Giant Cell Arteritis Challenging to Diagnose, Manage

Conclusions

At this juncture several outstanding problems need to be addressed to move the field of GCA forward. Although GCA is the most common form of primary vasculitis among adults in the U.S. and Europe, the cause of this disease is still unknown and its pathogenesis is poorly understood. Vascular inflammation in GCA can have catastrophic consequences, and standardized criteria for accurate diagnosis are lacking. Further, there is no acceptable alternative to treatment with prolonged courses of CS, which are highly toxic in this elderly population of patients.

IL-6 signaling inhibition therapy is currently being tested in a large multicenter clinical trial. The exact role of MRA/MRI, CTA and PET with respect to initial diagnosis, evaluation of treatment response, disease activity monitoring, and prediction of disease relapse and late arterial complications is to be defined. For this purpose, vascular imaging outcomes need to be factored into the design of clinical trials.

Sebastian Unizony, MD, is co-director of the Vasculitis and Glomerulonephritis Center in the Rheumatology, Allergy and Immunology Division of Massachusetts General Hospital at Harvard Medical School in Boston.

John H. Stone, MD, MPH, is director of clinical rheumatology in the Rheumatology, Allergy and Immunology Division of Massachusetts General Hospital in Boston. He is a professor of medicine at Harvard Medical School.

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