The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Untangling the Diagnosis & Management of GCA

Untangling the Diagnosis & Management of GCA

June 28, 2021 • By Jason Liebowitz, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

EULAR 2021—Temporal arteritis is the term previously applied to giant cell arteritis (GCA), given the predilection for this large vessel vasculitis to involve the temporal arteries. However, recent work on the manifestations of this disease demonstrate GCA is far more complex than previously understood. At EULAR 2021, Sarah Mackie, BMBCh, PhD, MRCP, associate clinical professor in vascular rheumatology, University of Leeds, U.K., provided an overview of the diagnosis and management of GCA.

You Might Also Like
  • Efficacy of Tocilizumab Monotherapy After Ultra-Short Glucocorticoid Administration in GCA
  • Tocilizumab Is Effective to Treat GCA
  • GCA Relapse Possible When Discontinuing Tocilizumab
Explore This Issue
August 2021
Also By This Author
  • Lessons from a Master Clinician: An Interview with Dr. Calvin Brown

Evaluation & Diagnosis

Diagnosing GCA can be challenging. Many of the symptoms are systemic and non-specific, and even more specific findings, such as anterior ischemic optic neuropathy, can be seen in other conditions or have close mimics (i.e., non-arteritic anterior ischemic optic neuropathy), noted Dr. Mackie. Temporal artery biopsy is frequently used to provide a pathologic diagnosis, but false-negative biopsy results are not uncommon.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Patients with GCA have traditionally been treated with high-dose glucocorticoids with a prolonged, slow taper, but the relapse rate may be as high as 50%. Risk factors for relapse include elevated baseline inflammatory markers and large vessel involvement.

Vision & GCA

Permanent vision loss is among the most feared complications of GCA. On this subject, Dr. Mackie noted the potential benefits of a fast-track evaluation pathway. Monti et al. conducted a study in which 63 patients with suspected GCA were fast-tracked to evaluation with an expert rheumatologist within one day and underwent clinical evaluation and color duplex sonography. The outcomes for these patients were compared with a historical cohort of 97 patients who were evaluated via the conventional approach prior to introduction of the fast-track assessment process.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

The researchers found the relative risk of blindness in the conventional group was 2.11 (95% confidence interval [CI] 1.02–4.36; P=0.04) compared with the fast-track assessment group.1 These results indicate fast-track assessments may provide significant benefits for patients in terms of preventing long-term disability from disease.

With regard to screening for disease, Dr. Mackie discussed the halo sign, a periluminal dark ring detected by color Doppler ultrasonography of the temporal arteries. This sign can be a helpful, non-invasive indicator of potential GCA. However, it’s possible to see the halo sign in the context of conditions other than GCA, such as atherosclerosis, narrow-angle glaucoma, non-Hodgkin’s lymphoma, skull base osteomyelitis and neurosyphilis. Dr. Mackie said some evidence indicates patients with GCA who demonstrate a halo sign around the vertebral artery may be at increased risk of stroke.2

Diplopia in patients with GCA is a concerning indication of possible impending vision loss. Mournet et al. evaluated 14 patients with GCA who presented with diplopia. Using high-resolution, 3D, contrast-enhanced magnetic resonance imaging (MRI), researchers detected third cranial nerve enhancement in seven out of eight patients with third cranial nerve impairment. None of the patients without diplopia showed third cranial nerve enhancement on MRI.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 | Single Page

Filed Under: Conditions, Meeting Reports, Vasculitis Tagged With: EULAR, EULAR 2021, GCA, giant cell arteritis (GCA), vision lossIssue: August 2021

You Might Also Like:
  • Efficacy of Tocilizumab Monotherapy After Ultra-Short Glucocorticoid Administration in GCA
  • Tocilizumab Is Effective to Treat GCA
  • GCA Relapse Possible When Discontinuing Tocilizumab
  • New Insights into the Management of Giant Cell Arteritis

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)