Materiały źródłowe

• #1 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  Giant cell arteritis can be difficult to diagnose because its early symptoms resemble those of other common conditions. For this reason, your doctor will try to rule out other possible causes of your problem. […] In addition to asking about your symptoms and medical history, your doctor is likely to perform a thorough physical exam, paying particular attention to your temporal arteries. Often, one or both of these arteries are tender, with a reduced pulse and a hard, cordlike feel and appearance. […] Your doctor might also recommend certain tests. […] The following tests might be used to help diagnose your condition and to follow your progress during treatment. […] These might be used to diagnose giant cell arteritis and to monitor your response to treatment. […] The best way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) of the temporal artery.

• #1 The Diagnosis and Treatment of Giant Cell Arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3679627/

  GCA is diagnosed on the basis of the combination of symptoms, clinical findings, laboratory results, and diagnostic imaging. […] The criteria for GCA published by the American College of Rheumatology (ACR) are intended to help distinguish GCA from other vasculitides for study purposes, and should not be mistaken for clinical diagnostic criteria. Nevertheless, they are useful for general orientation in everyday clinical routine. […] The clinical examination includes palpation of the temporal artery, auscultation of the arteries including the subclavian and axillary arteries, and bilateral blood pressure measurement in order to look for any one-sided vascular stenosis. […] In GCA, ESR is raised and so is CRP. These two investigations are non-specific, but are sensitive enough for everyday clinical routine.

• #1 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  Statistical prediction models can guide decisions to perform temporal artery biopsy and initiate glucocorticoids in giant cell arteritis (GCA), but do not supplant clinical judgment. […] The laboratory hallmarks of GCA include elevation in the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level and thrombocytosis. The ESR usually exceeds 50 mm/h and may exceed 100 mm/h, but may be normal in 7-20% of patients with GCA. […] Therefore, a normal ESR does not rule out GCA, and the level of elevation of ESR does not correlate reliably with the severity of the disease. […] CRP is of hepatic origin. The level usually rises before ESR in most disease states, and is often elevated in GCA. […] Nonconcordance between ESR and CRP can occur (ie, either an elevated ESR with normal CRP or a normal ESR with an elevated CRP).

• #1 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  How is Giant Cell Arteritis Diagnosed? The diagnosis is made by doing a biopsy of the temporal artery. […] There are blood tests that help the doctor decide who is likely to have GCA. […] Almost everyone with the condition has an elevated erythrocyte sedimentation rate (also called sed rate). […] In addition, most patients with GCA have a slight anemia, or low red blood cell count. […] Other conditions can also cause a high sed rate or anemia, so the final diagnosis depends on a temporal artery biopsy. […] A few patients with GCA do not have positive biopsies. […] When one biopsy is negative, biopsying the temporal artery on the other side can lead to the diagnosis. […] Because blindness from giant cell arteritis is almost irreversible, treatment with 40 to 60 mg of prednisone should be started as soon as the diagnosis is suspected.

• #1 The Diagnosis and Treatment of Giant Cell Arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3679627/

  With color-coded duplex sonography, the temporal arteries, extracranial vessels, and also the occipital, subclavian, and other arteries can be examined noninvasively for inflammation. […] High-resolution MRI allows detailed imaging of the walls and lumina of the superficial cranial arteries. […] Temporal artery biopsy is still regarded as the diagnostic gold standard for GCA. […] A positive biopsy result is proof of GCA, but a negative result does not rule GCA out.

• #1 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  If you have giant cell arteritis, the artery will often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name. It’s possible to have giant cell arteritis and have a negative biopsy result. […] If the results aren’t clear, your doctor might advise another temporal artery biopsy on the other side of your head.

• #1 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  Although immediate temporal artery biopsy has been preferred, one study suggests that biopsy remains positive within at least the first 2 weeks of corticosteroid therapy. […] In patients with giant cell arteritis, arterial involvement is patchy: therefore, maximizing the chance of diagnosis requires obtaining a long (3 to 4 cm) segment and examining multiple sections. […] Positive biopsy specimens show infiltration of the vessel wall with mononuclear inflammatory cells and giant cells, intimal proliferation, and thrombosis. […] Unilateral biopsy specimens are positive in approximately 85% of patients, and bilateral biopsy specimens are positive in 95%. […] Patients dramatically improve within 24 to 72 hours of beginning therapy, and the ESR usually normalizes within 1 month. […] Treatment decisions should probably be based on the patients symptoms, the hemoglobin, the ESR: ESR alone should not dictate therapy.

• #1 Giant cell arteritis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/giant-cell-arteritis?lang=us

  Giant cell arteritis (GCA) is a common granulomatous vasculitis affecting medium to large-sized arteries. It classically presents with involvement of the superficial temporal artery branches, with headache and blindness. Although temporal artery biopsy (TAB) is the gold standard in diagnosing giant cell arteritis, imaging is increasingly playing a role in non-invasive evaluation. […] Areas of normal superficial temporal artery interspersed within inflamed sections of artery, known as skip lesions, result in false negatives in up to 8-28% of cases. […] MRI brain with MR vessel wall imaging has a very high negative predictive value in evaluating giant cell arteritis, indeed it has been suggested in one study to obviate the need for temporal artery biopsy if the MRI is normal. […] On MR vessel wall imaging, giant cell arteritis is characterized by mural inflammation in the superficial temporal arteries, best seen on T1 C+ (Gd) sequences, whereby there is mural enhancement and thickening.

