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Current Neurology and Neuroscience Reports
Erschienen in: Current Neurology and Neuroscience Reports 9/2019

01.09.2019 | Headache (R.B. Halker Singh, Section Editor)

Updates in the Diagnosis and Management of Giant Cell Arteritis

verfasst von: Surabhi Uppal, Mohanad Hadi, Sheetal Chhaya

Erschienen in: Current Neurology and Neuroscience Reports | Ausgabe 9/2019

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Abstract

Purpose of Review

Giant cell arteritis is a systemic large vessel vasculitis that affects the older population and can cause progressive and at times, devastating complications including vision loss. While this has been commonly diagnosed and treated among vasculitides, the treatment options are limited and can have long-term adverse effects. The purpose of our review on GCA is to identify and discuss the pathophysiology and clinical aspects of GCA as they relate to the most recent data. The review will describe any new data on the diagnosis and treatment of this systemic large vessel vasculitis.

Recent Findings

The latest data suggests that the mainstay of treatment of GCA remains glucocorticoids but alternate agents are being identified and used in an attempt to reduce the cumulative exposure to glucocorticoids and reduce treatment-related adverse effects while managing and maintaining remission of this systemic disease.

Summary

There is much more information to collect in terms of identification and standardization of the optimal length of time to treat with glucocorticoids as well as regarding the long-term efficacy of alternate treatments. In addition, investigation continues to identify measureable risk factors to predict outcomes of individual patients with this diagnosis.
Literatur
1.
Kale N, Eggenberger E. Diagnosis and management of giant cell arteritis: a review. Curr Opin Ophthalmol. 2010;21:417–22.CrossRef
2.
Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, Miranda-Filloy JA, Gonzalez-Juanatey C, Martin J, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum. 2009;61(10):1454–61.CrossRef
3.
Kermani TA, Warrington KT, Crowson CS, Ytterberg SR, Hunder GG, Gabriel SE, et al. Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis. 2013;72(12):1989–94.CrossRef
4.
• Weyand CM, Younge BR, Goronzy JJ. IFN-gamma and IL-17: the two faces of T-cell pathology in giant cell arteritis. Curr Opin Rheumatol. 2011;23:43–9 This paper has a description of some additional potential mechanisms of pathophysiology of GCA which then can be used as targets for management of disease. CrossRef
5.
Cid MC, Campo E, Ercilla G, Palacin A, Vilaseca J, Villalta J, et al. Immunohistochemical analysis of lymphoid and macrophage cell subsets and their immunologic activation markers in temporal arteritis. Influence of corticosteroid treatment. Arthritis Rheum. 1989;32:884–93.PubMed
6.
Deng J, Younge BR, Olshen RA, Goronzy JT, Weyand CM. Th17 abd Th1 responses in giant cell arteritis. Circulation. 2010;121(7):906–15.CrossRef
7.
Terrier B, Geri G, Chaara W, Allenbach Y, Rosenzwajg M, Costedoat-Chalumeau N, et al. Interleukin 21 modulates Th1 and Th17 responses in giant cell arteritis. Arthritis Rheum. 2012;64(6):2001–11.CrossRef
8.
Dudakov JA, Hanash AM, van den Brink MR. Interleukin 22: immunology and pathology. Annu Rev Immunol. 2015;33:747–85.CrossRef
9.
• Gilden D, Nagel MA. Varicella zoster virus and giant cell arteritis. Curr Opin Infect Dis. 2016;29(3):275–9 This article discusses the possible role of VZV in triggering the immunopathology of GCA and the role of antivirals in treatment. CrossRef
10.
Gilden D, Nagel A. Varicella zoster virus triggers the immunopathology of giant cell arteritis. Curr Opin Rheumatol. 2016;28(4):376–82.CrossRef
11.
Font C, Cid MC, Coll-Vincent B, López-Soto A, Grau JM. Clinical features in patients with permanent visual loss due to biopsy proven giant cell arteritis. Br J Rheumatol. 1997;36(2):251–4.CrossRef
12.
González-Gay MA, Garcia-Porrúa C, Llorca J, Hajeer AH, Brañas F, Dababneh A, et al. Visual manifestations of giant cell arteritis. Trends and clinical spectrum in 161 patients. Medicine. 2000;79(5):283–92.CrossRef
