Serum interleukin-1 receptor antagonist levels are a useful marker of disease activity and risk of relapse in large vessel vasculitis.

In recent years, Janus kinase (JAK) inhibitors have been gradually approved for the treatment of immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, juvenile idiopathic arthritis, giant cell arteritis, atopic dermatitis, alopecia areata, psoriasis, and inflammatory bowel disease. To standardize the application of JAK inhibitors in IMIDs, the expert group of this consensus has formulated the Chinese expert consensus on the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors, based on the latest research data, relevant guidelines, domestic and international literature, and clinical practice experience of the experts. This consensus provides a comprehensive introduction to treatment regimens, safety management, and medication use in specific populations, aiming to assist clinicians in making reasonable clinical decisions.

Multimodality imaging of giant cell arteritis.

When the Eyes Deceive: Uncommon Ophthalmic Presentation of Giant Cell Arteritis

ABSTRACTAneurysms of pulmonary arteries and aorta are rare, typically caused by infections, congenital heart defects, vascular abnormalities, or medical interventions. This report presents an unusual case of a 72‐year‐old man with a history of smoking, hypertension, and emphysema, who was found to have a large pulmonary artery aneurysm (63.5 mm) and aortic root dilation (46 mm). Despite normal inflammatory markers and no typical giant cell arteritis (GCA) symptoms, histopathology following surgical repair revealed focal GCA as the underlying cause. The patient underwent successful valve‐sparing root replacement and was subsequently treated with prednisone and tocilizumab, showing clinical improvement. This case underscores the existence of a rare GCA phenotype—extracranial GCA—that affects major arteries without cranial involvement and often lacks classic symptoms. Extracranial GCA carries serious risks, including dissection and rupture, particularly in hypertensive individuals. The continuous inflammation in GCA leads to medial degeneration and aneurysm formation. Advancements in imaging have improved early detection and intervention, though the rarity of this condition limits large‐scale studies. As a result, diagnosis and treatment rely heavily on case reports. Glucocorticoids and immunomodulators remain the mainstay of therapy, but more research is needed to optimize management for this atypical GCA presentation.

Background: giant cell arteritis (GCA) is the most frequent large vessel vasculitis, affecting both male and female patients older than 50 years old. Opposite to the cranic involvement (common carotid arteries and their branches) that may debut with headache and visus loss, the extra-cranic involvement (aorta and its branches) is more subtle, leading to a delayed diagnosis, causing the development of aneurisms and dissections [1-3]. Usually, these are late disease complications (after 10 years) but can be found even at diagnosis [1-3]. Case report: a 68-year-old woman, ex-smoker, comes to visit because of a 4-month history of daily fever (up to 38.5°C) with shivers and night sweats, myalgias, fatigue and weight loss. Blood tests showed high neutrophil and platelet count, with persistent inflammation (CRP 35 mg/L). To rule out an occult infection, the patient had been thoroughly screened with blood cultures, urine cultures, treponemic tests, which all came back negative. Being affected by a fever of unknown origin (FUO), the patient was admitted to our Clinic to undergo further testing from which no sign of autoimmunity emerged. Given the development of a persistent frontal headache, even though no other arteritis symptoms were present, an ultrasonographic study of the temporal, axillary, and carotid arteries was performed, showing no halo sign. Because of the persistence of fever and inflammation without explanation, a PET-CT and an echocardiography (to rule out infective endocarditis) were performed and, since GCA was still highly suspected, a temporal artery biopsy was scheduled. PET-CT (Figure 1) showed an intense FDG avidity along the full length of the aortic wall and the carotid and axillary arteries while the echocardiography found a dilation of the aortic root with valve insufficiency and no sign of endocarditis. Granulomatous inflammation suggesting GCA was found in the biopsy specimen of the temporal artery. The aortic dilation was studied performing a CT angiography that confirmed the enlargement of the aortic root and arch and showed a focal dissection 4 cm wide (Figure 2). Glucocorticoid therapy was immediately started and tapered for 8 weeks, alongside tocilizumab, leading to the resolution of fever and inflammation. In the meantime, heart surgeons successfully performed a replacement of the aortic arch. Histological analysis of the aortic wall confirmed the GCA diagnosis (Figure 3). Conclusions. PET-CT and temporal artery biopsy should always be a part of the FUO diagnostic work-up, even when signs or symptoms suggesting GCA are absent. They turn out to be crucial to timely diagnose the disease and may help early identify severe and potentially fatal complications like aneurisms and aortic dissections that, despite being more frequent in the late course of the disease, can also be found at its debut4. This has important therapeutic and prognostic implications.

