Giant cell arteritis: Current treatment and management

Abstract

Glucocorticoids remain the cornerstone of medical therapy in giant cell arteritis (GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. Tocilizumab, a monoclonal IL-6 receptor blocker, has shown promising results in a number of case series and is now being tested in a multi-centre randomized controlled trial. Other targeted treatments, such as the use of abatacept, are also now under investigation in GCA. The need for surgical treatment is rare and should ideally be performed in a quiescent phase of the disease. Not all patients follow the same course, but there are no valid biomarkers to assess therapy response. Monitoring of disease progress still relies on assessing clinical features and measuring inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). Imaging techniques (e.g., ultrasound) are clearly important screening tools for aortic aneurysms and assessing patients with large-vessel involvement, but may also have an important role as biomarkers of disease activity over time or in response to therapy. Although GCA is the most common form of primary vasculitis, the optimal strategies for treatment and monitoring remain uncertain.

Utility of serological biomarkers for giant cell arteritis in a large cohort of treatment-naïve patients

“…On the other hand, indicators of an enhanced systemic inflammatory response may lead to an earlier diagnosis and timely treatment, thus preventing ischemic complications [23]. There have been reports indicating the usefulness of serological acute phase (ESR and CRP) and inflammatory markers (IL-6) for the course during therapy of GCA [17,19,24]. However, there is still a paucity of valid serological markers strongly needed for monitoring GCA relapse and complications [21,[24][25][26].…”

“…There have been reports indicating the usefulness of serological acute phase (ESR and CRP) and inflammatory markers (IL-6) for the course during therapy of GCA [17,19,24]. However, there is still a paucity of valid serological markers strongly needed for monitoring GCA relapse and complications [21,[24][25][26]. Therefore, we set out to measure and analyze serological analytes in a large cohort of clinically wellcharacterized untreated GCA patients that could help clinicians evaluate the course of the disease, including relapse/ complications.…”

Giant Cell Arteritis of the Breast

“…Surgery is implemented especially in developing symptomatic aneurysms in large vessel involvements. In the case of the development of artery stenosis other than this, interventions such as "stent," "bypass," or "angioplasty" can be applied (10). Most interestingly, even if no treatment applied, spontaneous remission can be seen in some patients (2).…”

Investigation and management of giant cell arteritis

“…Aspirin use is controversial; however, it remains in the recommendations where there is no contraindication. Some retrospective analyses have found that aspirin is protective against cerebrovascular and cardiovascular events .…”