13.
Miller NR. Visual manifestations of temporal arteritis. Rheum Dis Clin N Am. 2001;27(4):781–97.CrossRef
14.
Hayreh SS, Podhajsky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol. 1998;125(4):509–20.CrossRef
15.
Gonzalez-Gay MA, Barros S, Lopez-Diaz MJ, Garcia-Porrua C, Sanchez-Andrade A, Llorca J. Giant cell arteritis: disease patterns of clinical presentation in a series of 240 patients. Medicine. 2005;84(5):269–76.CrossRef
16.
Gabriel SE, O’Fallon WM, Achkar AA, Lie JT, Hunder GG. The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis. J Rheumatol. 1995;22(1):93–6.PubMed
17.
Nuenninghoff DM, Hunder GG, Christianson TJ, et al. Mortality of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. Arthritis Rheum. 2003;48:3532–7.CrossRef
18.
Prieto-González S, Arguis P, García-Martínez A, Espígol-Frigolé G, Tavera-Bahillo I, Butjòsa M, et al. Large vessel involvement in biopsy-proven giant cell arteritis:prospective study in 4 newly diagnosed patients using GT angiography. Ann Rheum Dis. 2012 Jul;71(7):1170–6.CrossRef
19.
Borchers AT, Gershwin ME, et al. Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmun Rev. 2012;11(6–7):544–54.CrossRef
20.
Breuer GS, Nesher G, Nesher R. Rate of discordant findings in bilateral temporal artery biopsy to diagnose giant cell arteritis. J Rheumatol. 2009;36(4):794–6.CrossRef
21.
Durling B, Toren A, Patel V, Gilberg S, Weis E, Jordan D. Incidence of discordant temporal artery biopsy in the diagnosis of giant cell arteritis. Can J Ophthalmol. 2014;49(2):157–61.CrossRef
22.
• Jakobsson K, Jacobsson L, Mohammad AJ, Nilsson JÅ, Warrington K, Matteson EL, et al. The effect of clinical features and glucocorticoids on biopsy findings in giant cell arteritis. BMC Musculoskelet Disord. 2016;17(1):–363 This article addresses the common and clinically relevant question regarding whether steroids should be started prior to a temporal artery biopsy.
23.
Arida A, Kyprianou M, Kanakis M, Sfikakis PP. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord. 2010;11:44.CrossRef
24.
Duftner C, Dejaco C, Sepriano A, Falzon L, Schmidt WA, Ramiro S. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations. RMD Open. 2018;4(1):e000612.CrossRef
25.
Blockmans D, de Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum. 2006 Feb;55(1):131–7.CrossRef
26.
Naderi N, Mohammad AJ, Turesson C. Large vessel involvement in biopsy-proven giant cell arteritis: incidence, distribution and predictors. Scand J Rheumatol. 2017;46(3):215–21.CrossRef
27.
De Boysson H, Lambert M, Liozon E, Boutemy J, Maigné G, Ollivier Y, et al. Giant-cell arteritis without cranial manifestations: working diagnosis of a distinct disease pattern. Medicine. 2016;95(26).
28.
• Langford CA, Cuthbertson D, Ytterberg SR, Khalidi N, Monach PA, Carette S, et al. A randomized, double-blind trial of abatacept (CTLA-4Ig) for the treatment of giant cell arteritis. Arthritis Rheum. 2017;69(4):837 This article discusses another alternative to steroids for the treatment of GCA. CrossRef
29.
Conway R, O'Neill L, O'Flynn E, Gallagher P, McCarthy GM, Murphy CC, et al. Ustekinumab for the treatment of refractory giant cell arteritis. Ann Rheum Dis. 2016;75(8):1578–9.CrossRef
30.
De Silva M, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study. Ann Rheum Dis. 1986;45(2):136–8.CrossRef
31.
de Boysson H, Boutemy J, Creveuil C, Ollivier Y, Letellier P, Pagnoux C, et al. Is there a place for cyclophosphamide in the treatment of giant-cell arteritis? A case series and systematic review. Semin Arthritis Rheum. 2013;43(1):105.CrossRef
32.
Hocevar A, Jese R, Rotar Z, Tomsic M. Does leflunomide have a role in giant cell arte`ritis? An open label study. Clin Rheumatol. 2019;38:291.CrossRef
33.
Hoffman GS, Cid MC, Rendt-Zagar KE, Merkel PA, Weyand CM, Stone JH, et al. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial. Ann Intern Med. 2007;146(9):621.CrossRef
34.
Seror R, Baron G, Hachulla E, Debandt M, Larroche C, Puéchal X, et al. Adalimumab for steroid sparing in patients with giant-cell arteritis: results of a multicentre randomised controlled trial. Ann Rheum Dis. 2014;73(12):2074–81.CrossRef
