Giant cell arteritis: is the clinical spectrum of the disease changing?

Miguel Á González-Gay,Liliana Ercole,Norberto Ortego-Centeno,Miguel Ortego-Jurado

doi:10.1186/s12877-019-1225-9

Abstract

BackgroundGiant cell arteritis is a vasculitis of large and middle-sized arteries that affects patients aged over 50 years. It can show a typical clinical picture consisting of cranial manifestations but sometimes nonspecific symptoms and large-vessel involvement prevail. Prompt diagnosis and treatment is essential to avoid irreversible damage.DiscussionThere has been an increasing knowledge on the occurrence of the disease without the typical cranial symptoms and its close relationship and overlap with polymyalgia rheumatica, and this may contribute to reduce the number of underdiagnosed patients. Although temporal artery biopsy is still the gold-standard and temporal artery ultrasonography is being widely used, newer imaging techniques (FDG-PET/TAC, MRI, CT) can be of valuable help to identify giant cell arteritis, in particular in those cases with a predominance of extracranial large-vessel manifestations.ConclusionsGiant cell arteritis is a more heterogeneous condition than previously thought. Awareness of all the potential clinical manifestations and judicious use of diagnostic tests may be an aid to avoid delayed detection and consequently ominous complications.

Highlights

Changing epidemiology Giant cell arteritis (GCA) is the most common type of vasculitis in Europe and North America
A survey directed to general practitioners in the UK disclosed that more than 20% of them would rule out GCA if headache was not present among the patient’s symptoms [81]
- GCA may present with isolated extra-cranial involvement

Summary

Introduction

Changing epidemiology GCA is the most common type of vasculitis in Europe and North America It is a disease of the elderly, with a peak of prevalence in the seventh and eighth decades of life [33]. Giant cell arteritis is a vasculitis of large and middle-sized arteries that affects patients aged over 50 years. It can show a typical clinical picture consisting of cranial manifestations but sometimes nonspecific symptoms and large-vessel involvement prevail. Non-specific clinical features related to the general inflammatory state, such as low-grade fever, malaise, fatigue, constitutional symptoms or anemia, may prevail in some cases In this later group of patients, a lower index of suspicion may yield a significant diagnostic and therapeutic delay with potential serious consequences [7]. Involvement of the aorta is associated with a higher risk for developing aneurysms and dissection over

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