Giant Cell Arteritis

Abstract

Giant Cell Arteritis (GCA) is the inflammation of middle and large arteries commonly affecting the elderly with a female preponderance. In this chapter, we have included a detailed description and the latest management. Its diagnosis is muddled by a constellation of vague manifestations like fever, headache, anemia, high ESR, which may or may not include the characteristic symptoms due to ophthalmic arteritis and polymyalgia rheumatica. On temporal artery biopsy, which remains the gold standard of diagnosis, patchy pan-arteritis, with focal granulomatous lesions and giant cells, is seen. Recently, ultrasonography (USG), MRI, and PET scans are being adopted to optimize the diagnostic process. Corticosteroids remain the mainstay of treatment and are crucial in retarding the disease process to prevent blindness. Though methotrexate and various immunosuppressants have been tried as adjuncts with arguable results, Tocilizumab has been approved for use in the treatment of GCA. Abatacept and Ustekinumab are promising new candidates. GCA is an evolving field in terms of diagnosis and new biological therapies.