Background. Immune checkpoint inhibitors (ICIs), widely used in cancer immunotherapy, can trigger immune-related adverse events, including polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), likely through mechanisms involving altered immune tolerance. We conducted a systematic review (SLR) and meta-analysis to characterize these conditions and explore potential differences from the idiopathic forms. Materials and Methods. The SLR analyzed Medline and EMBASE databases up to July 2024, comparing ICI-induced PMR and GCA to their primary forms. Where direct comparisons with idiopathic forms were unavailable, we referred to data from prior meta-analyses and large observational cohorts to qualitatively explore potential differences. Results. From 1,237 abstracts, 46 were included, yielding 358 patients (314 with ICI-PMR and 44 with ICI-GCA). ICI-PMR had a pooled prevalence of 0.3% [95% CI: 0.1%–1.2%] among ICI recipients. Patients were predominantly males (64% [95% CI: 54%–73%]), with a mean age of 71 years [95% CI: 68–74]. PD1/PDL1 blockers were used in 85% [95% CI: 80%–89%] of cases. Inflammatory pain in the girdles was universal (100%), however pelvic girdle involvement was explicitly reported in only 3 studies. Peripheral arthritis in ICI-PMR was present in 26% [95% CI: 9%–54%], and normal inflammatory markers were detected in 26% [95% CI: 15%–40%]. Glucocorticoids (GCs) completely improved symptoms in 83% of patients [95% CI: 66%–92%], with 13% [95% CI: 12%–34%] requiring DMARDs and 18% [95% CI: 9%–33%] experiencing relapses (Figure 1). Two comparative case-control studies showed significant differences between ICI-induced and primary PMR. ICI-PMR patients had milder symptoms, lower C-reactive protein levels, and required lower median prednisone dosages. ICI-GCA prevalence was 0.06% among ICI recipients. Male patients comprised 51% [95% CI: 36%–66%], with a mean age of 71 years [95% CI: 68–74]. About 50% [95% CI: 23%–77%] received anti-CTLA4 blockers (alone or with PD1 blockers), while the rest received PD1/PDL1 blockers. Clinical features included cephalic symptoms (85% [95% CI: 70%–93%]), permanent visual loss (23% [95% CI: 12%–39%]), and large-vessel involvement (62% [95% CI: 40%–80%]). No comparative studies between ICI-GCA vs primary GCA were retrieved. High-dose GCs permitted remission in 95% [95% CI: 73%–99%], though 19% [95% CI: 7%–41%] experienced relapses and 10% [2% - 31%] required DMARDs (Figure 1). Conclusions. ICI-induced PMR and GCA may differ from idiopathic forms, potentially presenting with milder symptoms and more favorable treatment responses. Large observational data and meta-analyses on primary forms suggest higher relapse rates and prolonged GC use [1,2], yet further robust comparative studies are needed to validate whether ICI-induced syndromes truly represent a distinct and less severe clinical entity.

