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Spectrum of giant cell vasculitis

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Abstract

Giant cell arteritis (GCA) is the commonest primary systemic vasculitis in the United States. Severe outcomes include blindness and stroke, and death may result from aortic dissection. Temporal artery biopsy remains the gold standard for diagnosis. Magnetic resonance imaging (MRI) of involved vessels shows promise as a useful noninvasive method for diagnosis and assessment of disease activity. Corticosteroid therapy is effective but is associated with considerable morbidity. Longitudinal studies with large numbers of patients are required to identify appropriate steroid-sparing agents. New insights into the immunopathogenesis of GCA have allowed us to identify heterogeneous subsets of patients with varying clinical presentations corresponding to specific cytokine profiles. The concept of the involved artery as an active participant in the events leading to luminal obstruction has been realized and provides the opportunity to evaluate novel therapies to modify the course of the disease.

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References and Recommended Reading

  1. Hunder GG, Michet CJ: Giant cell arteritis and polymyalgia h i Cli h i

  2. Watts RA, Scott DG: Classification and epidemiology of the vasculitides. Bal Clin Rheumatol 1997, 11:2.

    Google Scholar 

  3. Horton BT, Magath TB, Brown GE. An undescribed form of arteritis of the temporal vessels. Mayo Clinic Proc 1932, 7:700–701.

    Google Scholar 

  4. Cid MC, Font C, et al.: Large vessel vasculitides. Curr Opin Rheumatol 1998, 10:18–28. Concise review of large vessel vasculitis including both GCA as well as Takayasu’s arteritis.

    Article  PubMed  CAS  Google Scholar 

  5. Weyand CM, Hicock KC, Hunder GG, Goronzy JJ: Tissue cytokine patterns in patients with polymyalgia rheumatica and giant cell arteritis. Ann Intern Med 1994, 121:484–491.

    PubMed  CAS  Google Scholar 

  6. Weyand CM, Shonberger J, Oppitz U, et al.:Distinct vascular lesions in giant cell arteritis share identical T cell clonotypes. J Exp Med 1994, 179:951–960.

    Article  PubMed  CAS  Google Scholar 

  7. Bridgeford PH, Lowenstein M, Bocanergra TS, et al.:Polymyalgia rheumatica and giant cell arteritis: histocompatibility typing and hepatitis-B infection studies. Arthritis Rheum 1980, 23:516–518.

    Article  PubMed  CAS  Google Scholar 

  8. Duhaut P, Bosshard S, Calvet A, et al.:Giant cell arteritis, polymyalgia rheumatica, and viral hypothesis: a multicenter, prospective case-control study. J Rheumatol 1999, 26:361–369.

    PubMed  CAS  Google Scholar 

  9. Gabriel SE, Espy M, Erdman DD, et al.:The role of parvovirus B19 in the pathogenesis of giant cell arteritis. Arthritis Rheum 1999, 42:1255–1258.

    Article  PubMed  CAS  Google Scholar 

  10. Weyand CM, Goronzy JJ: Multisystem interactions in the pathogenesis of vasculitis. Curr Opin Rheumatol 1997, 9:3–11.

    Article  PubMed  CAS  Google Scholar 

  11. Weyand CM, Tetzlaff N, Bjornsson J, Goronzy JJ: Disease patterns and tissue cytokine profiles in giant cell arteritis. Arthritis Rheum 1997, 40:19–26. Variations in the clinical presentation of GCA are demonstrated to be correlated with cytokine mRNA expression in the affected temporal arteries.

    Article  PubMed  CAS  Google Scholar 

  12. Weyand CM: The pathogenesis of giant cell arteritis. J Rheumatol 2000, 27:517–522. Excellent review of the pathogenenic mechanisms involved in GCA, which clearly explains that the major determinants of disease include the immune response of the affected individual and the contribution of the artery that is hosting the immune response.

    PubMed  CAS  Google Scholar 

  13. Caselli RJ, Hunder GG, Whisnant JP: Neurologic disease in biopsy-proven giant cell (temporal) arteritis. Neurology 1988, 38:352–359.

    PubMed  CAS  Google Scholar 

  14. Mehler MF, Rabinowich L: The clinical neuro-opthalmologic spectrum of temporal arteritis. Am J Med 1988, 85:839–844.

    Article  PubMed  CAS  Google Scholar 

  15. Reich KA, Giansiracusa DS, Strongwater SL: Neurologic manifestations of giant cell arteritis. Am J Med 1990, 89:67–72.

    Article  PubMed  CAS  Google Scholar 

  16. Evans JM, O’Fallon M, Hunder GG: Increased incidence of aortic aneurysm and dissection of giant cell (temporal) arteritis. Ann Intern Med 1995, 122:502–507.

    PubMed  CAS  Google Scholar 

  17. Brack A, Martinez-Taboada V, et al.:Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum 1999, 42(2):311–317. This article identifies variables that distinguish large-vessel GCA with subclavian/axillary/brachial artery involvement from cranial GCA, and suggests that GCA is not a single entity but includes several variants of disease.

    Article  PubMed  CAS  Google Scholar 

  18. Salvarani C, Hunder GG: Musculoskeletal manifestation in a population-based cohort of patients with giant cell arteritis. Arthritis Rheum 1999, 42(6):1259–1266. Most recent study of the musculoskeletal manifestations in GCA.

    Article  PubMed  CAS  Google Scholar 

  19. De Heide LJ, Talsma MA: Giant-cell arteritis presenting as an orbital tumor. Neth J Med 1999, 55(4):196–198.

    Article  PubMed  Google Scholar 

  20. Lim KH, Liam CK, Vasudevan AE, Wong CM: Giant cell arteritis presenting as chronic cough and prolonged fever. Respirology 1999, 4(3):299–301.

