Giant Cell Arteritis (GCA): Pathogenesis, Clinical Aspects and Treatment Approaches

Andrea      Ciofalo; Giampiero      Gulotta; Giannicola      Iannella; Benedetta      Pasquariello; Alessandra      Manno; Diletta      Angeletti; Annalisa      Pace; Antonio      Greco; Giancarlo      Altissimi; Marco      de Vincentiis; Giuseppe      Magliulo
Abstract

Giant Cell Arteritis (GCA), or Horton’s Arteritis, is a chronic form of vasculitis of the large and medium vessels, especially involving the extracranial branches of the carotid arteries, in particular, the temporal artery, with the involvement of the axillary, femoral and iliac arteries too. Arterial wall inflammation leads to luminal occlusion and tissue ischemia, which is responsible for the clinical manifestations of the disease.
A substantial number of patients affected by GCA present head and neck symptoms, including ocular, neurological and otorhinolaryngological manifestations.
The aim of this article is to present pathogenesis, clinical aspects and treatment approaches of GCA manifestations.
Keywords: Autoimmune disease, GCA, ENT, audiovestibular abnormalities, hearing loss, vasculitis, polymyalgia rheumatica.
Graphical Abstract

[1] 
Evans JM, Hunder GG. Polymyalgia rheumatica and giant cell arteritis. Rheum Dis Clin North Am  2000; 26(3): 493-515.
[http://dx.doi.org/10.1016/S0889-857X(05)70153-8] [PMID:  10989509] 
[2] 
Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med  2002; 347(4): 261-71.
[http://dx.doi.org/10.1056/NEJMra011913] [PMID:  12140303] 
[3] 
Iraj Salehi-Abari 2016 ACR Revised criteria for early diag-nosis of giant cell (Temporal) arteritis. Autoimmune Dis Ther Approaches  2016; 3: 119-22.
[4] 
Kisza K, Murchison AP, Dai Y, et al. Giant cell arteritis incidence: analysis by season and year in mid-Atlantic United States. Clin Exp Ophthalmol  2013; 41(6): 577-81.
[http://dx.doi.org/10.1111/ceo.12069] [PMID:  23332080] 
[5] 
Hunder GG. Epidemiology of giant-cell arteritis. Cleve Clin J Med  2002; 69: SII79-82.
[http://dx.doi.org/10.3949/ccjm.69.Suppl_2.SII79] 
[6] 
Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum  2009; 61(10): 1454-61.
[http://dx.doi.org/10.1002/art.24459] [PMID:  19790127] 
[7] 
Liozon E, Ouattara B, Rhaiem K, et al. Familial aggregation in giant cell arteritis and polymyalgia rheumatica: a comprehensive literature review including 4 new families. Clin Exp Rheumatol  2009; 27(1)(Suppl. 52): S89-94.
[PMID:  19646354] 
[8] 
Gran JT, Myklebust G. The incidence of polymyalgia rheumatica and temporal arteritis in the county of Aust Agder, south Norway: A prospective study 1987-94. J Rheumatol  1997; 24(9): 1739-43.
[9] 
Wagner AD, Gérard HC, Fresemann T, et al. Detection of Chlamydia Pneumoniae in giant cell vasculitis and correlation with the topographic arrangement of tissue-infiltrating dendritic cells. Arthritis Rheum  2000; 43(7): 1543-51.
[http://dx.doi.org/10.1002/1529-0131(200007)43:7<1543:AID-ANR19>3.0.CO;2-8] [PMID:  10902759] 
[10] 
Elling P, Olsson AT, Elling H. Synchronous variations in the incidence of temporal arteritis and polymyalgia rheumatica in Danish counties. Association with epidemics of Mycoplasma pneumonia infection. Ugeskr Laeger  1997; 159(26): 4123-8.
[PMID:  9229871] 
[11] 
Nordborg C, Nordborg E, Petursdottir V, et al. Search for varicella zoster virus in giant cell arteritis. Ann Neurol  1998; 44(3): 413-4.
[http://dx.doi.org/10.1002/ana.410440323] [PMID:  9749614] 
[12] 
Gabriel SE, Espy M, Erdman DD, Bjornsson J, Smith TF, Hunder GG. The role of parvovirus B19 in the pathogenesis of giant cell arteritis: a preliminary evaluation. Arthritis Rheum  1999; 42(6): 1255-8.
[http://dx.doi.org/10.1002/1529-0131(199906)42:6<1255:AID-ANR23>3.0.CO;2-P] [PMID:  10366119] 
[13] 
Gilden D, White T, Khmeleva N, et al. Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis. Neurology  2015; 84(19): 1948-55.
[http://dx.doi.org/10.1212/WNL.0000000000001409] [PMID:  25695965] 
[14] 
Gran JT, Myklebust G, Wilsgaard T, Jacobsen BK. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology (Oxford)  2001; 40(11): 1238-42.