Background. Osteomyelitis of the jaw is a complication of odontogenic infections, primarily involving the dentate portion of the mandible. Osteomyelitis of the mandibular condyle is exceptionally rare, and spread may occur via hematogenous or contiguous routes (1). We here present a case of osteomyelitis of the mandibular condyle initially diagnosed as Horton's arteritis. Case report. An 87-year-old woman with a recent diagnosis of giant cell arteritis underwent rheumatological evaluation (Figure 1). The patient had been complaining for 1 year of non-NSAIDs-responsive headache in the temporal and preauricular regions and jaw claudication. A few months earlier the headache onset, she underwent a tooth extraction with the positioning of a mobile prosthesis. The patient reported that she was first evaluated by a neurologist who, considering the elevation of inflammatory lab tests (CRP 2.8 mg/dL), diagnosed Horton's arteritis and started prednisone 50 mg/day, with remission of the symptoms, but relapse at steroids tapering. At the first rheumatological evaluation, the patient reported pain in the right temporal region, greater at night, with a sense of ear fullness, hyporexia, and weight loss. In laboratory tests conducted under a low-dose steroids regimen (prednisone 7.5 mg/day), a modest increase in inflammation (CRP 1.5 mg/dL) was observed. For a better diagnostic review, the steroids were discontinued, and the patient underwent a temporal artery Doppler ultrasound, which detected no arteritis-compatible abnormalities. Given the worsening of pain, the rise in inflammation (CRP 4 mg/dL) and the swelling of the soft tissues upon discontinuation of the steroids, the patient underwent an 18FDG-PET/CT scan, which excluded vascular uptake but demonstrated intense uptake of the mandibular condyle, pterygoid muscle, and zygomatic bone. She also underwent a contrast-enhanced CT scan, which revealed erosions and periosteal reaction in the jaw, suggestive of osteomyelitis, along with inflammation of the adjacent soft tissues. Conclusions. Mandibular condyle osteomyelitis is a rare complication of dental infections and invasive dental procedures. The associated symptomatology (temporal headache, difficulty in chewing) may resemble giant cell arteritis. An accurate medical history, which also examines previous dental history and pain features, may guide the diagnosis. Anyway, radiologic exams and/or temporal artery biopsy are still necessary for differential diagnosis.

BACKGROUND Nocardia species are opportunistic pathogens that primarily cause infections in immunocompromised individuals. Giant-cell arteritis is a granulomatous vasculitis of large- and medium-sized arteries in individuals aged ≥50 years, typically requiring prolonged glucocorticoid therapy, which increases susceptibility to opportunistic infections. CASE REPORT We report the case of a 73-year-old man with giant-cell arteritis treated with prednisolone who developed disseminated nocardiosis. Four months after giant-cell arteritis diagnosis, a new pulmonary nodule was detected on follow-up imaging, followed by acute onset of loss of consciousness. Brain magnetic resonance imaging revealed multiple abscesses, and Nocardia farcinica was identified from aspirated pus. The patient was initially treated with intravenous meropenem and amikacin. Therapy was then transitioned to the first-line oral agent sulfamethoxazole-trimethoprim, but this was discontinued due to renal dysfunction. Long-term oral minocycline and moxifloxacin were subsequently administered, although the latter was later withdrawn because of QT prolongation. He ultimately completed 1 year of antimicrobial therapy and remained recurrence-free without neurological sequelae. CONCLUSIONS This case illustrates that nocardiosis can occur even in the early phase of giant-cell arteritis therapy and at moderate doses of glucocorticoids. Clinicians should maintain vigilance for Nocardia infection when evaluating pulmonary or neurological lesions in patients with giant-cell arteritis. Alternative therapeutic regimens, guided by susceptibility testing, may be required when first-line agents are not tolerated.

Polymyalgia rheumatica and giant cell arteritis: lumping versus splitting.

Syphilis incidence has been rising worldwide over the last few decades, raising concern for a resurgence of tertiary complications. Syphilitic cardiovascular disease is a rare but serious manifestation of tertiary syphilis, formerly a major cause of aortitis and thoracic aortic aneurysms before the antibiotic era. This review provides an updated overview of syphilitic cardiac and vascular disease for the cardiology specialist. We will discuss the historical and epidemiological context of cardiovascular syphilis, including longitudinal preantibiotic era studies and contemporary case series. We outline the pathophysiology of syphilitic aortitis, highlighting mechanisms whereby Treponema pallidum infection causes obliterative endarteritis of the vasa vasorum, ischemic injury to the aortic wall, and resulting aneurysm formation with aortic valve and coronary ostia involvement. The clinical manifestations are presented, with emphasis on the triad of classic tertiary cardiovascular syphilis, which includes syphilitic thoracic aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. The diagnostic strategies are covered, including modern imaging findings (CT, MRI, echocardiography), serologic test algorithms for syphilis, and histopathologic features. Differential diagnosis is covered in depth, contrasting syphilitic aortitis with other causes of aortitis such as Takayasu arteritis, giant cell arteritis, and other infectious or idiopathic aortitides. Management principles are laid out, with antibiotic therapy and surgery as indicated for late disease. We also cover reported case outcomes and registry reports-including modern surgical series and a recent population-based study implicating syphilis in increased cardiovascular risk-and highlight prognosis with modern therapies. Syphilitic cardiac and vascular disease remains a relevant clinical entity-the "great imitator" of cardiovascular medicine-despite decreased incidence in the antibiotic. Early recognition of this treatable cause of aortitis is critical. Outcomes may be favorable with appropriate antibiotic treatment and early surgical repair of complications, but delayed diagnosis is perilous. Ongoing vigilance, research into optimal management, and public health measures to restrict syphilis are required to further reduce the impact of this disease.