• #1 Giant Cell Arteritis (Temporal Arteritis) Workup: Approach Considerations, Temporal Artery Biopsy, Ultrasonography

  https://emedicine.medscape.com/article/332483-workup

  A complete blood cell count (CBC) should always be obtained. […] A positive TAB has 100% specificity but relatively low sensitivity (15%-87%) for the diagnosis of GCA. […] Color duplex ultrasonography of the temporal artery has emerged as a promising alternative or complement to TAB. […] The sensitivity of TAB was 39%, which was significantly lower than previously reported and inferior to that of ultrasound (54%). […] The TABUL authors noted that performing ultrasound scans in all patients with suspected GCA and performing biopsies only on negative cases would increase the sensitivity of ultrasound to 65% while maintaining specificity at 81%. […] Superficial temporal artery biopsy (TAB) is the criterion standard for diagnosing temporal arteritis. […] The reported sensitivity of TAB has ranged widely, from as low as 15% to as high as 87%. […] The clinical significance of giant cells seen on TAB in temporal arteritis is unknown. […] Studies have found that bilateral biopsies do not increase the diagnostic yield in the vast majority of patients (99%). […] The presence of a headache and jaw claudication may also increase the yield.

• #1 Approach to the diagnosis of giant cell arteritis – UpToDate

  https://www.uptodate.com/contents/image?imageKey=RHEUM/134374

  False negatives can occur with a temporal artery biopsy and CDUS. […] We routinely evaluate for large vessel involvement in all patients with newly diagnosed cranial GCA by performing CDUS of the epiaortic vessels (eg, carotid, subclavian, and axillary arteries). […] In some cases, GCA is confined to the large vessels (ie, the aorta and/or its first-order branches) instead of the more common form, which involves the cranial arteries. Imaging modalities include MRA, CTA, and PET. CDUS of the epiaortic vessels (eg, carotid, subclavian, and axillary arteries) can also be used to identify large vessel GCA. […] High-dose glucocorticoid therapy in individuals with negative temporal artery biopsies and large vessel imaging must be carefully considered and reserved for selected patients with a classic clinical presentation of GCA and no other plausible alternative diagnoses. Clinical improvement following a brief trial of high-dose glucocorticoids is nonspecific and should not be relied upon for establishing the diagnosis of GCA.

• #1 Giant Cell Arteritis (Temporal Arteritis) | Doctor

  https://patient.info/doctor/giant-cell-arteritis-pro

  More recently, ultrasound of the temporal artery has emerged as a diagnostic surrogate for temporal artery biopsies, as a non-invasive test that can often be performed more quickly. […] The presence of the halo sign on temporal artery ultrasound is highly specific for giant cell arteritis, and now appears in diagnostic criteria. A positive temporal artery ultrasound may obviate the need for a biopsy. […] FDG-PET/CT is increasingly important as part of the diagnostic workup, as it aids in ruling out alternative diagnoses and can detect extra-cranial large vessel involvement. […] Magnetic resonance angiography, CT angiography, and axillary artery ultrasound may also be used to evaluate for large vessel involvement.

• #1

  https://www.healio.com/news/rheumatology/20231024/eular-taps-ultrasound-as-firstline-diagnosis-technique-in-giant-cell-arteritis

  Patients with suspected giant cell arteritis should undergo an ultrasound as the first-line imaging method, according to updated EULAR recommendations published in the Annals of the Rheumatic Diseases. […] Among patients with suspected GCA, early imaging tests are recommended to confirm diagnoses. In these cases, therapy should not be held on account of imaging. […] Imaging tests should only be conducted by trained professionals. […] Patients with a high clinical suspicion of GCA who have a positive imaging result can be diagnosed with GCA. […] Temporal and axillary artery ultrasounds should be the first imaging technique used to check mural inflammatory changes in patients with suspected GCA. […] High-resolution MR-angiography (MRA) or FDG-PET can be used instead of ultrasound to assess cranial arteries in patients with possible GCA.

• #1 Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/10/16/3704

  Early recognition of giant cell arteritis (GCA) is crucial to avoid the development of ischemic vascular complications, such as blindness. The classic approach to making the diagnosis of GCA is based on a positive temporal artery biopsy, which is among the criteria proposed by the American College of Rheumatology (ACR) in 1990 to classify a patient as having GCA. However, imaging techniques, particularly ultrasound (US) of the temporal arteries, are increasingly being considered as an alternative for the diagnosis of GCA. Recent recommendations from the European League Against Rheumatism (EULAR) for the use of imaging techniques for large vessel vasculitis (LVV) included US as the first imaging option for the diagnosis of GCA. Furthermore, although the ACR classification criteria are useful in identifying patients with the classic cranial pattern of GCA, they are often inadequate in identifying GCA patients who have the extracranial phenotype of LVV. In this sense, the advent of other imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET)/CT, has made it possible to detect the presence of extracranial involvement of the LVV in patients with GCA presenting as refractory rheumatic polymyalgia without cranial ischemic manifestations. Imaging techniques have been the key elements in redefining the diagnostic work-up of GCA. US is currently considered the main imaging modality to improve the early diagnosis of GCA.

