Giant cell arteritis — clinical presentation, diagnosis and treatment
Abstract
A systemic vasculitis is a diverse group of disorders, in which the immune-mediated inflammatory process primarily affects the walls of blood vessels. Giant cell arteritis (GCA), classified according to the International Chapel Hill Consensus Conference (2012) in the group of large vessel vasculitis, is a condition of a not fully understood aetiology, which predominantly affects women over 50 years of age. The initial phase of the disease is characterized by unspecific general symptoms. The paper aims to highlight the dermatological manifestations of the condition. GCA should be suspected in patients with erythema and oedema of the skin above the temporal artery and macular/bullous eruption or hair loss in the temporal area. In GCA, scalp necrosis, sometimes extensive and bilateral, as well as glossitis with bullous eruption or necrosis, may also occur. Treatment with systemic corticosteroids (CS) should be started as soon as the suspicion of GCA is raised to avoid irreversible complications, including permanent blindness.
Keywords: systemic vasculitisgiant cell arteritisscalp necrosis
References
- Jennette JC, Falk RJ, Bacon PA, et al. 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis & Rheumatism. 2012; 65(1): 1–11.
- Rinden T, Miller E, Nasr R. Giant cell arteritis: An updated review of an old disease. Cleve Clin J Med. 2019; 86(7): 465–472.
- Buttgereit F, Dejaco C, Matteson EL, et al. Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review. JAMA. 2016; 315(22): 2442–2458.
- KINMONT PD, MCCALLUM DI, KINMONT PD, et al. SKIN MANIFESTATIONS OF GIANT-CELL ARTERITIS. Br J Dermatol. 1964; 76: 299–308.
- Currey J. Scalp necrosis in giant cell arteritis and review of the literature. Br J Rheumatol. 1997; 36(7): 814–816.
- Hansen BL, Junker P. Giant cell arteritis presenting with ischaemic skin lesions of the neck. Br J Rheumatol. 1995; 34(12): 1182–1184.
- Goldberg JW, Lee ML, Sajjad SM. Giant cell arteritis of the skin simulating erythema nodosum. Ann Rheum Dis. 1987; 46(9): 706–708.
- Yáñez S, Val-Bernal JF, Peña-Sagredo JL, et al. Generalized granuloma annulare and giant cell arteritis. Clin Exp Rheumatol. 2008; 26(3 Suppl 49): S108–S110.
- Matteson EL, Gold KN, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990; 33(8): 1122–1128.
- Bowling K, Rait J, Atkinson J, et al. Temporal artery biopsy in the diagnosis of giant cell arteritis: Does the end justify the means? Ann Med Surg (Lond). 2017; 20: 1–5.
- Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018; 77(5): 636–643.
- Mukhtyar C, Guillevin L, Cid MC, et al. European Vasculitis Study Group. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2009; 68(3): 318–323.
- Żychowska M, Baran W. Choroby naczyniowe. [w:] Terapia w dermatologii. Szepietowski J, Baran W (red. ), PZWL, Warszawa. ; 2019: 292–318.
- Seror R, Baron G, Hachulla E, et al. Adalimumab for steroid sparing in patients with giant-cell arteritis: results of a multicentre randomised controlled trial. Ann Rheum Dis. 2014; 73(12): 2074–2081.
- Martínez-Taboada VM, Rodríguez-Valverde V, Carreño L, et al. A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effects. Ann Rheum Dis. 2008; 67(5): 625–630.
- Hoffman GS, Cid MC, Rendt-Zagar KE, et al. Infliximab-GCA Study Group. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial. Ann Intern Med. 2007; 146(9): 621–630.
- Villiger P, Adler S, Kuchen S, et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. The Lancet. 2016; 387(10031): 1921–1927.
- González-Gay MÁ, Pina T, Prieto-Peña D, et al. Treatment of giant cell arteritis. Biochem Pharmacol. 2019; 165: 230–239.