INTRODUCTION Central retinal artery occlusion (CRAO) is a vision‐threatening emergency and a marker of systemic vascular disease, associated with increased risk of stroke and myocardial infarction. Although early treatment may preserve vision, most patients present too late for intervention due to delayed recognition and systemic barriers. As a result, longitudinal follow‐up is crucial to monitor both visual recovery and vascular risk, yet follow‐up practices vary widely and may influence outcomes. Methods This retrospective cohort study analyzed 74 patients evaluated for CRAO from January 1, 2015, to December 31, 2024, at a comprehensive stroke center. Related conditions—branch retinal artery occlusion (BRAO), amaurosis fugax, and giant cell arteritis—were included to ensure comprehensive case capture. Patient demographics, presentation details, treatments, and follow‐up data were reviewed. RESULTS The cohort was 51.6% male and racially diverse: 49.5% non‐Hispanic White, 20.9% African American, 16.5% Hispanic, 6.6% Asian, and 6.6% other. Follow‐up patterns were weak predictors of visual outcomes. Neither general follow‐up nor ophthalmology visits were significantly associated with visual improvement or worsening. In CRAO/BRAO patients, ophthalmology follow‐up was significantly associated with worsening vision (OR 1.45, p < 0.01), likely due to referral bias, but not with improvement. Patient‐reported visual outcomes mirrored this trend, with no statistically significant associations between follow‐up specialty and reported vision changes. Most visual improvement occurred during hospitalization and was unrelated to outpatient follow‐up or ophthalmology consultation. In contrast, stroke etiology and preventive strategies were strong predictors of outcomes. Etiology and secondary prevention were significantly associated with both improvement (OR 1.65, p < 0.01) and worsening (OR 1.52, p < 0.01). Inflammatory causes, such as giant cell arteritis or vasculitis, were linked to better visual recovery, while ischemic etiologies—embolic or atherosclerotic—were associated with poorer outcomes. Preventive therapies (aspirin, anticoagulation, or dual antiplatelet therapy) similarly influenced prognosis, though no single regimen was superior (all p > 0.10). CONCLUSION In this retrospective cohort study, visual prognosis after CRAO and BRAO is primarily influenced by underlying etiology and preventive strategies, not follow‐up patterns. Ophthalmology follow‐up was not predictive of improvement and may reflect selection bias. Effective prevention, regardless of specific therapy, was key to better outcomes. These findings emphasize the importance of acute care and vascular risk management, with primary care follow‐up offering a viable approach in settings with limited specialty access.

Glucocorticoid-induced bradycardia in a patient with giant cell arteritis

Tocilizumab monotherapy versus combined in aortitis associated with giant cell arteritis: Factors associated with imaging remission in a multicenter open-label study of 196 patients.