• #1 Temporal Artery Ultrasonography for the Diagnosis of Giant Cell Arteritis | AAFP

  https://www.aafp.org/pubs/afp/issues/2025/0300/diagnostic-tests-temporal-artery-ultrasonography-giant-cell-arte.html

  Giant cell arteritis (GCA) should be suspected in patients 50 years and older with new onset of headaches. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are often elevated in patients with GCA. Temporal artery biopsy and vascular ultrasonography are two modalities that can be used to diagnose GCA. Ultrasonography of the temporal artery is the preferred method of diagnosis in Europe. Key findings that suggest GCA on ultrasonography include the halo sign (hypoechoic arterial wall thickening due to edema), the compression sign (inability of the technician to compress the lumen of the superficial temporal artery due to vessel wall inflammation), vessel stenosis, or total occlusion. There is no standard cutoff for halo sign thickness that is universally considered diagnostic of GCA.

• #1 Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/10/16/3704

  The most recent EULAR guidelines recommended the use of high-resolution 3-T MRI of cranial arteries as an alternative for GCA diagnosis if US is not available or is inconclusive. […] CTA is another option for the diagnosis of extracranial LVV-GCA. […] 18F-FDG-PET combined with CT is a functional imaging technique that has demonstrated usefulness for LVV diagnosis due to its ability to detect glucose uptake from the high activity of inflammatory cells in the vessel walls. […] In current clinical practice, PET/CT is being increasingly used for the early diagnosis of isolated extracranial LVV-GCA. This technique has been shown to be particularly useful in patients who present with refractory polymyalgia rheumatica, associated with atypical symptoms such as a predominant pelvic girdle involvement, inflammatory lumbar pain, and limb claudication.

• #1 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  Angiography with MRI and contrast can be used as well. Expected changes with GCA include mural edema. Similar to CDUS, the sensitivity decreases with corticosteroid treatment. A meta-analysis showed approximately 73% sensitivity and 88% specificity for GCA. Other imaging modalities, include fluorodeoxyglucose positron emission tomography(FDG-PET)/CT, although this also decreases in sensitivity with steroid treatment and the sensitivity and specificity is lower than biopsy.

• #1 Approach to the diagnosis of giant cell arteritis – UpToDate

  https://www.uptodate.com/contents/image?imageKey=RHEUM/134374

  Approach to the diagnosis of giant cell arteritis […] While a high ESR and/or CRP increases the diagnostic significance of the above symptoms or signs, low or normal values do not exclude the diagnosis of GCA. However, an ESR and CRP should always be included as part of the initial diagnostic workup since they are almost always elevated in GCA. […] A current or prior diagnosis of PMR increases the diagnostic significance of any of these symptoms or signs because of the association between GCA and PMR. […] High-dose glucocorticoids should be started once GCA is suspected. […] For skilled operators, CDUS can be an acceptable alternative to the temporal artery biopsy as an initial diagnostic procedure. […] In a subset of patients with GCA, the disease is confined to the large vessels, and temporal artery biopsies in such patients are more often negative than positive.

• #1 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  The standard for diagnosis is histopathology of the temporal artery, which is highly specific and sensitive and can be done in an outpatient setting. The biopsy is usually done on a temporal periauricular artery in the scalp to avoid damaging frontal branches that supply the facial nerve. Surgeons will usually take 20 to 25 mm of the artery to get good sensitivity. False-negatives can occur because there may be segmental skip areas within an affected artery. The biopsy usually remains positive for 2 to 6 weeks, in most cases even if steroid treatment has been started. […] Color Doppler ultrasound (CDUS) involves imaging the temporal, facial, occipital, vertebral, axillary, and subclavian arteries to a resolution of 0.1 mm. Affected vessels will show the halo sign, a darkened area around the vascular lumen caused by edema. This can turn into the compression sign, in which the area of the vessel remains visible after compression by the ultrasound probe. The sensitivity of this technique is 28.6% to 100% and may be operator dependent. There is evidence that these changes are not visible after treatment with corticosteroids. It is, therefore, still not widely used.

• #1 Giant cell arteritis: reviewing the advancing diagnostics and management | Eye

  https://www.nature.com/articles/s41433-023-02433-y

  A single centre study has used halo sign thickness to develop Halo scores, which were associated with markers of systemic inflammation such as CRP, platelet count and haemoglobin, but not ESR. […] Ultrasonography holds great promise for diagnosing forms of GCA other than cranial. […] There is currently debate regarding the sensitivity of US in GCA diagnosis after starting glucocorticoid treatment. […] Despite the evidence of persistent pathological features whilst receiving glucocorticoid therapy, clinicians are currently recommended to scan as early as feasible due to variability in patient response to glucocorticoid treatment.

