Conference paper

GIANT CELL ARTERITIS – AN OVERVIEW

Alojzija Hočevar ; Department of Rheumatology, UMC Ljubljana, Ljubljana, Slovenia

Abstract

Giant cell arteritis (GCA) is the most common systemic vasculitis in adults over age of 50 years in Western countries, affecting aorta and its primary branches (1). Though detailed etiopathogenesis of GCA is not completely understood, studies point to the breakage of immune privilegence of vessel wall, resulting in predominantly TH1 and TH17 mediated vascular inflammation and damage (2). Symptoms and signs of GCA are heterogeneous and reflect tissue and organ ischemia due to vessel wall inflammation, stenosis and/or occlusion (eg. headache, jaw
claudication, vision disturbances, arm claudication, etc.), and systemic inflammation (constitutional symptoms, increased inflammatory parameters, polymyalgia rheumatica, ect.) (3). Based on the location of inflamed arteries, GCA could be divided into “cranial limited” and “extracranial large vessel” GCA. Due to severe ischemic manifestations
(such as an irreversible vision loss or stroke), GCA represents a medical emergency. Major improvements in the diagnostic approach were reached in the last years, with the implementation of fast track clinics and imaging (mainly ultrasonography) into daily practice (4). Besides, European League Against Rheumatism recently published recommendations on imaging in large vessel vasculitides, acknowledging imaging result in clinically suspected GCA as sufficient for diagnosing GCA and thus equivalent to the position of histology (i.e.b temporal artery biopsy) (5). Furthermore, advances in the treatment of GCA have been made. The treatment goals are the prevention of ischemic complications and the achievement of sustained remission, with the minimum treatment related adverse events. Glucocorticoids have been for decades the standard therapy in GCA6. As prolonged glucocorticoid therapy could be associated with significant adverse events, different medications have been evaluated for the steroid sparing effect (6). Methotrexate was the most common conventional immunosuppressive drug used until very recently, when tocilizumab was approved for the GCA treatment, based on GiACTA trial (7). But therapeutic armamentarium is rapidly evolving and new medications (i.e. biologic and conventional targeted) for GCA are expected in the future.
References:
1. Pucelj NP, Hočevar A, Ješe R, et al. The incidence of giant cell arteritis in Slovenia. Clin Rheumatol. 2018 Jul 30. doi: 10.1007/s10067- 018-4236-6.
2. Terrades-Garcia N, Cid MC. Pathogenesis of giant-cell arteritis: how targeted therapies are influencing our understanding of the mechanisms involved. Rheumatology (Oxford) 2018; 57(suppl_2):ii51–62..
3. Koster MJ, Matteson EL, Warrington KJ. Large-vessel giant cell arteritis: diagnosis, onitoring and management. Rheumatology (Oxford) 2018;57(suppl_2):ii32–42.
4. Hocevar A, Rotar Z, Jese R, et al. Do Early Diagnosis and Glucocorticoid Treatment Decrease the Risk of Permanent Visual Loss and Early Relapses in Giant Cell Arteritis: A Prospective Longitudinal Study. Medicine (Baltimore). 2016 Apr;95(14):e3210
5. Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018; 77:636–6436. Kermani TA, Dasgupta B. Current and emerging therapies in large-vessel vasculitis. Rheumatology (Oxford). 2018 Sep 1;57(9):1513–1524 7. Hočevar A, Ješe R, Rotar Ž, et al. Does leflunomide have a role in giant cell arteritis? An open-label study. Clin Rheumatol. 2018 Aug
6. doi: 10.1007/s10067-018-4232-x

Keywords

Hrčak ID:

210531

URI

https://hrcak.srce.hr/210531

Publication date:

5.12.2018.

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