Giant Cell Arteritis versus Takayasu Arteritis: An Update

Abstract

Giant cell arteritis (GCA) and Takayasu Arteritis (TAK) are two systemic granulomatous vasculitides affecting medium- and large-sized arteries. Similarities in GCA and TAK regarding the clinical presentation, the systemic inflammatory response and the distribution of the arterial lesions, have triggered a debate over the last decade about whether GCA and TAK represent two different diseases, or are age-associated different clinical phenotypes of the same disease. On the other hand, there are differences regarding epidemiology, several clinical features (eg, polymyalgia rheumatica in GCA) and treatment. The aim of this review is to present the latest data regarding this question and to shed some light on the differences and similarities between GCA and TAK regarding epidemiology, genetics, pathogenesis, histopathology, clinical presentation, imaging and treatment. The existing data in literature support the opinion that GCA and TAK are different clinical entities.

Vasculitis with granulomatosis: An atypical presentation of giant cell arteritis

“…Patients with GCA can present with involvement of the aorta; aortic arch, axillary, or subclavian disease; and low burden of disease in the aorta. 8 Our patient has been able to taper off steroids without disease recurrence, which is more consistent with GCA. TA typically requires chronic therapy to maintain disease control.…”

Case Report: Disappearance of Coronary Anastomotic Aneurysm by Steroid Therapy in Takayasu Arteritis: Pseudorepair of Pseudoaneurysm?

“…There are some clues to differentiate two diseases, though it remains unclear whether GCA and TA, predominant causes of large vessel vasculitis, are different clinical entities (3)(4)(5)(6). The age of onset is usually younger in patients with TA (<40 years) than in patients with GCA (>50 years).…”

“…The age of onset is usually younger in patients with TA (<40 years) than in patients with GCA (>50 years). GCA is usually associated with polymyalgia rheumatica, resulting in repeated episodes of fever, and is also associated with involvement of temporal artery, leading to a higher prevalence of headache (3)(4)(5)(6). There are differences in genetic backgrounds between two diseases: GCA is associated with genes in the HLA class II, while TA is associated with those in the HLA class I including the HLA-B52 gene (3)(4)(5)(6).…”

“…GCA is usually associated with polymyalgia rheumatica, resulting in repeated episodes of fever, and is also associated with involvement of temporal artery, leading to a higher prevalence of headache (3)(4)(5)(6). There are differences in genetic backgrounds between two diseases: GCA is associated with genes in the HLA class II, while TA is associated with those in the HLA class I including the HLA-B52 gene (3)(4)(5)(6). Although GCA and TA share similar pathological features, GCA is usually associated with severe inflammation in the inner and middle layer of the media, whereas TA is associated with the outer layer of the media to the adventitia and a marked thickening of adventitia (3)(4)(5)(6)(7).…”

“…There are differences in genetic backgrounds between two diseases: GCA is associated with genes in the HLA class II, while TA is associated with those in the HLA class I including the HLA-B52 gene (3)(4)(5)(6). Although GCA and TA share similar pathological features, GCA is usually associated with severe inflammation in the inner and middle layer of the media, whereas TA is associated with the outer layer of the media to the adventitia and a marked thickening of adventitia (3)(4)(5)(6)(7). In addition, copious infiltration of giant cells and well-formed granulomas are usually observed in large vessels of GCA (7).…”