• #1 Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0871-z

  Giant cell arteritis (GCA), if untreated, can lead to blindness and stroke. The study’s objectives were to (1) determine a new evidence-based benchmark of the extent of diagnostic delay for GCA and (2) examine the role of GCA-specific characteristics on diagnostic delay. […] Mean diagnostic delay was 9.0 weeks (95% CI, 6.5 to 11.4) between symptom onset and GCA diagnosis. […] The mean delay from symptom onset to GCA diagnosis was 9 weeks, or longer when cranial symptoms were absent. […] Diagnosis of GCA in primary care remains difficult. […] Delay to diagnosis is therefore not unusual. […] The importance of understanding the extent of diagnostic delay, and the reasons associated with delay, has been widely investigated by those seeking to improve care for patients with other conditions.

• #1 Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0871-z

  Our aim was to systematically review the existing literature reporting the extent of delay in receiving a GCA diagnosis. […] The pooled mean time between GCA symptom onset and GCA diagnosis was 9.0 weeks (95% CI, 6.5 to 11.4). […] Our meta-analysis demonstrated that those with cranial GCA received a diagnosis after 7.7 weeks and those with non-cranial GCA after 17.6 weeks. […] Despite the reported time-period of diagnostic delay being considerably varied within some article samples, on average, patients experience a 9-week delay between the onset of their symptoms and receiving a diagnosis of GCA.

• #1 Giant cell arteritis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/symptoms-causes/syc-20372758

  If you develop a new, persistent headache or any of the signs and symptoms listed above, see your doctor without delay. […] If you’re diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent vision loss. […] Diagnosis of giant cell arteritis.

• #1 Giant cell arteritis: is the clinical spectrum of the disease changing? | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1225-9

  Nevertheless, the most recent EULAR guidelines consider that early imaging test, such as temporal artery ultrasound, performed by a trained specialist using appropriate operational procedures and settings, may be an alternative to the temporal artery biopsy. […] Advances in imaging over the last few years have constituted a major step forward in the diagnosis of GCA. […] The presence of cardiovascular risk factors of atherosclerosis at the time of diagnosis of GCA may influence the development of severe ischemic manifestations of the disease. […] The remarkably improved performance of all these imaging modalities and their increasing availability are reflected in the recently published EULAR recommendations, which stated that temporal artery biopsy could be obviated in patients with a strong clinical suspicion and a positive, reliable imaging test. […] GCA is not always a readily suspected condition. Initial diagnosis often relies on primary care physicians and specialists in Geriatrics, so they should be aware of the importance of a prompt detection to avoid serious and irreversible complications due to the delay in treatment.

• #1 Giant Cell Arteritis

  https://rheumatology.org/patients/giant-cell-arteritis

  GCA treatment should start immediately after diagnosis to prevent vision loss. There is no simple blood test to confirm the diagnosis of GCA. The erythrocyte sedimentation rate (or sed rate) is a blood test that measures inflammation but finding alone is not proof for GCA. In some cases, an ultrasound of the temporal arteries can be done. It is common to do biopsy of the temporal artery to confirm. […] It is vital that patients who have active or inactive PMR report any symptoms of new headache, changes in vision, or jaw pain to their doctors.

• #1 Giant Cell Arteritis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/vasculitis/giant-cell-arteritis

  Giant cell arteritis is suspected in patients 50 years if any of the following develops, especially if they also have symptoms and laboratory evidence of systemic inflammation: […] The diagnosis of giant cell arteritis is more likely if patients also have symptoms of polymyalgia rheumatica. […] If the diagnosis is suspected, ESR, CRP, and CBC are obtained. In most patients, ESR and CRP are elevated; anemia of chronic disease is common. […] If the diagnosis of giant cell arteritis is suspected, biopsy of an artery is recommended. […] Color Doppler ultrasound of the temporal artery may detect vessel wall edema, seen as a halo, when performed by experts, and can sometimes substitute for temporal artery biopsy in the diagnosis of giant cell arteritis in selected cases. […] Imaging of the aorta and its branches should be done at the time of diagnosis and then periodically after, even in the absence of suggestive symptoms or signs.

• #1 Temporal Artery Ultrasound for Diagnosing Giant Cell Arteritislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na57515/2024/05/21/temporal-artery-ultrasound-diagnosing-giant-cell-arteritis

  This procedure — when performed by an experienced clinician — can suffice for confirming the diagnosis. […] Color Doppler ultrasound of the temporal arteries has emerged as an alternative to biopsy for diagnosing giant cell arteritis (GCA). […] Ultrasound was the initial test (after clinical assessment and laboratory testing). If ultrasound was positive (i.e., “halo sign” in both temporal arteries), no further testing was done. […] If ultrasound was negative, temporal artery biopsy was done. […] If both ultrasound and biopsy were negative, clinicians still could diagnose GCA if vasculitis was identified on large-vessel imaging (by computed tomography or magnetic resonance imaging) or if patients had classic clinical presentations. […] In the cohort overall, GCA was diagnosed by ultrasound in 44% of patients, by biopsy in 17%, and by additional evaluation in 21%; the remaining 18% had alternative diagnoses.

