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Recent advances in the diagnosis and management of giant cell arteritis.
- Source :
-
Current opinion in rheumatology [Curr Opin Rheumatol] 2020 May; Vol. 32 (3), pp. 201-207. - Publication Year :
- 2020
-
Abstract
- Purpose of Review: Giant cell arteritis (GCA) has classically been diagnosed by temporal artery biopsy and treated with high-dose, long-term glucocorticoid therapy. Noninvasive imaging increasingly is employed for diagnostic purposes, but further studies are needed to determine the role of imaging in monitoring longitudinal disease activity. Glucocorticoid-sparing therapy mitigates the numerous adverse effects of glucocorticoids. This review addresses new developments in these areas.<br />Recent Findings: For diagnosis, when performed at a center with expertise in its use, temporal artery ultrasound has an estimated sensitivity and specificity of 78 and 79%, respectively. State-of-the-art time-of-flight positron emission tomography/computed tomography (PET/CT) has an estimated sensitivity and specificity of 71 and 91%, respectively. The sensitivities of both imaging modalities decrease following glucocorticoid administration. Tocilizumab is an effective glucocorticoid-sparing therapy, demonstrating sustained glucocorticoid-free remission in 56% of patients receiving weekly tocilizumab compared with 18% of patients receiving a 52-week prednisone taper. The traditional acute phase reactants are of no value in patients treated with interleukin-6 receptor (IL6-R) blockade, and thus, the development of new biomarkers is an important priority in the field.<br />Summary: Noninvasive imaging techniques are increasingly used in the absence of temporal artery biopsy to confirm diagnostic suspicions of GCA. Tocilizumab reduces the cumulative glucocorticoid exposure and increases the rate of sustained remission. Ongoing efforts are directed towards new methods to identify disease flares.
- Subjects :
- Antibodies, Monoclonal, Humanized therapeutic use
Biopsy
Giant Cell Arteritis diagnostic imaging
Giant Cell Arteritis drug therapy
Giant Cell Arteritis pathology
Glucocorticoids therapeutic use
Humans
Positron Emission Tomography Computed Tomography
Prednisone therapeutic use
Sensitivity and Specificity
Temporal Arteries pathology
Giant Cell Arteritis diagnosis
Temporal Arteries diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1531-6963
- Volume :
- 32
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Current opinion in rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 32168069
- Full Text :
- https://doi.org/10.1097/BOR.0000000000000700