Anthony Michael Sammel1,2,3, Clare Louise Fraser4,5. 1. Rheumatology Department, Royal North Shore Hospital. 2. Rheumatology Department, Prince of Wales Hospital. 3. Northern Clinical School, Sydney Medical School. 4. Save Sight Institute, University of Sydney. 5. Macquarie Ophthalmology, Macquarie University, Sydney, Australia.
Abstract
PURPOSE OF REVIEW: Giant cell arteritis (GCA) is a challenging condition to manage because of the potential for acute irreversible vision loss and corticosteroid-related morbidity. Recent developments offer the potential to improve both the assessment and treatment of patients. RECENT FINDINGS: Vascular imaging is increasingly being used in the diagnostic algorithm for GCA. Results from recent vascular ultrasound and high-resolution cranial MRI studies have led some groups to suggest forgoing temporal artery biopsy (TAB) in selected patients. The treatment armamentarium has been enhanced with the addition of Tocilizumab, a monoclonal antibody that inhibits IL-6 and has been shown to be effective in sustaining glucocorticoid-free remission out to 52 weeks. New publications have provided guidance in how clinicians can interpret minimally inflamed biopsies and navigate the controversy about what role, if any, varicella zoster virus may play in the pathophysiology of GCA. Basic science developments have improved our understanding of the immunopathology of GCA including the role of Th1 and Th17 lymphocytes and mechanisms of arterial wall lymphocyte invasion. SUMMARY: There have been significant recent advances in GCA, particularly in relation to imaging and treatment options. Longer term outcome data will help clarify how best to utilize them in routine clinical practice.
PURPOSE OF REVIEW: Giant cell arteritis (GCA) is a challenging condition to manage because of the potential for acute irreversible vision loss and corticosteroid-related morbidity. Recent developments offer the potential to improve both the assessment and treatment of patients. RECENT FINDINGS: Vascular imaging is increasingly being used in the diagnostic algorithm for GCA. Results from recent vascular ultrasound and high-resolution cranial MRI studies have led some groups to suggest forgoing temporal artery biopsy (TAB) in selected patients. The treatment armamentarium has been enhanced with the addition of Tocilizumab, a monoclonal antibody that inhibits IL-6 and has been shown to be effective in sustaining glucocorticoid-free remission out to 52 weeks. New publications have provided guidance in how clinicians can interpret minimally inflamed biopsies and navigate the controversy about what role, if any, varicella zoster virus may play in the pathophysiology of GCA. Basic science developments have improved our understanding of the immunopathology of GCA including the role of Th1 and Th17 lymphocytes and mechanisms of arterial wall lymphocyte invasion. SUMMARY: There have been significant recent advances in GCA, particularly in relation to imaging and treatment options. Longer term outcome data will help clarify how best to utilize them in routine clinical practice.
Authors: Joseph M Dardick; Charles C Esenwa; Richard L Zampolin; Berrin Ustun; Bibi Ayesha; Kathryn F Kirchoff-Torres; Ava L Liberman Journal: Stroke Date: 2019-09-09 Impact factor: 7.914