Prognosis and monitoring of giant cell arteritis and associated complications

Abstract

Giant cell arteritis (GCA) is the most common systemic vasculitis in people over the age of 50 years. Prospective imaging studies in GCA highlight the systemic nature of this vasculitis. Areas covered: This review summarizes literature using PubMed on complications of GCA and its treatment. Emphasis was placed on articles published within the past 5 years. Disease associated complications including vision loss from arteritic anterior ischemic optic neuropathy, large-artery stenoses and ischemia, and, aortic aneurysms and dissections. Glucocorticoids are effective but have serious adverse effects. Furthermore, relapses are frequent and treatment- or disease-associated damage may accrue. Tocilizumab is the first treatment that showed efficacy in a large randomized prospective trial as a glucocorticoid sparing agent for GCA. Patients with GCA are also at increased risk for multiple cardiovascular diseases and venous thromboembolism. Monitoring for large-vessel involvement, particularly late manifestations like aortic aneurysms is important. Expert commentary: Advances in, and the incorporation of, imaging in GCA have led to better recognition and diagnosis of patients with large-vessel involvement. Prompt treatment with glucocorticoids is essential in preventing the occurrence or progression of vision loss. Therapeutics that allow sustained remission and reduce vessel damage in patients with GCA will play a crucial role.

Keywords: Giant cell arteritis; aortic aneurysm; aortic dissection; glucocorticoid; ischemic optic neuropathy; large-artery stenosis; large-vessel manifestations; large-vessel vasculitis; mortality; treatment.