Abstract
Giantcell arteritis (GCA) involves the major branches of the aorta with predilection for the extracranial branches of the carotid artery. It occurs in individuals older than 50 years, and the incidence increases with age. The signs and symptoms of GCA can be classified into four subsets: manifestations of cranial arteritis (mainly headache, jaw claudication and visual manifestations), extracranial arteritis, systemic symptoms and polymyalgia rheumatica. Patients may develop any combination of these manifestations, which are associated with laboratory evidence of an acute-phase reaction. The only test that confirms the diagnosis is a temporal artery biopsy showing vasculitis with mononuclear cell or granulomatous inflammation usually with giant cells. However, areas of vasculitis may be missed by the biopsy and the histological examination is normal in about 15% of the cases. Some imaging modalities may aid in the diagnosis of GCA. Among these, color duplex ultrasonography of the temporal arteries is more commonly used. There are no independent validating criteria to determine whether GCA is present when a temporal artery biopsy is negative. The American College of Rheumatology (ACR) criteria for the classification of GCA may assist in the diagnosis. However, meeting classification criteria is not equivalent to making the diagnosis in individual patients, and the final diagnosis should be based on all clinical, laboratory, imaging and histological findings. Glucocorticoids are the treatment of choice for GCA. The initial dose is 40–60 mg/day for most uncomplicated cases. Addition of low-dose aspirin (100 mg/day) has been shown to significantly decrease the rate of vision loss and stroke during the course of the disease.
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References
Salvarani C, Crowson CS, O’Fallon WM, Hunder GG, and Gabriel SE. Reappraisal of the epidemiology of giant cell arteritis in Olmsted County, Minnesota, over fifty-year period. Arthritis Rheum 2004; 51: 264–8.
Boesen P and Sorensen SF. Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a Danish county. Arthritis Rheum 1987; 30: 294–9.
Smetana GW and Shmerling RH. Does this patient have temporal arteritis? J Am Med Assoc 2002; 287: 92–101.
Seo P and Stone JH. Large-vessel vasculitis. Arthritis Rheum 2004; 51: 128–39.
Nesher G, Berkun Y, Mates M, et al. Risk factors for cranial ischemic complications in giant cell arteritis. Medicine 2004; 83: 114–22.
Schmidt WA, Kraft HE, Vorpahl K, Volker L, and Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 1997; 337: 1336–42.
Karassa FB, Matsagas MI, Schmidt WA, and Iannidis JP. Meta-analysis: Test performance of ultrasonography for giant cell arteritis. Ann Intern Med 2005; 142: 359–69.
Bley TA, Weiben O, Uhl M, et al. Assessment of the cranial involvement pattern of giant cell arteritis with 3T magnetic resonance imaging. Arthritis Rheum 2005; 52: 2470–7.
Brack A, Martinez-Taboada V, Stanson A, Goronzy JJ, and Weyand CM. Disease pattern in cranial and large-vessel giant-cell arteritis. Arthritis Rheum 1999; 42: 311–17.
Blockmans D, Stroobants S, Maes A, and Mortelmans L. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: Evidence for inflammation of the aortic arch. Am J Med 2000; 108: 246–9.
González-Gay MA, García-Porrua C, Liorca J, et al. Biopsy-negative giant cell arteritis: Clinical spectrum and predictive factors for positive temporal artery biopsy. Semin Arthritis Rheum 2001; 30: 249–56.
Taylor-Gjevre R, Vo M, Shukla D, and Resch L. Temporal artery biopsy for giant cell arteritis. J Rheumatol 2005; 32: 1279–82.
Hall S and Hunder GG. Is temporal artery biopsy prudent? Mayo Clin Proc 1984; 59: 793–6.
Pless M, Rizzo JF III, Lamkin JC, and Lessell S. Concordance of bilateral temporal artery biopsy in giant cell arteritis. J Neuroophthalmol 2000; 20: 216–8.
Ray-Chaudhuri N, Kine DA, Tijani SO, et al. Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis. Br J Ophthalmol 2002; 86: 530–2.
Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990; 33: 1122–8.
Hunder GG. The use and misuse of classification and diagnostic criteria for complex disease. Ann Intern Med 1998; 129: 417–8.
Dasgupta B and Hassan N. Giant cell arteritis: Recent advances and guidelines for management. Clin Exp Rheumatol 2007; 25(Suppl. 44): S62–5.
Nesher G, Berkun Y, Mates M, Baras M, Rubinow A, and Sonnenblick M. Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum 2004; 50: 1332–7.
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© 2008 Humana Press, a part of Springer Science+Business Media, LLC
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Nesher, G. (2008). Giant Cell Arteritis. In: Shoenfeld, Y., Cervera, R., Gershwin, M.E. (eds) Diagnostic Criteria in Autoimmune Diseases. Humana Press. https://doi.org/10.1007/978-1-60327-285-8_13
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DOI: https://doi.org/10.1007/978-1-60327-285-8_13
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