Table 2 Practical recommendations and learning points in the diagnostic approach and management of GCA
From: Giant cell arteritis: is the clinical spectrum of the disease changing?
- Former term “temporal arteritis” might be misleading or confounding, as virtually any large or medium-sized artery may be affected. | |
- GCA may present with isolated extra-cranial involvement. | |
- PMR may be present before, during or after diagnosis of GCA has been established, and vice versa | |
- Comprehensive clinical assessment should include palpation of the temporal arteries as well as palpation and auscultation of extracranial vascular territories, including axillary and subclavian arteries, in order to look for any one-sided vascular stenosis. Arterial pressures should also be measured in all four limbs. | |
- Temporal artery biopsy is the gold standard for the diagnosis of GCA with cranial manifestations. However, the temporal artery yield decreases significantly in patients presenting with extra-cranial GCA. | |
- Temporal artery biopsy is positive in patients with cranial manifestations even several weeks after the onset of glucocorticoids. | |
- When there is a very suggestive clinical picture and a positive imaging test, presumptive diagnosis of GCA may be established, thus obviating temporal artery biopsy. | |
- Glucocorticoid therapy should be started immediately in patients with a high clinical suspicion of GCA, even before histologic confirmation or imaging tests are available. | |
- When ophthalmologic symptoms are present, high doses of glucocorticoids are recommended. | |
- After diagnosis of GCA has been established, it may be advisable to use CT-angiography or FDG-PET/CT for screening of large-vessel involvement. | |
- Large-vessel complications (aneurysm and dissection) may develop several years after initial diagnosis of GCA, therefore long-term close follow-up is advised. |