Clinical importance of the presence of giant cells in temporal arteritis

Armstrong, Arthur T.; Tyler, William; Wood, G C; Harrington, Thomas M.

doi:10.1136/jcp.2007.049049

Cited by 28 publications

(18 citation statements)

References 11 publications

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“…Biopsy of the contralateral artery does not add significantly to the diagnostic yield and is therefore not routinely recommended. Overall, available data do not provide convincing evidence that any individual characteristics of the biopsy findings (eg, composition or intensity of the inflammatory infiltrate) are sufficiently predictive for subsequent clinical events to allow guidance of treatment decisions or follow-up in clinical practice 23–35…”

Section: Resultsmentioning

confidence: 99%

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

Hellmich

Águeda

Monti

et al. 2020

Annals of the Rheumatic Diseases

852

706

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BackgroundSince the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations.MethodsUsing EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations.ResultsThree overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40–60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons.ConclusionsWe have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.

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Section: Resultsmentioning

confidence: 99%

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

Hellmich

Águeda

Monti

et al. 2020

Annals of the Rheumatic Diseases

852

706

View full text Add to dashboard Cite

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“…A total of 259 records were identified through electronic searches, and 131 records were extracted from meta‐analysis addressing GCA. The results of the systematic review are shown in Figure ; 34 studies were included (Table ), encompassing 35 arms with GC treatment and totaling 2,505 patients, with a mean age of 69.9 years at diagnosis and 69% women. Inclusions were consecutive in 13 studies (38%) , and 19 studies (56%) were prospective .…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta‐Analysis

Mainbourg

Addario

Samson³

et al. 2020

Arthritis Care & Research

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Objective. The relapse rate of patients with giant cell arteritis (GCA) treated with glucocorticoids (GCs) alone varied widely in observational series and randomized controlled trials (RCTs). The purpose of this systematic review was to evaluate the prevalence of relapse and predisposing factors in patients receiving GCs alone.Methods. We searched Medline up to December 2017. The prevalence of relapse was pooled using a randomeffects model.Results. A total of 34 studies (2,505 patients), comprising 8 RCTs, were included. The overall prevalence of relapse was 47.2% (95% confidence interval 40.0, 54.3) with a high heterogeneity (I 2 = 93%). Prevalence of relapse was significantly higher for patients included in an RCT compared to those included in an observational study (P < 0.0001), but was not significantly different according to design (P = 0.06). The relapse rate was associated with year of publication (34 studies, rate increase of 8.3% for 1 decade; P < 0.0001) and with shorter GC regimens (17 studies, rate decrease of 1.7% for 1 additional month; P < 0.001), the duration of scheduled GC therapy being shorter in RCTs (12.8 months) compared to observational studies (28.8 months). The effective duration of GC therapy (P = 0.23), initial GC dose (P = 0.49), duration of follow-up (P = 0.14), sex (P = 0.29), and age (P = 0.43) were not associated with the prevalence of relapse.Conclusion. GCA relapses occur in half of patients and without improvement across decades in patients receiving GC alone, and the relapse rate is more related to short duration of GC administration than to the initial dose at induction. These results advocate for trial design with at least 12 months of GC therapy.

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“…Macrophages around the internal elastic membrane are activated by Th1 cells and CD8+ T cells and develop into multinucleated giant cells under the influence of IFNγ . The presence of giant cells was associated with an increased risk of cranial ischemia in 2 studies , and also tended to correlate with more cranial ischemic symptoms in a third study . Macrophages and giant cells near the internal elastic membrane may secrete platelet‐derived growth factor (PDGF) and VEGF, which activate VSMCs .…”

Section: Evidence For Distinct Gca Subsets Based On Immunologic Featuresmentioning

confidence: 99%

Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?

Geest

Sandovici

Sleen

et al. 2018

Arthritis & Rheumatology

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Giant cell arteritis (GCA) is an autoimmune vasculitis affecting large and medium‐sized arteries. Ample evidence indicates that GCA is a heterogeneous disease in terms of symptoms, immune pathology, and response to treatment. In the current review, we discuss the evidence for disease subsets in GCA. We describe clinical and immunologic characteristics that may impact the risk of cranial ischemic symptoms, relapse rates, and long‐term glucocorticoid requirements in patients with GCA. In addition, we discuss both proven and putative immunologic targets for therapy in patients with GCA who have an unfavorable prognosis. Finally, we provide recommendations for further research on disease subsets in GCA.

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Clinical importance of the presence of giant cells in temporal arteritis

Cited by 28 publications

References 11 publications

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

2018 Update of the EULAR recommendations for the management of large vessel vasculitis

Prevalence of Giant Cell Arteritis Relapse in Patients Treated With Glucocorticoids: A Meta‐Analysis

Review: What Is the Current Evidence for Disease Subsets in Giant Cell Arteritis?

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