• #1 Giant Cell Arteritis – EyeWiki

  https://eyewiki.org/Giant_Cell_Arteritis

  Giant cell arteritis (GCA) is the most common primary vasculitis in adults. […] Since patients with GCA often present with vision loss, ophthalmologists are on the front lines of diagnosing the disorder. […] When GCA is suspected, treatment with corticosteroids is indicated on an urgent basis, as further vision loss and fellow eye involvement are usually preventable. […] The diagnosis of GCA is complicated by the fact that there is no single lab value, imaging result or biopsy that will always be positive in all patients. […] It is crucial that clinicians maintain a high index of suspicion in any elderly patient with a new onset headache or visual changes. […] The most common ocular manifestation in GCA is acute unilateral vision loss, which has been reported in 7-60% of patients with GCA.

• #1 Giant Cell Arteritis – EyeWiki

  https://eyewiki.org/Giant_Cell_Arteritis

  The physical examination of a patient in whom GCA is suspected should include careful evaluation of the following elements: detailed examination of the temporal artery to detect prominence, nodularity, or tenderness to palpation of the artery and the surrounding skin. […] Temporal artery biopsy is the gold standard; however, a negative biopsy does not confirm a negative diagnosis. […] The Southend giant cell arteritis (GCA) probability score (GCAPS) is a pre-test tool that helps assess the likelihood of a patient having GCA. […] The diagnosis of GCA should be considered in any patient over the age of 50 with new headaches, acute visual changes, symptoms of polymyalgia rheumatica, unexplained constitutional symptoms, or jaw claudication.

• #1 Giant Cell Arteritis: Examining Challenges in Diagnosis and Treatment – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/giant-cell-arteritis-examining-challenges-in-diagnosis-and-treatment/

  Improved biomarkers are needed to monitor disease activity effectively in giant cell arteritis. […] Because these nonspecific symptoms of giant cell arteritis are also seen in many other conditions, diagnostic delays of 9 weeks or longer are common. […] Diagnostic delay in patients with giant cell arteritis can lead to devastating consequences, including stroke or permanent blindness, making it imperative that clinicians maintain a high index of clinical suspicion for the disease. […] Dr Unizony noted that there are important unmet needs remaining for patients with giant cell arteritis. First, we need more prednisone-sparing options for patients who do not tolerate tocilizumab or [who have a] flare on tocilizumab, he told Rheumatology Advisor. Second, because of its mechanism of action, tocilizumab makes the traditional inflammatory markers ESR and CRP unreliable for monitoring of disease activity. So, we need better biomarkers in giant cell arteritis.

• #1 Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/10/16/3704

  In conclusion, the use of imaging techniques has revolutionized the diagnosis of GCA, making it possible to improve the early diagnosis of GCA. In particular, temporal artery US has become the main imaging technique in the clinical evaluation and treatment of GCA, and it is currently used in most centers treating patients with GCA.

• #1 Giant Cell Arteritis – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/giant-cell-arteritis/

  GCA is typically treated with high doses of glucocorticoids such as prednisone, and sometimes with other medications that also suppress the immune system, to control inflammation. […] Because this form of vasculitis can lead to vision loss early on, it is essential that patients with suspected disease be evaluated promptly. Your doctor will consider several factors including symptoms, a detailed medical history, physical exam findings, and results of blood tests and imaging studies. A biopsy of the arteries in one or both temples is usually obtained to confirm the diagnosis. […] The gold standard test to confirm the diagnosis of GCA is a biopsy of the temporal artery. A segment of the artery is surgically removed and then examined under a microscope. In most cases of GCA, there will be evidence of inflammation that includes abnormally large cells called giant cells which give the disease its name. However, in some individuals the biopsy may be negative or normal, even though the disease is present.

• #1 Giant Cell Arteritis (Temporal Arteritis) | Doctor

  https://patient.info/doctor/giant-cell-arteritis-pro

  Giant cell arteritis is a medical emergency. Same-day secondary care referral should be made (usually to a rheumatologist) for an urgent specialist opinion and consideration of further investigations. […] Glucocorticoid therapy should be started if there is a clinical suspicion of giant cell arteritis, and should not be delayed whilst waiting for diagnostic imaging or a temporal artery biopsy. […] Investigations include: Blood tests. These may provide evidence in support of, or against, the diagnosis: Blood inflammatory markers (ESR and CRP) are usually elevated, and raised levels support the diagnosis. […] A full blood count may show a normocytic anaemia, leukocytosis, and thrombocytosis. […] Ultrasound imaging or biopsy: Historically, a temporal artery biopsy was considered the 'gold standard’ for confirming a diagnosis of giant cell arteritis.