Abstract Introduction Ankylosing spondylitis (AS) is a chronic inflammatory condition that primarily affects the spine and sacroiliac joint. It commonly presents in males under the age of 40. A key early symptom is inflammatory back pain. In addition to axial symptoms, AS can involve peripheral sites, leading to enthesitis, arthritis, psoriasis, inflammatory bowel disease, and cardiac involvement as aortic regurgitation. Coexistence of AS with systemic vasculitis is exceptionally rare. This case highlights the complexity of managing overlapping autoimmune conditions, including the selection of appropriate biologic therapy and prolonged steroid use leading to complications. Common complications are infections and fragility fractures with clinical deterioration. Case description A 75-year-old woman with long-standing AS diagnosed in her 30s was well-controlled with etanercept. In 2017, she developed symptoms of temporal headache, jaw claudication, and blurring of vision, consistent with giant cell arteritis (GCA). Temporal artery ultrasound confirmed arteritis, and PET/CT revealed large vessel vasculitis (LVV) with active aortitis. High-dose methylprednisolone was started, followed by tapering dose of oral steroids. Etanercept was discontinued and replaced with tocilizumab, which provided GCA control between 2018 and 2021. However, treatment had to later stop due to significant cytopenia and worsening axial symptoms. In 2022 adalimumab was initiated, resulting in improved AS control though her LVV relapsed upon steroid tapering. Methotrexate was poorly tolerated and leflunomide was ineffective. Secukinumab was considered after multidisciplinary discussion. The patient developed severe osteoporosis resulting in multiple vertebral fractures, kyphosis and chronic back pain. She was shifted to denosumab after failure of oral bisphosphonates. Recurrent hospitalisations for dyspnoea were attributed to underlying emphysema and thoracic deformity. Planned initiation of secukinumab was complicated by suspected inflammatory bowel disease and recurrent infections. In early 2024, she was admitted with sepsis, rapidly deteriorated and subsequently passed away. Imaging demonstrated bowel ischaemia and visceral infarcts, likely related to septic emboli in the context of prolonged steroid-induced immunosuppression. Discussion The coexistence of AS and LVV is rare, and managing such overlap conditions carries significant clinical challenges due to their distinct immunopathological pathways. AS is predominantly associated with IL-17/IL-23 axis dysregulation, while LVV is primarily mediated by IL-6 and Th1/Th17 responses. These mechanistic differences complicate the selection of targeted biologic therapies, especially when treatment for one condition may aggravate the other. This case highlights the therapeutic dilemma. The limited efficacy of TNF inhibitors in controlling LVV, in contrast to the potential for IL-6 blockade to worsen axial disease or induce cytopenias, narrows the available treatment options. The role of IL-17 inhibitors such as secukinumab in this context remains uncertain, particularly when comorbidities like inflammatory bowel disease raise further concerns about safety and tolerability. The adverse effects of prolonged corticosteroid use are evident, underscoring the need for early implementation of effective steroid-sparing strategies. Key learning points Concurrent LVV and axial spondyloarthropathy are rare and clinically challenging to manage. This case highlights the limitations of current treatment options, as therapeutic options effective for one condition may worsen the other or cause intolerable side effects. The complications arising from prolonged corticosteroid use underscore the critical need for early introduction of effective steroid-sparing therapies. Additionally, the case demonstrates the value of advanced imaging techniques in diagnosis and disease monitoring and stresses the importance of a coordinated multidisciplinary approach to optimize management in patients with complex autoimmune overlap syndromes.

The 2022 version of the American College of Rheumatology (ACR)-European Alliance of Associations for Rheumatology (EULAR) classification criteria for large vessel vasculitis and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) was substantially updated from the previous 1990 ACR criteria, with the role of diagnostic imaging significantly increased in accordance with the development of imaging modalities and expanding knowledge of the imaging findings. This review illustrates the basic characteristics of vasculitis syndromes in adults involving large vessels such as Takayasu arteritis, giant cell arteritis, and AAVs, with a brief introduction to the updated 2022 ACR/EULAR classification criteria, along with key clinical and imaging clues from a neuroradiologist's perspective.

This study aimed to assess the risk of hospitalisation with pneumonia (HP) among patients with giant cell arteritis (GCA) and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). This population-based cohort study identified patients with GCA and AAV diagnosed between 2000-2021 using the Danish National Patient Registry. Patients were matched 1:10 with controls on sex and year of birth. Using the Pseudo-observation method we evaluated the cumulative incidence proportion (CIP) and risk difference (RD) after one, two, and five years. Furthermore, a nested-case control (NCC) analysis was carried out to assess variables affecting the risk of HP. The CIP of HP for 9307 patients with GCA was 6.0% (5.5-6.5), 9.4% (8.8-10.0), and 17.6% (16.8-18.4) after one, two, and five years. The RD compared with 92 806 matched controls was 3.0% (2.6-3.5), 3.8% (3.2-4.4), to 5.3% (4.5-6.1). For 2401 patients with AAV, the CIP of HP was 12.6% (11.2-13.9), 17.9% (16.3-19.5), and 28.3% (26.4-30.3) after one, two, and five years. Compared with 24 013 matched controls, the RD was 10.1% (8.8-11.5), 14.8% (12.3-15.4) and 20.4% (17.9-21.8). The NCC found comorbidities and immunosuppressive treatment to be associated with higher risk of HP. Patients with GCA or AAV had increased risk of HP compared with matched controls. Comorbidities and recent immunosuppressive treatment were associated with higher risk of HP, highlighting need for focused preventive strategies.

