Liječnički vjesnik (Apr 2021)
Giant cell arteritis
Abstract
Giant cell arteritis (GCA) is the most common vasculitis of older age. It usually affects the branches of carotid arteries, especially temporal and ophthalmic artery. In addition to genetic predisposition, environmental factors also contribute to the development of the disease. Interleukin 6 (IL-6), whose level correlates with inflammatory activity, is one of the key cytokines in the pathogenesis of the disease. Sterile inflammation of the artery wall with intimal hyperplasia and the development of occlusion leads to ischemia which is responsible for the onset of symptoms. The clinical picture is dominated by headache together with general symptoms. Sudden loss of vision may occur due to anterior ischemic optic neuropathy (AION). Frequently, signs of rheumatic polymyalgia are also present. Markedly high erythrocyte sedimentation rate (ESR) and elevated C reactive protein (CRP) are typical. The diagnosis is based on clinical and laboratory findings, temporal artery biopsy, and imaging examinations. Prompt diagnosis is crucial for timely and adequate treatment as well as prevention of early and late complications (blindness, arterial aneurysm or dissection). Until recently, treatment has been limited to the use of glucocorticoids and conventional immunomodulating drugs. This review paper outlines new therapeutic approaches arising from a better knowledge of pathophysiology. Insights from recent studies led to corrections of GCA treatment guidelines (as did the Croatian Society for Rheumatology in 2018) by recommending IL-6 inhibitor tocilizumab for patients with refractory or relapsing disease, and initially in patients at increased risk for complications. Clinical trials are underway that could deliver other therapeutic options in the near future.
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