• #1 Giant Cell Arteritis Part 1: Diagnosis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/giant-cell-arteritis-part-1-diagnosis/

  In patients with clinical symptoms of GCA, normal ESR/CRP does not exclude diagnosis of GCA. […] A suspected diagnosis of GCA should be confirmed with a unilateral TAB of at least 1.5 cm in length. TAB should be ideally obtained within two weeks of GC therapy initiation. […] GCA can still be present with normal CRP, atypical symptoms or a negative biopsy.

• #1 Giant Cell Arteritis (Temporal Arteritis): Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis

  Giant cell arteritis is a kind of vasculitis, which is inflammation of your blood vessels. […] Giant cell arteritis (GCA), previously known as temporal arteritis, is a form of vasculitis (inflammation of your blood vessels). […] Your healthcare provider will ask about your medical history and perform a physical examination. […] Your healthcare provider will first order blood tests, like erythrocyte sedimentation rate and C-reactive protein, to measure how much inflammation you have in your body. […] If they suspect giant cell (temporal) arteritis, your provider may order a temporal artery ultrasound or temporal artery biopsy. […] Giant cell arteritis treatment should begin immediately to prevent vision loss. […] The primary treatment is a glucocorticoid, usually prednisone. […] If you already have vision loss or other vision symptoms, your provider may treat you with a high dose of glucocorticoids through a catheter in your vein (IV). […] Without early treatment, the GCA can lead to permanent vision loss, and life-threatening complications, such as aneurysms and stroke. […] It’s important to see your healthcare provider right away if you experience any of the symptoms associated with GCA.

• #2 Diagnosis of giant cell arteritis – UpToDate

  https://www.uptodate.com/contents/diagnosis-of-giant-cell-arteritis

  Diagnosis of giant cell arteritis […] The diagnosis of GCA will be reviewed here. […] The diagnosis of giant cell arteritis (GCA) should be considered in a patient over the age of 50 years who has one or more of the following symptoms or signs, particularly in the setting of an elevated erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP).

• #2 Giant cell arteritis: reviewing the advancing diagnostics and management | Eye

  https://www.nature.com/articles/s41433-023-02433-y

  GCA diagnosis is made on a clinical basis, in conjunction with laboratory, temporal artery biopsy (TAB), or vascular imaging evidence, as the clinical findings can help improve pre-test probability. […] Modern publications have suggested regression, neural networks, machine learning models, or clinical scoring systems however all of these rely on complete clinical information about the individual patient. […] There are currently no diagnostic criteria for GCA, however classification criteria such as the American College of Rheumatology (ACR) are often used inappropriately for the purpose of diagnosis. […] Key developments in the field of GCA have now been incorporated into the 2022 ACR/European League Against Rheumatism (EULAR) classification criteria for GCA which include the advancements in ultrasound and PET imaging.

• #2 Giant Cell Arteritis (Temporal Arteritis) | Doctor

  https://patient.info/doctor/giant-cell-arteritis-pro

  Giant cell arteritis is a medical emergency. Same-day secondary care referral should be made (usually to a rheumatologist) for an urgent specialist opinion and consideration of further investigations. […] Glucocorticoid therapy should be started if there is a clinical suspicion of giant cell arteritis, and should not be delayed whilst waiting for diagnostic imaging or a temporal artery biopsy. […] Investigations include: Blood tests. These may provide evidence in support of, or against, the diagnosis: Blood inflammatory markers (ESR and CRP) are usually elevated, and raised levels support the diagnosis. […] A full blood count may show a normocytic anaemia, leukocytosis, and thrombocytosis. […] Ultrasound imaging or biopsy: Historically, a temporal artery biopsy was considered the 'gold standard’ for confirming a diagnosis of giant cell arteritis.

• #2 Giant Cell Arteritis Part 1: Diagnosis | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/giant-cell-arteritis-part-1-diagnosis/

  Giant cell arteritis (GCA) is the most common vasculitis in adults above 50 years of age. […] GCA is a rheumatological emergency. Rapid diagnosis and treatment are required to reduce the risk of complications. […] In GCA, it is critical to obtain a temporal artery biopsy (TAB) to help confirm the diagnosis. TAB still remains the gold standard diagnostic test in North America. […] A suspected diagnosis of GCA should be confirmed with a temporal artery biopsy (or imaging) even when clinical suspicion is high. […] The sensitivity of a biopsy ranges from 30-70% depending on the centre and longer biopsy lengths have shown higher sensitivity. […] It is important to note that a negative biopsy does not rule out GCA if clinical suspicion for the diagnosis remains high. […] The EULAR guidelines for imaging in large vessel vasculitis recommend the use of ultrasound as the first test when suspecting cranial GCA.