35.
Martínez-Taboada VM, Rodríguez-Valverde V, Carreño L, López-Longo J, Figueroa M, Belzunegui J, et al. A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effects. Ann Rheum Dis. 2008;67(5):625–30.CrossRef
36.
Dasgupta B, Borg FA, Hassan N, Alexander L, Barraclough K, Bourke B, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010;49(8):1594–7.CrossRef
37.
• Bienvenu B, Ly KH, Lambert M, Agard C, AndréM BY, Bonnotte B, et al. Management of giant cell arteritis: recommendations of the French Study Group for Large Vessel Vasculitis (GEFA). Rev Med Interne. 2016;37(3):154 This article is significant for recommendations on the management of GCA with corticosteroids. CrossRef
38.
Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, Gross W, et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2009;68(3):318.CrossRef
39.
Delecoeuillerie G, Joly P, Cohen de Lara A, Paolaggi JB. Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients). Ann Rheum Dis. 1988;47(9):733.CrossRef
40.
Kyle V, Hazleman BL. Treatment of polymyalgia rheumatica and giant cell arteritis. II. Relation between steroid dose and steroid associated side effects. Ann Rheum Dis. 1989;48(8):662.CrossRef
41.
Ponte C, Rodriguez AF, O’Neill L, Luqmani RA. Giant cell arteritis:current treatment and management. World J Clin Cases. 2015;3(6):484–94.CrossRef
42.
Chevalet P, Barrier JH, Pottier P, Magadur-Joly G, Pottier MA, Hamidou M, et al. Agron a randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a one year followup study of 164 patients. J Rheumatol. 2000;27(6):1484.PubMed
43.
Tsalapaki C, Lazarini A, Antonatou K, Thomas K, Klavdianou K, Koutsianas C, et al. Frequency of relapses and treatment discontinuation during long-term follow-up of patients with giant cell arteritis. Ann Rheum Dis. 2017;76(sup 2):321–1.
44.
Hoffman GS, Cid MC, Hellmann DB, Guillevin L, Stone JH, Schousboe J, et al. A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum. 2002;46(5):1309.CrossRef
45.
Jover JA, Hernández-García C, Morado IC, Vargas E, Bañares A, Fernández-Gutiérrez B. Combined treatment of giant-cell arteritis with methotrexate and prednisone. a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2001;134(2):106.CrossRef
46.
Spiera RF, Mitnick HJ, Kupersmith M, Richmond M, Spiera H, Peterson MG, et al. A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol. 2001;19(5):495–501.PubMed
47.
• Henry IM, Coronel L, Castaño I, Peiteado D, García-Carazo S, Balsa A, et al. THU0447 No advantage of methotrexate in the treatment of giant cell arteritis. Ann Rheum Dis. 2018;77(2 Supp):435 This addresses the effect of using Methotrexate as a steroid sparing agent in GCA which is commonly done in clinical practice.
48.
Richez C, Barnetche T, Khoryati L, et al. Tocilizumab treatment decreases circulating myeloid dendritic cells and monocytes, 2 components of the myeloid lineage. J Respir Dis. 2012;39:1192–7.
49.
Weyand CM, Goronzy JJ. Clinical practice: giant-cell arteritis and polymyalgia rheumatica. N Engl J Med. 2014;371:50–7.CrossRef
50.
• Rubbert-Roth A, Furst DE, Nebesky JM, et al. A review of recent advances using tocilizumab in the treatment of rheumatic diseases. Rheumatol Ther. 2018;5:21–42 This article discusses the use of an effective steroid sparing agent for GCA. CrossRef
51.
Durand M, Thomas SL. Incidence of infections in patients with giant cell arteritis: a cohort study. Arthritis Care Res. 2012 Apr;64(4):581–8.CrossRef
52.
Kermani TA, Ytterberg SR, Warrington KJ. Pneumocystis jirovecii pneumonia in giant cell arteritis: a case series. Arthritis Care Res. 2011;63(5):761–5.CrossRef
Metadaten
Titel
Updates in the Diagnosis and Management of Giant Cell Arteritis
verfasst von
Surabhi Uppal
Mohanad Hadi
Sheetal Chhaya
Publikationsdatum
01.09.2019
Verlag
Springer US
Erschienen in
Current Neurology and Neuroscience Reports / Ausgabe 9/2019
Print ISSN: 1528-4042
Elektronische ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-019-0982-3

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