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Giant cell arteritis: Update on clinical manifestations, diagnosis, and management

  • Nicola Farina
    Affiliations
    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy

    Vita-Salute San Raffaele University, Milan, Italy
    Search for articles by this author
  • Alessandro Tomelleri
    Correspondence
    Corresponding author at: Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy.
    Affiliations
    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy

    Vita-Salute San Raffaele University, Milan, Italy
    Search for articles by this author
  • Corrado Campochiaro
    Affiliations
    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy

    Vita-Salute San Raffaele University, Milan, Italy
    Search for articles by this author
  • Lorenzo Dagna
    Affiliations
    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele, via Olgettina 60, Milan, Italy

    Vita-Salute San Raffaele University, Milan, Italy
    Search for articles by this author
Published:November 04, 2022DOI:https://doi.org/10.1016/j.ejim.2022.10.025

      Highlights

      • GCA encompasses inflammation of cranial and extra-cranial arteries and girdles.
      • Imaging has replaced biopsy as the first diagnostic aid in most cases of GCA.
      • Extra-cranial involvement has a prognostic value but may be overlooked.
      • Non-steroid therapies are becoming increasingly important in the management of GCA.

      Abstract

      Giant cell arteritis (GCA) is the most common vasculitis affecting people older than 50 years. The last decades have shed new light on the clinical paradigm of this condition, expanding its spectrum beyond cranial vessel inflammation. GCA can be now considered a multifaceted vasculitic syndrome encompassing inflammation of cranial and extra-cranial arteries and girdles, isolated or combined. Such heterogeneity often leads to diagnostic delays and increases the likelihood of acute and chronic GCA-related damage. On the other hand, the approach to suspected GCA patients has been revolutionized by the introduction of vascular ultrasound which allows a rapid, cost-effective, and non-invasive GCA diagnosis. Likewise, the use of tocilizumab is now part of the therapeutic algorithm of GCA and ensures a satisfactory disease control even in steroid-refractory patients. Nonetheless, some aspects of GCA still need to be clarified, including the clinical correlation of different histological patterns, and the prevention of long-term vascular complications.
      This narrative review depicts the diagnostic and therapeutic aspects of GCA most relevant in clinical practice, with a focus on clinical updates and novelties introduced over the last decade.

      Keywords

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