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    Giant cell arteritis: advances in diagnosis and management. Raza Mehdi,El Maideny Yasser,Bokhari Nadia British journal of hospital medicine (London, England : 2005) Giant cell arteritis has been widely studied throughout the world. Involvement of cranial vessels can lead to visual loss and strokes. This review primarily focusses on the presentation, diagnosis and treatment. The last 10 years have brought dramatic improvements in the imaging and medical therapies for this condition. After the American College of Rheumatology suggested criteria for the diagnosis of giant cell arteritis, many studies have been performed to find alternatives to a temporal artery biopsy. There is growing evidence that a biopsy may not be needed when one can make a convincing clinical and radiological diagnosis. Although glucocorticoids are the mainstay of treatment and their role has not changed, various biological and non-biological therapies are being used to reduce relapses and prolong remission of symptoms. 10.12968/hmed.2019.80.8.448
    Prognosis and monitoring of giant cell arteritis and associated complications. Kermani Tanaz A,Warrington Kenneth J Expert review of clinical immunology INTRODUCTION:Giant cell arteritis (GCA) is the most common systemic vasculitis in people over the age of 50 years. Prospective imaging studies in GCA highlight the systemic nature of this vasculitis. Areas covered: This review summarizes literature using PubMed on complications of GCA and its treatment. Emphasis was placed on articles published within the past 5 years. Disease associated complications including vision loss from arteritic anterior ischemic optic neuropathy, large-artery stenoses and ischemia, and, aortic aneurysms and dissections. Glucocorticoids are effective but have serious adverse effects. Furthermore, relapses are frequent and treatment- or disease-associated damage may accrue. Tocilizumab is the first treatment that showed efficacy in a large randomized prospective trial as a glucocorticoid sparing agent for GCA. Patients with GCA are also at increased risk for multiple cardiovascular diseases and venous thromboembolism. Monitoring for large-vessel involvement, particularly late manifestations like aortic aneurysms is important. Expert commentary: Advances in, and the incorporation of, imaging in GCA have led to better recognition and diagnosis of patients with large-vessel involvement. Prompt treatment with glucocorticoids is essential in preventing the occurrence or progression of vision loss. Therapeutics that allow sustained remission and reduce vessel damage in patients with GCA will play a crucial role. 10.1080/1744666X.2018.1467758
    Updates in the Diagnosis and Management of Giant Cell Arteritis. Uppal Surabhi,Hadi Mohanad,Chhaya Sheetal Current neurology and neuroscience reports PURPOSE OF REVIEW:Giant cell arteritis is a systemic large vessel vasculitis that affects the older population and can cause progressive and at times, devastating complications including vision loss. While this has been commonly diagnosed and treated among vasculitides, the treatment options are limited and can have long-term adverse effects. The purpose of our review on GCA is to identify and discuss the pathophysiology and clinical aspects of GCA as they relate to the most recent data. The review will describe any new data on the diagnosis and treatment of this systemic large vessel vasculitis. RECENT FINDINGS:The latest data suggests that the mainstay of treatment of GCA remains glucocorticoids but alternate agents are being identified and used in an attempt to reduce the cumulative exposure to glucocorticoids and reduce treatment-related adverse effects while managing and maintaining remission of this systemic disease. There is much more information to collect in terms of identification and standardization of the optimal length of time to treat with glucocorticoids as well as regarding the long-term efficacy of alternate treatments. In addition, investigation continues to identify measureable risk factors to predict outcomes of individual patients with this diagnosis. 10.1007/s11910-019-0982-3
    The role of vascular ultrasound in managing giant cell arteritis in ophthalmology. Ching Jared,Smith Sonja Mansfield,Dasgupta Bhaskar,Damato Erika Marie Survey of ophthalmology Giant cell arteritis is the most common systemic vasculitis in the elderly and is a potentially life-threatening ophthalmic emergency that can result in irreversible blindness. Blindness is most commonly associated with acute onset, irreversible arteritic ischemic optic neuropathy. Without treatment, second eye involvement may occur, resulting in bilateral blindness. Patients with established visual loss are treated with high-dose steroids and generally undergo a temporal artery biopsy to confirm their diagnosis. A significant number of patients are, however, referred for urgent ophthalmology assessment from concerns about "incipient" arteritic ischemic optic neuropathy. Before visual loss, patients may experience a range of ocular symptoms related to ischemia. This generally leads to treatment with high-dose systemic steroid and an urgent request for a temporal artery biopsy. Temporal artery biopsy is considered as the standard investigation for confirmatory diagnosis. It is generally arranged as soon as possible, although it is often not carried out for several days, and there may also be delays in histopathological reporting. It is often perceived that the patient is "safe" while on corticosteroids, in that they are being treated to avoid visual loss. What is not acknowledged, however, is that, if patients do not have giant cell arteritis and are being treated "just in case," they will often require a tapering of oral steroids over several weeks, exposing them to unnecessary and significant side effects. In the rheumatology setting, vascular ultrasound has emerged as a safe and reliable alternative to temporal artery biopsy as a point of care diagnostic tool in the management of giant cell arteritis. Given an experienced sonographer and optimal equipment, a rapid diagnosis can be established in a fast-track clinic setting, taking into consideration clinical assessment, scoring, and ultrasound findings. A huge advantage of ultrasound is that it provides immediate information that can be used to inform treatment decisions. We explore the evidence that supports the incorporation of vascular ultrasound into the ophthalmology repertoire to make a more efficient diagnosis that is cost-effective and associated with better patient outcomes, including a potential reduction in loss of sight and avoidance of unnecessary long-term steroid treatment by early exclusion of mimics. 10.1016/j.survophthal.2019.11.004
    Spontaneous remission of giant cell arteritis: possible association with a preceding acute respiratory infection and seropositivity to antibodies. Maekawa Michitaka,Iwadate Tomonobu,Watanabe Kenshi,Yamamoto Rie,Imaizumi Takahiro,Yamakawa Taishi Nagoya journal of medical science Recent epidemiological or immunopathological studies demonstrate the possible association between giant cell arteritis and infectious agents including . A 62-year-old Japanese man with type 1 diabetes mellitus developed biopsy-proven giant cell arteritis after acute upper respiratory infection. Serological examination indicated concurrent re-infection with . Clinical manifestations of the vasculitis subsided within a month without any immunosuppressive therapy, and no relapse was observed for the following 12 months. The natural history of this disease is unclear and spontaneous remission is rarely reported. The self-limiting nature of the infection could contribute to this phenomenon. 10.18999/nagjms.81.1.151