[What have we learned about giant cell arteritis during the last decade?].
BACKGROUND
We propose a review on the current state of knowledge in giant cell arteritis (GCA), with particular emphasis on advances produced during the past 10 years.


BACKGROUND
The physiopathology of GCA is better understood. GCA is considered as a T-cell mediated, antigen driven disease. The expression of interferon-gamma greatly influences the clinical expression of the vasculitis. The disease occurs preferentially in women. HLADR4 group and an atheromatous background have been shown to be risk factors for the disease. Infections (parainfluenzae virus, parvovirus B19) may act as triggers at the onset of GCA. In Europe, GCA incidence seems to be increasing in most countries in which it has been studied, especially in women. The diagnostic usefulness of the halo sign detected by high resolution Doppler ultrasonography seems limited. An excess of cardiovascular mortality is described in some countries. There is no consensus regarding the risk factors for thrombotic events. Randomized studies have not proved that methotrexate is a significantly efficient corticosteroid sparing agent. The value of high doses of methylprednisolone for severe thrombotic events has not been established. Benefits and risks of antiaggregation and anticoagulation are unknown.


CONCLUSIONS
Numerous important questions regarding the management of GCA remain unresolved. Well designed prospective studies are rare, and necessary in the future.
Sailler
L
L
Service de médecine interne, pavillon des médecines, CHU de Purpan, 1, place du Dr-Baylac, 31059 Toulouse cedex, France. sailler.l@chu-toulouse.fr <sailler.l@chu-toulouse.fr>
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D008727:Methotrexate