• #2 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  How is Giant Cell Arteritis Diagnosed? The diagnosis is made by doing a biopsy of the temporal artery. […] There are blood tests that help the doctor decide who is likely to have GCA. […] Almost everyone with the condition has an elevated erythrocyte sedimentation rate (also called sed rate). […] In addition, most patients with GCA have a slight anemia, or low red blood cell count. […] Other conditions can also cause a high sed rate or anemia, so the final diagnosis depends on a temporal artery biopsy. […] A few patients with GCA do not have positive biopsies. […] When one biopsy is negative, biopsying the temporal artery on the other side can lead to the diagnosis. […] Because blindness from giant cell arteritis is almost irreversible, treatment with 40 to 60 mg of prednisone should be started as soon as the diagnosis is suspected.

• #2 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  If you have giant cell arteritis, the artery will often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name. It’s possible to have giant cell arteritis and have a negative biopsy result. […] If the results aren’t clear, your doctor might advise another temporal artery biopsy on the other side of your head.

• #2 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  The standard for diagnosis is histopathology of the temporal artery, which is highly specific and sensitive and can be done in an outpatient setting. The biopsy is usually done on a temporal periauricular artery in the scalp to avoid damaging frontal branches that supply the facial nerve. Surgeons will usually take 20 to 25 mm of the artery to get good sensitivity. False-negatives can occur because there may be segmental skip areas within an affected artery. The biopsy usually remains positive for 2 to 6 weeks, in most cases even if steroid treatment has been started. […] Color Doppler ultrasound (CDUS) involves imaging the temporal, facial, occipital, vertebral, axillary, and subclavian arteries to a resolution of 0.1 mm. Affected vessels will show the halo sign, a darkened area around the vascular lumen caused by edema. This can turn into the compression sign, in which the area of the vessel remains visible after compression by the ultrasound probe. The sensitivity of this technique is 28.6% to 100% and may be operator dependent. There is evidence that these changes are not visible after treatment with corticosteroids. It is, therefore, still not widely used.

• #2

  https://www.healio.com/news/rheumatology/20231024/eular-taps-ultrasound-as-firstline-diagnosis-technique-in-giant-cell-arteritis

  Patients with suspected giant cell arteritis should undergo an ultrasound as the first-line imaging method, according to updated EULAR recommendations published in the Annals of the Rheumatic Diseases. […] Among patients with suspected GCA, early imaging tests are recommended to confirm diagnoses. In these cases, therapy should not be held on account of imaging. […] Imaging tests should only be conducted by trained professionals. […] Patients with a high clinical suspicion of GCA who have a positive imaging result can be diagnosed with GCA. […] Temporal and axillary artery ultrasounds should be the first imaging technique used to check mural inflammatory changes in patients with suspected GCA. […] High-resolution MR-angiography (MRA) or FDG-PET can be used instead of ultrasound to assess cranial arteries in patients with possible GCA.

• #2 Imaging Tests in the Early Diagnosis of Giant Cell Arteritis

  https://www.mdpi.com/2077-0383/10/16/3704

  According to the last EULAR recommendations for the use of imaging in LVV, US of temporal arteries is recommended as the first imaging tool in patients with suspected predominantly cranial GCA. The four principal US findings in patients with GCA are thickening of the vessel wall or halo sign, non-compressible arteries or compression sign, stenosis, and occlusions. […] Ultrasound in patients with suspected cranial GCA should always include assessment of the temporal and axillary arteries, as stated in the EULAR imaging in LVV recommendations. Temporal artery evaluations should include the common temporal arteries and their frontal and parietal branches, assessed both in longitudinal and transverse planes bilaterally. […] High-resolution MRI has been shown to be useful for the diagnosis and long-term monitoring of GCA.

• #2 Giant Cell Arteritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/giant-cell-arteritis/

  Vascular ultrasound of superficial temporal and axillary arteries should be performed according to current guidelines. Sensitivity for a diagnosis was found to be higher for ultrasound than biopsy (54% vs 39%), but specificity was lower for ultrasound (81% vs 100%). […] In cases of giant cell arteritis with noncranial presentation, MRA can be used to check for large vessel vasculitis. […] Large vessels in patients with GCA are examined using CTA not just to identify any concurrent aortitis but also for diagnosis of patients who do not have the usual cranial giant cell arteritis signs and symptoms. […] When TAB is negative or inconclusive, FFA might be used as a supplementary tool to evaluate individuals with vision loss and a history of giant cell arteritis. […] GCA is typically diagnosed through a combination of physical examination, blood tests, and imaging studies. […] The most common way to detect GCA is to meet three or more of the five criteria developed by the American College of Rheumatology (ACR).

• #2 Giant Cell Arteritis

  https://practicalneurology.com/articles/2020-may/giant-cell-arteritis

  Angiography with MRI and contrast can be used as well. Expected changes with GCA include mural edema. Similar to CDUS, the sensitivity decreases with corticosteroid treatment. A meta-analysis showed approximately 73% sensitivity and 88% specificity for GCA. Other imaging modalities, include fluorodeoxyglucose positron emission tomography(FDG-PET)/CT, although this also decreases in sensitivity with steroid treatment and the sensitivity and specificity is lower than biopsy.

