Giant Cell Arteritis (Temporal Arteritis)

Excerpt

Giant cell arteritis (GCA) is a chronic inflammatory vasculitis that predominantly affects large- and medium-sized arteries in individuals older than 50. This complex disorder commonly involves the cranial branches of the carotid arteries. The granulomatous nature of GCA contributes to the loss of vascular smooth muscle cells and elastic fibers, potentially leading to aneurysm formation and vascular remodeling. Intimal hyperplasia and lumen occlusion contribute to ischemic complications.

The spectrum of manifestations in GCA varies, ranging from cranial engagement evidenced by constitutional symptoms, headache, and jaw claudication and a positive temporal artery biopsy to the involvement of large vessels, characterized by nonspecific systemic symptoms and observable vasculitis on imaging. Vision loss, a severe complication primarily manifesting as transient monocular visual loss, necessitates early recognition and treatment with high-dose systemic glucocorticoids, possibly combined with interleukin-6 (IL-6) receptor antagonists. Notably associated with polymyalgia rheumatica, management involves considering the diverse clinical presentations and potential surgical interventions for vascular complications. The management approach for GCA with large vessel involvement mirrors that without large vessel involvement, with additional considerations such as antiplatelet therapy for selected patients. Considering the diverse clinical presentations and treatment options, a comprehensive approach is essential in addressing the complexities of GCA.