Giant cell arteritis: proven and debatable aspects of treatment

Abstract

Giant cell arteritis is the most common systemic vasculitis in adults and especially in older people. Its development and treatment is often associated with comorbidities, relapses and va­rious complications. The paper represents an analytical review, systema­tic generalization and discussion of evidence on modern strategies, main risks, medicines and outcomes of the treatment of patients with giant cell arteritis. We studied specialized literature data published in English, Russian and German, found by electronic and manual search, checked for indexing in the main computer databa­ses of evidence-based medicine (Cochrane Library and Medline) and selec­ted without time limiting. Special attention is paid to prevention of early and severe complications and adverse effects of therapy — eye, cardiovascular, cerebrovascular and infectious diseases, diabetes, osteoporosis, fractures and malignancies. Best practice and the results of the introduction of an accelerated approach to management of a patient with suspected giant cell arteritis in primary healthcare setting are described, as well as current evidence base and prospects for early diagnosis and use of glucocorticoids and adjuvant immunosuppressive and biologic therapy with a focus on methotrexate and tocilizumab. Main principles, recommendations and evidence base of the 2020 British Society for Rheumatology guidelines on diagnosis and treatment of this vasculitis are represented and discussed.

Keywords

• giant cell arteritis
• drug therapy
• complications
• treatment outcome
• standards
• review