IntroductionGiant cell arteritis (GCA) is a vision-threatening systemic vasculitis for which no universally accessible diagnostic tool exists. Optic nerve sheath diameter (ONSD), measurable via ultrasound, has emerged as a promising, non-invasive biomarker of cranial GCA. The Sonographic Assessment of the Optic Nerve Sheath in Giant Cell Arteritis (SONIC-GCA) aims to validate ONSD ultrasound as a diagnostic and monitoring tool in GCA.Methods and analysisSONIC-GCA is a prospective, multicentre study enrolling patients referred for the evaluation of suspected GCA. A total of 285 participants will undergo optic nerve sheath ultrasound and digital retinal funduscopy, followed by a standardised GCA assessment. All participants will be followed for a minimum of 6 months, at which time an external adjudication committee will confirm the diagnosis of GCA. Those diagnosed with GCA will be followed for 2 years, with repeated optic nerve sheath ultrasound and digital retinal funduscopy at months 3, 6, 12, 18, 24 and at relapse, if applicable.The primary outcome is the diagnostic accuracy of ONSD to detect GCA, which will be evaluated using receiver operating characteristic curve analysis, with adjudicated GCA status serving as the reference standard. Secondary outcomes will address several complementary domains: its value for relapse monitoring will be assessed through time-dependent Cox proportional hazards models, examining whether baseline or longitudinal ONSD predicts relapse risk; intraobserver and interobserver reliability will be determined using intraclass correlation coefficients, providing quantitative estimates of measurement reproducibility; and its association with retinal findings will be evaluated by correlating ONSD measurements with ocular imaging and clinical retinal outcomes. Together, these analyses will comprehensively determine the diagnostic, prognostic and operational utility of ONSD in GCA.Ethics and disseminationThe study has been peer-reviewed by the scientific committee and approved by the CIUSSS du Nord-de-l’Île-de-Montréal Research Ethics Board. Each participating site will obtain local ethics approval prior to enrolment. All participants will provide informed consent. Results will be disseminated through peer-reviewed publications, conference presentations and webinars.Trial registration numberNCT05749094.

Temporal artery biopsy (TAB) and, more recently, temporal artery ultrasound are recommended for the diagnosis of giant cell arteritis (GCA). The inter-rater agreement for TAB is poorly reported, and agreement for ultrasound is variable. A prospective study, the ECHORTON study, evaluated a diagnostic strategy for GCA that used temporal artery ultrasound as the first-line diagnostic test and TAB for ultrasound-negative patients. Clinical expertise served as the reference method. We propose assessing the inter-rater agreement in interpreting TAB and ultrasound images collected in this study. From 2016 to 2020, 165 patients with high suspicion of GCA were enrolled in the ECHORTON study at four general hospitals and two university hospitals. Pathologists and vascular medicine experts independently reviewed TAB and ultrasounds, respectively. The TAB samples were stained with eosin and silver and classified as positive, negative, or equivocal for GCA. Ultrasound results were considered positive when halos were detected around the lumen of both temporal arteries using 9-4 to 18-6 MHz linear probes. This study involved double-blind analysis of 4384 sections from 77 TAB, and 5781 images from 132 ultrasound scans. Kappa coefficients were 0.75 [95% CI: 0.56-0.94] for temporal artery biopsy and 0.73 [95% CI: 0.56-0.90] for temporal artery ultrasound. The reproducibility of interpretations showed heterogeneity across centres, with agreement ranging from fair to excellent. Overall, both TAB and ultrasound demonstrated good inter-rater agreement for GCA diagnosis, though agreement levels varied from fair to excellent across hospitals. Trial registration: The ECHORTON study was registered in ClinicalTrials.gov under the number NCT02703922 on March 3, 2016.

Reviewer Comment on Rizwan et al. "CT Angiography of the Head for the Initial Assessment of Giant Cell Arteritis: Presenting Symptoms, Biopsy Outcomes and Alternative Diagnosis".