Abstract
Giant cell arteritis (GCA) is a primary granulomatous systemic vasculitis involving the aorta and its main branches that affects people aged over 50 years with a genetic predisposition. Its main phenotypes are cranial and extracranial involvement, with or without symptoms of polymyalgia rheumatica. These phenotypes can overlap. The extracranial form can be oligosymptomatic and must be sought directly. The main complications of the disease are ischemia of essential territories such as the optic nerve or cerebral circulation, and aneurysmal dilations of the aorta and its large branches. Clinicians must be aware of all the presentation forms of the disease, to start a timely treatment and avoid potentially serious or fatal consequences. To date, the diagnosis of GCA is based on clinical and pathological criteria, with the temporal artery biopsy as the "gold standard" for diagnosis, although its sensitivity is variable. This can lead to an underdiagnosis in patients with negative biopsies or predominant extra-cranial symptoms. The emergence of new and valuable imaging tools substantially improved the timely diagnosis, mainly in subclinical and oligosymptomatic forms. Among them we highlight ultrasonography of the temporal and axillary arteries, Computed Tomography Angiography, Magnetic Resonance Angiography, and PET-CT. These imaging techniques are complementary, and their use is highly recommended. GCA treatment is based on steroidal therapy, often associated with a corticosteroid-sparing immunosuppressive agent. The follow-up is eminently clinical.
Highlights
La arteritis de células gigantes (ACG) es una vasculitis sistémica granulomatosa, primaria e idiopática que involucra arterias medianas y grandes en mayores de 50 años[1]
Los criterios internacionales de clasificación (ACR) aún vigentes para ACG10 incluyen 5 variables, 4 de las cuales son síntomas craneanos y una es el resultado de la biopsia de las arterias temporales (BAT), la cual aún es considerada formalmente el “gold-standard” para el diagnóstico
Diagnostic Value of Color Doppler Ultrasonography of Temporal Arteries and Large Vessels in Giant Cell Arteritis: A Consecutive Case Series
Summary
Giant cell arteritis (GCA) is a primary granulomatous systemic vasculitis involving the aorta and its main branches that affects people aged over 50 years with a genetic predisposition. The diagnosis of GCA is based on clinical and pathological criteria, with the temporal artery biopsy as the “gold standard” for diagnosis, its sensitivity is variable. This can lead to an underdiagnosis in patients with negative biopsies or predominant extra-cranial symptoms. La forma clínica más conocida es la variante que compromete las ramas craneanas de la aorta, principalmente la arteria temporal (“arteritis de la temporal”). En los últimos años se ha reconocido que la ACG comprende un espectro de fenotipos entre los que encontramos, además de la vasculitis craneana, la polimialgia reumática (PMR) y la variante “extra-craneana” (VEC) o de vasos grandes, que compromete la aorta y sus ramas principales. El tratamiento de la ACG escapa al foco principal de nuestra revisión, por lo que no será analizado en profundidad
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