title: Giant cell arteritis.
abstract: Giant cell arteritis (GCA) is the most common vasculitis of the elderly. The diagnosis can be challenging at times because of the limitation of the American Rheumatology Association (ARA) classification criteria and the significant proportion of biopsy-negative patients with GCA. We discuss the role of advanced imaging techniques, including positron emission tomography (PET) scanning, in establishing diagnosis and improved histopathology techniques to improve the sensitivity of temporal artery biopsy. There have been significant advances in the understanding of the pathogenesis of GCA, particularly the role of cytokine pathways such as the interleukins, IL-6-IL-17 axis, and the IL-12-interferon-γ axis and their implication for new therapies. We highlight that glucocorticoids remain the primary treatment for GCA, but recognize the risk of steroid-induced side effects. A number of pharmacotherapies to enable glucocorticoid dose reduction and prevent relapse have been studied. Early diagnosis and fast-track pathways have improved outcomes by encouraging adherence to evidence-based practice.
authors.affiliation: Rheumatology Unit, Modbury Hospital, Modbury, South Australia, Australia.
authors.forename: Jem
authors.initials: J
authors.lastname: Ninan
authors.affiliation: Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; Department of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Lester
authors.affiliation: Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia; Department of Medicine, University of Adelaide, Adelaide, Australia; Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: catherine.hill@sa.gov.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hill
mesh_terms: D000368:Aged; D001706:Biopsy; D016207:Cytokines / Q000378:metabolism*; D013700:Giant Cell Arteritis / Q000175:diagnosis* / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D020381:Interleukin-17 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D049268:Positron-Emission Tomography; D013699:Temporal Arteries / Q000473:pathology
chemical_list: D016207:Cytokines; D005938:Glucocorticoids; D020381:Interleukin-17; D015850:Interleukin-6
keywords: Diagnosis; Giant cell arteritis; Imaging; Management