    Article  PubMed  CAS  Google Scholar 

  21. Blockmans D, Knockaert D, Bobbaers H: Giant cell arteritis can be associated with T4-lymphocytic alveolitis. Clin Rheumatol 1999, 18(40):330–333.

    Article  PubMed  CAS  Google Scholar 

  22. Burton EA, Winer JB, Barber PC: Giant cell arteritis of the cervical radicular vessels presenting with diaphragmatic weakness. J Neurol Neurosurg Psychiatry 1999, 67(2):223–236.

    PubMed  CAS  Google Scholar 

  23. Lacomis D, Giuliani MJ, Wasko MC, Oddis CV: Giant cell arteritis presenting with proximal weakness and skeletal muscle vasculitis. Muscle Nerve 1999 22(1):142–144.

    Article  PubMed  CAS  Google Scholar 

  24. Wilke WS: Large vessel vasculitis (giant cell arteritis, Takayasu’s arteritis). Baillier Clin Rheumatol 1997, 11(2):285–313.

    Article  CAS  Google Scholar 

  25. Wilke WS, Hoffman GS: Treatment of corticosteroid-resistant giant cell arteritis. Rheumatic Dis Clin North Am 1995, 21:59–71.

    CAS  Google Scholar 

  26. Cid MC, Font C, Oristrell J, et al.:Association between strong inflammatory response and low risk of developing visual loss and other cranial ischemic complications in giant cell (temporal) arteritis. Arthritis Rheum 1998, 41(1):26–32. The presence of a strong inflammatory response is associated with low risk for developing cranial ischemic complications suggesting a rationale for testing less aggressive treatment schedules in these individuals.

    Article  PubMed  CAS  Google Scholar 

  27. Johansen JS, Baslund B, Garbarsch C, et al.:YKL-40 in giant cells and macrophages from patients with GCA. Arthritis Rheum 1999, 42(12):2624–2630.

    Article  PubMed  CAS  Google Scholar 

  28. Coll-Vincent B, Vilardell C, Font C, et al.:Circulating soluble adhesion molecules in patients with giant cell arteritis: correlation between soluble intercellular adhesion molecule-1 (sICAM-1) concentrations and disease activity. Ann Rheum Dis 1999, 58:189–192.

    Article  Google Scholar 

  29. Cid MC, Monteagudo J, Oristrell J, et al.:von Willebrand factory in the outcome of temporal arteritis. Ann Rheum Dis 1996, 55:927–930.

    Article  PubMed  CAS  Google Scholar 

  30. Achkar AA, Lie JT, Hunder GG, et al.:How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med 1994, 120:987–992.

    PubMed  CAS  Google Scholar 

  31. Hall S, Lie JT, Kurland LT, et al.:The therapeutic impact of temporal artery biopsy. Lancet 1983, 2:1217–1220.

    Article  PubMed  CAS  Google Scholar 

  32. Duhaut P, Pinede L, Bornet H, et al.:Biopsy proven and biopsy negative temporal arteritis: differences in clinical spectrum at the onset of the disease. Ann Rheum Dis 1999, 58:335–341.

    PubMed  CAS  Google Scholar 

  33. Schmidt WA, Kraft HE, Borkowski A, et al.:Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 1997, 337:1336–1342.

    Article  PubMed  CAS  Google Scholar 

  34. Botella-Estrada R, Sammartin O, Martinez V, et al.:Magnetic resonance angiography in the diagnosis of a case of giant cell arteritis manifesting as scalp necrosis. Arch Dermatol 1999, 135(7):769–771.

    Article  PubMed  CAS  Google Scholar 

  35. Anders HJ, Sigl T, Sander A, et al.:Gadolinium contrast magnetic resonance imaging of the temporal artery in giant cell arteritis. J Rheumatol 1999, 26(10):2287–2288.

    PubMed  CAS  Google Scholar 

  36. Mitomo T, Funyu T, Takahashi Y, et al.:Giant cell arteritis and magnetic resonance angiography. Arthritis Rheum 1998, 41(9):1702.

    Article  PubMed  CAS  Google Scholar 

  37. Blockmans D, Stroobants S, Maes A, Mortelmans L: Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 2000, 108:246–248.

    Article  PubMed  CAS  Google Scholar 

  38. Hunder GG: Giant cell arteritis and polymyalgia rheumatica. Med Clin North Am 1997, 81:195–219.

    Article  PubMed  CAS  Google Scholar 

  39. Wilke WS, Hoffman GS: Treatment of corticosteroid-resistant giant cell arteritis. Rheum Dis Clin North Am 1995, 21:59–71.

    PubMed  CAS  Google Scholar 

  40. Evans J, Hunder GG: The implications of recognizing largevessel involvement in elderly patients with giant cell arteritis. Curr Opin Rheumatol 1997, 9:37–40. The nature of aortic aneurysm formation in association with GCA is discussed, along with the implications of recognizing large-vessel involvement in elderly patients with GCA.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Rheumatology, Veterans Affairs Medical Center, 50 Irving Street, 20422, Washington, DC, USA

    Niveditha Mohan MD & Gail Kerr MD

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  1. Niveditha Mohan MD
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  2. Gail Kerr MD
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Mohan, N., Kerr, G. Spectrum of giant cell vasculitis. Curr Rheumatol Rep 2, 390–395 (2000). https://doi.org/10.1007/s11926-000-0038-2

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  • DOI: https://doi.org/10.1007/s11926-000-0038-2

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