• #2 Approach to the diagnosis of giant cell arteritis – UpToDate

  https://www.uptodate.com/contents/image?imageKey=RHEUM/134374

  False negatives can occur with a temporal artery biopsy and CDUS. […] We routinely evaluate for large vessel involvement in all patients with newly diagnosed cranial GCA by performing CDUS of the epiaortic vessels (eg, carotid, subclavian, and axillary arteries). […] In some cases, GCA is confined to the large vessels (ie, the aorta and/or its first-order branches) instead of the more common form, which involves the cranial arteries. Imaging modalities include MRA, CTA, and PET. CDUS of the epiaortic vessels (eg, carotid, subclavian, and axillary arteries) can also be used to identify large vessel GCA. […] High-dose glucocorticoid therapy in individuals with negative temporal artery biopsies and large vessel imaging must be carefully considered and reserved for selected patients with a classic clinical presentation of GCA and no other plausible alternative diagnoses. Clinical improvement following a brief trial of high-dose glucocorticoids is nonspecific and should not be relied upon for establishing the diagnosis of GCA.

• #2 Giant cell arteritis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/giant-cell-arteritis/

  If there is strong clinical suspicion for GCA, glucocorticoids should be administered immediately, even prior to diagnostic workup if needed, to reduce the risk of permanent vision loss and cerebral ischemia. […] Laboratory studies typically show signs of inflammation (e.g., elevated erythrocyte sedimentation rate and CRP), and temporal artery biopsy and/or imaging (e.g., duplex ultrasound) should be performed to confirm the diagnosis of vasculitis. […] If clinical suspicion for GCA is high, initiate high-dose glucocorticoids before the diagnostic workup to minimize the risk of complications such as vision loss or stroke. […] All patients require imaging studies and/or a temporal artery biopsy to confirm the diagnosis of vasculitis. […] Temporal artery biopsy with histopathology is the only study that can definitively confirm GCA and should be considered in all patients, especially if GCA cannot be ruled out with imaging.

• #2 Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0871-z

  Our aim was to systematically review the existing literature reporting the extent of delay in receiving a GCA diagnosis. […] The pooled mean time between GCA symptom onset and GCA diagnosis was 9.0 weeks (95% CI, 6.5 to 11.4). […] Our meta-analysis demonstrated that those with cranial GCA received a diagnosis after 7.7 weeks and those with non-cranial GCA after 17.6 weeks. […] Despite the reported time-period of diagnostic delay being considerably varied within some article samples, on average, patients experience a 9-week delay between the onset of their symptoms and receiving a diagnosis of GCA.

• #2 Giant Cell Arteritis – EyeWiki

  https://eyewiki.org/Giant_Cell_Arteritis

  Giant cell arteritis (GCA) is the most common primary vasculitis in adults. […] Since patients with GCA often present with vision loss, ophthalmologists are on the front lines of diagnosing the disorder. […] When GCA is suspected, treatment with corticosteroids is indicated on an urgent basis, as further vision loss and fellow eye involvement are usually preventable. […] The diagnosis of GCA is complicated by the fact that there is no single lab value, imaging result or biopsy that will always be positive in all patients. […] It is crucial that clinicians maintain a high index of suspicion in any elderly patient with a new onset headache or visual changes. […] The most common ocular manifestation in GCA is acute unilateral vision loss, which has been reported in 7-60% of patients with GCA.

• #2 Giant Cell Arteritis (Temporal Arteritis): Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis

  Giant cell arteritis is a kind of vasculitis, which is inflammation of your blood vessels. […] Giant cell arteritis (GCA), previously known as temporal arteritis, is a form of vasculitis (inflammation of your blood vessels). […] Your healthcare provider will ask about your medical history and perform a physical examination. […] Your healthcare provider will first order blood tests, like erythrocyte sedimentation rate and C-reactive protein, to measure how much inflammation you have in your body. […] If they suspect giant cell (temporal) arteritis, your provider may order a temporal artery ultrasound or temporal artery biopsy. […] Giant cell arteritis treatment should begin immediately to prevent vision loss. […] The primary treatment is a glucocorticoid, usually prednisone. […] If you already have vision loss or other vision symptoms, your provider may treat you with a high dose of glucocorticoids through a catheter in your vein (IV). […] Without early treatment, the GCA can lead to permanent vision loss, and life-threatening complications, such as aneurysms and stroke. […] It’s important to see your healthcare provider right away if you experience any of the symptoms associated with GCA.

• #2 Giant Cell Arteritis (Temporal Arteritis) | Doctor

  https://patient.info/doctor/giant-cell-arteritis-pro

  More recently, ultrasound of the temporal artery has emerged as a diagnostic surrogate for temporal artery biopsies, as a non-invasive test that can often be performed more quickly. […] The presence of the halo sign on temporal artery ultrasound is highly specific for giant cell arteritis, and now appears in diagnostic criteria. A positive temporal artery ultrasound may obviate the need for a biopsy. […] FDG-PET/CT is increasingly important as part of the diagnostic workup, as it aids in ruling out alternative diagnoses and can detect extra-cranial large vessel involvement. […] Magnetic resonance angiography, CT angiography, and axillary artery ultrasound may also be used to evaluate for large vessel involvement.

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