Giant Cell Arteritis

Abstract

Giant cell arteritis is a relatively common form of systemic vasculitis, best known for its predisposition to affect the extracranial branches of the carotid artery and associated potential for visual loss. Additional vascular manifestations include stroke, aortic aneurysm or dissection, and even aortic rupture. Cardiac manifestations include coronary artery disease, aortic valve insufficiency, or left ventricular dysfunction, which may occur independently from the valvular disease or hypertension. Physicians need to be vigilant for this disorder, particularly because the tragic end-organ outcomes such as visual loss can be effectively prevented with early use of corticosteroids. We review the pathophysiology and clinical manifestations of giant cell arteritis and present a rationale for diagnosis and therapy for this disease.

<p>Giant cell arteritis: early diagnosis is key</p>

“…In one study examining GCA patients with visual symptoms (ie, amaurosis fugax), 58% of patients whot were started on corticosteroids within 24 hours of visual symptom onset experienced improvement in those symptoms 37. However, in those patients with delayed corticosteroid initiation, only 6% experienced improvement in visual symptoms 37.…”

“…In one study examining GCA patients with visual symptoms (ie, amaurosis fugax), 58% of patients whot were started on corticosteroids within 24 hours of visual symptom onset experienced improvement in those symptoms 37. However, in those patients with delayed corticosteroid initiation, only 6% experienced improvement in visual symptoms 37. Furthermore, in those patients who do not receive corticosteroids, up to 60% suffer vision loss in the contralateral eye, whereas if corticosteroids are given, that probability is decreased to 10%–20% 38.…”

“…Typically, corticosteroid therapy is promptly initiated if the patient’s signs, symptoms, and/or laboratory studies (ESR/CRP) intimate that GCA is the likely diagnosis 37,39. Treatment should not be delayed awaiting the results of the TAB 1.…”

“…The duration of treatment with corticosteroids may last months to years and is determined by both resolution of patients’ symptoms and normalization of inflammatory markers (ESR/CRP) 36. CRP typically stabilizes earlier than ESR 1,37. A gradual tapering of high-dose corticosteroids can be started once ESR and CRP are stabilized, eventually culminating in either complete weaning off of corticosteroids or finding a stable maintenance dose.…”

Cardiac Manifestations of Rheumatological Conditions: A Narrative Review

“…Another manifestation of GCA is thoracic aortic dissection which leads to increased mortality in GCA patients [108]. Coronary artery disease, aortic valve insufficiency, and left ventricular dysfunction are other cardiac involvements [109, 110]. Myocardial infarction is rare in patients with giant cell arteritis [111].…”