. Diseases of the arteries. Archives of Surgery (London) 1: 323–329, 1890
Jonasson F, Cullen JF, Elton RA. Temporal arteritis. A 14-year epidemiological, clinical and prognostic study. Scottish Medical Journa1 24: 111–117, 1979
Jones JG, Hazleman BL. Prognosis and management of polymyalgia rheumatica. Annals of the Rheumatic Diseases 40: 1–5, 1981
Kamide R, Ishikawa T, Aizawa H, Aoki I, Niimura M. A case of temporal arteritis successfully treated with recombinant interleukin-2. Journal of Dermatology 16: 487–491, 1989
Kemp A. Monocygotic twins with temporal arteritis and ophthalmic arteritis. Acta Ophthalmologica (Copenhagen) 55: 183–190, 1977
Krall PL, Mazanec DJ, Wilke WS. Methotrexate for corticosteroid-resistant polymyalgia rheumatica and giant cell arteritis. Cleveland Clinic Journal of Medicine 56: 253–257, 1989
Kyle V, Hazleman BL. Treatment of polymyalgia rheumatica and giant cell arteritis. I. Steroid regimens in the first two months. Annals of the Rheumatic Diseases 48: 658–661, 1989
Liang M, Greenberg H, Pincus T, Robinson WS. Hepatitis B antibody in polymyalgia rheumatica. Lancet 1: 43, 1976
Love DC, Rapkin J, Lesser RG. Temporal arteritis in blacks. Annals of Internal Medicine 105: 387–389, 1986
Machado EBV, Michet CJ, Ballard DJ, Hunder GG, Beard CM, et al. Trends in incidence and clinical presentation of temporal arteritis in Olmsted County, Minnesota 1950–1985. Arthritis and Rheumatism 31: 745–749, 1988
Meadows SP. Temporal or giant cell arteritis — ophthalmic aspects. In Smith JL (Ed.) Neuro-ophthalmology. Symposium of the University of Miami and the Bascom Palmer Eye Institute IV, pp. 148–157, St Louis, Mosby, 1968
Nordborg E, Bengtsson BÅ. Death rates and causes of death in 284 consecutive patients with giant cell arteritis confirmed by biopsy. British Medical Journal 299: 549–550, 1989
Nordborg E, Bengtsson BÅ. Epidemiology of biopsy-proven giant cell arteritis (GCA). Journal of Internal Medicine 227: 233–236, 1990
Nordborg E, Bengtsson B, Nordborg C. Temporal artery morphology and morphometry in giant cell arteritis. Acta Pathologica et Microbiologica Immunologica Scandinavica 99: 1013–1023, 1991
Nordborg E, Hansson T, Jonson R, Szucs J, Bengtsson B. Bone minerai content of the third lumbar vertebra during 18–24 months of prednisolone treatment for giant cell arteritis. Clinical Rheumatology, in press, 1993
O’Brian JP. A concept of diffuse actinic arteritis: the role of actinic damage to elastin in age change and arteritis of the temporal artery and in polymyalgia rheumatica. British Journal of Dermatology 98: 1–13, 1978
Ornilla E, Swannell AJ, Dixon AStJ. Myalgia and birdkeeping. Lancet 2: 96, 1970
Ostberg G. On arteritis with special reference to polymyalgia arteritica. Acta Pathologica Microbiologica Scandinavica Section A 273 (Suppl.): 1–59, 1973
Paulley JW. Anarthritic rheumatoid disease. Lancet 2: 946, 1956
Porsman VA. Proc II Congress European Editorial Scientia, Barcelona, p. 479, 1951
Reid DM, Nicoll JJ, Smith MA, Higgins B, Tothill P, et al. Corticosteroids and bone mass in asthma. Comparisons with rheumatoid arthritis and polymyalgiarheumatica. British Medical Journal 293: 1463–1466, 1986
Richardson JE, Gladman DD, Fam A, Keystone EC. HLA DR4 in giant cell arteritis: association with polymyalgia rheumatica syndrome. Arthritis and Rheumatism 30: 1293–1297, 1987
Rosenfeldt SI, Kosmorsky GS, Klingeje TG, Burde RM, Cohn EM. Treatment of temporal arteritis with ocular involvement. American Journal of Medicine 80: 143–145, 1986
Salvarani C, Macchioni P, Zizzi F, Mantovani W, Rossi F, et al. Epidemiologic and immunogenetic aspects of polymyalgia rheumatica and giant cell arteritis in Northern Italy. Arthritis and Rheumatism 34 (3): 351–356, 1991
Shick RM, Baggenstoss AH, Fuller BF, Polley HE Effects of cortisone and ACTH on periarteritis nodose and cranial arteritis. Staff meetings of the Mayo Clinic: 492–494, 1950
Smith CA, Fidler WJ, Pinals RS. The epidemiology of giant cell arteritis. Report of a 10 year study of Shelby County, Tennessee. Arthritis and Rheumatism 25: 1214–1218, 1983
Soelberg-Sorensen P, Lorentzen I. Giant cell arteritis, temporal arteritis and polymyalgia rheumatica. Acta Medica Scandinavica 201: 207–213, 1977
Spiera H, Davidson S. Long-term follow-up of polymyalgia rheumatica. Mount Sinai Journal of Medicine 45: 225–229, 1978
von Knorring J. Treatment and prognosis in polymyalgia rheumatica and temporal arteritis. Acta Medica Scandinavica 205: 429–435, 1979
Wilske KR, Healey LA. Polymyalgia rheumatica. A manifestation of systemic giant cell arteritis. Annals of Internal Medicine 66: 77–86, 1967
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Nordborg, E., Andersson, R. & Bengtsson, BÅ. Giant Cell Arteritis. Drugs & Aging 4, 135–144 (1994). https://doi.org/10.2165/00002512-199404020-00006
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DOI: https://doi.org/10.2165/00002512-199404020-00006