New developments in Giant Cell Arteritis

Abstract Giant cell arteritis (GCA) is a medium to large vessel vasculitis with potentially sight and life threatening complications. Our understanding of the pathogenesis, diagnosis and treatment of GCA has advanced rapidly in recent times. The validity of using the American College of Rheumatology...

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Veröffentlicht in:Survey of ophthalmology 2016-07, Vol.61 (4), p.400-421
Hauptverfasser: Frohman, Larry, MD, Wong, Aaron B.C., MBChB, Matheos, Kaliopy, MBChB, Leon-Alvarado, Luis G., MD, Danesh-Meyer, Helen V., FRANZCO, PhD
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container_end_page 421
container_issue 4
container_start_page 400
container_title Survey of ophthalmology
container_volume 61
creator Frohman, Larry, MD
Wong, Aaron B.C., MBChB
Matheos, Kaliopy, MBChB
Leon-Alvarado, Luis G., MD
Danesh-Meyer, Helen V., FRANZCO, PhD
description Abstract Giant cell arteritis (GCA) is a medium to large vessel vasculitis with potentially sight and life threatening complications. Our understanding of the pathogenesis, diagnosis and treatment of GCA has advanced rapidly in recent times. The validity of using the American College of Rheumatology guidelines for diagnosis of GCA in a clinical setting has been robustly challenged. Erythrocyte sedimentation rate, an important marker of inflammation, is lowered by the use of statins and non-steroidal anti-inflammatory drugs. Conversely, it may be falsely elevated with a low hematocrit. Despite the emergence of new diagnostic modalities, temporal artery biopsy remains the gold standard. Evidence suggests that shorter biopsy lengths and biopsies done weeks to months after initiation of steroid therapy are still useful. New imaging techniques such as positron emission tomography (PET) have shown that vascular inflammation in GCA is more widespread than originally thought. GCA, Takayasu arteritis, and polymyalgia rheumatica are no longer thought to exist as distinct entities and are more likely parts of a spectrum of disease. A range of immunosuppressive drugs have been used in conjunction with corticosteroids to treat GCA; in particular, interleukin-6 inhibitors are showing promise as a therapy.
doi_str_mv 10.1016/j.survophthal.2016.01.001
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Our understanding of the pathogenesis, diagnosis and treatment of GCA has advanced rapidly in recent times. The validity of using the American College of Rheumatology guidelines for diagnosis of GCA in a clinical setting has been robustly challenged. Erythrocyte sedimentation rate, an important marker of inflammation, is lowered by the use of statins and non-steroidal anti-inflammatory drugs. Conversely, it may be falsely elevated with a low hematocrit. Despite the emergence of new diagnostic modalities, temporal artery biopsy remains the gold standard. Evidence suggests that shorter biopsy lengths and biopsies done weeks to months after initiation of steroid therapy are still useful. New imaging techniques such as positron emission tomography (PET) have shown that vascular inflammation in GCA is more widespread than originally thought. GCA, Takayasu arteritis, and polymyalgia rheumatica are no longer thought to exist as distinct entities and are more likely parts of a spectrum of disease. 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GCA, Takayasu arteritis, and polymyalgia rheumatica are no longer thought to exist as distinct entities and are more likely parts of a spectrum of disease. 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source MEDLINE; Elsevier ScienceDirect Journals Complete
subjects Biopsy
corticosteroids
diagnosis
giant cell arteritis
Giant Cell Arteritis - diagnosis
Giant Cell Arteritis - drug therapy
Glucocorticoids - therapeutic use
Humans
Ophthalmology
pathogenesis
Positron-Emission Tomography - methods
Temporal Arteries - diagnostic imaging
temporal arteritis
therapy
title New developments in Giant Cell Arteritis
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