[http://dx.doi.org/10.1093/rheumatology/40.11.1238] [PMID:  11709607] 
[15] 
Machado EB, Micher CJ, Ballard DJ. Trends in incidence and clinical presentation of temporal arteritis in Olmested County, Minnesota, 1950-85. Arthritis Rheuma  1988; 31: 754-9.
[16] 
Weyand CM, Goronzy JJ, Weyand CM, et al. Giant-cell arteritis and polymyalgia rheumatica. Ann Intern Med  2003; 139(6): 505-15.
[http://dx.doi.org/10.7326/0003-4819-139-6-200309160-00015] [PMID:  13679329] 
[17] 
Savage CO, Harper L, Holland M. New findings in pathogenesis of antineutrophil cytoplasm antibody-associated vasculitis. Curr Opin Rheumatol  2002; 14(1): 15-22.
[http://dx.doi.org/10.1097/00002281-200201000-00004] [PMID:  11790991] 
[18] 
Weyand CM, Wagner AD, Björnsson J, Goronzy JJ. Correlation of the topographical arrangement and the functional pattern of tissue-infiltrating macrophages in giant cell arteritis. J Clin Invest  1996; 98(7): 1642-9.
[http://dx.doi.org/10.1172/JCI118959] [PMID:  8833914] 
[19] 
Rittner HL, Kaiser M, Brack A, Szweda LI, Goronzy JJ, Weyand CM. Tissue-destructive macrophages in giant cell arteritis. Circ Res  1999; 84(9): 1050-8.
[http://dx.doi.org/10.1161/01.RES.84.9.1050] [PMID:  10325242] 
[20] 
Kaiser M, Weyand CM, Björnsson J, Goronzy JJ. Platelet-derived growth factor, intimal hyperplasia, and ischemic complications in giant cell arteritis. Arthritis Rheum  1998; 41(4): 623-33.
[http://dx.doi.org/10.1002/1529-0131(199804)41:4<623:AID-ART9>3.0.CO;2-6] [PMID:  9550471] 
[21] 
Weyand CM, Tetzlaff N, Björnsson J, Brack A, Younge B, Goronzy JJ. Disease patterns and tissue cytokine profiles in giant cell arteritis. Arthritis Rheum  1997; 40(1): 19-26.
[http://dx.doi.org/10.1002/art.1780400105] [PMID:  9008596] 
[22] 
Salvarani C, Casali B, Farnetti E, et al. -463 G/A myeloperoxidase promoter polymorphism in giant cell arteritis. Ann Rheum Dis  2008; 67(4): 485-8.
[http://dx.doi.org/10.1136/ard.2007.074666] [PMID:  17704068] 
[23] 
Macchion P. La polimialgia reumatica. Lo Spallanzani  2007; 21: 81-6.
[24] 
Wang X, Hu ZP, Lu W, et al. Giant cell arteritis. Rheumatol Int  2008; 29(1): 1-7.
[http://dx.doi.org/10.1007/s00296-008-0662-0] [PMID:  18716781] 
[25] 
Rahman W, Rahman FZ. Giant cell (temporal) arteritis: an overview and update. Surv Ophthalmol  2005; 50(5): 415-28.
[http://dx.doi.org/10.1016/j.survophthal.2005.06.011] [PMID:  16139037] 
[26] 
Weyand CM, Bartley GB. Giant cell arteritis: new concepts in pathogenesis and implications for management. Am J Ophthalmol  1997; 123(3): 392-5.
[http://dx.doi.org/10.1016/S0002-9394(14)70136-9] [PMID:  9063250] 
[27] 
Ferlucci C, Ghisla MK, Baroni F, et al. Rheumatic disease in geriatry. Giant cell arteritis: case report. Gerontol  2006; 54: 271-5.
[28] 
Barilla-LaBarca ML, Lenschow DJ, Brasington RD Jr. Polymyalgia rheumatica/temporal arteritis: recent advances. Curr Rheumatol Rep  2002; 4(1): 39-46.
[http://dx.doi.org/10.1007/s11926-002-0022-0] [PMID:  11798981] 
[29] 
Klein RG, Hunder GG, Stanson AW, Sheps SG. Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med  1975; 83(6): 806-12.
[http://dx.doi.org/10.7326/0003-4819-83-6-806] [PMID:  1200525] 
[30] 
Evans JM, O’Fallon WM, Hunder GG. Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis. A population-based study. Ann Intern Med  1995; 122(7): 502-7.
[http://dx.doi.org/10.7326/0003-4819-122-7-199504010-00004] [PMID:  7872584] 
[31] 
Weyand CM, Hicok KC, Hunder GG, Goronzy JJ. Tissue cytokine patterns in patients with polymyalgia rheumatica and giant cell arteritis. Ann Intern Med  1994; 121(7): 484-91.
[http://dx.doi.org/10.7326/0003-4819-121-7-199410010-00003] [PMID:  8067646] 
[32] 
Hunder GG. Giant cell arteritis in polymyalgia rheumatica. Am J Med  1997; 102(6): 514-6.
[PMID:  9217664] 
[33] 
Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet  2008; 372(9634): 234-45.
[http://dx.doi.org/10.1016/S0140-6736(08)61077-6] [PMID:  18640460] 
[34] 
Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med  2002; 347(4): 261-71.
[http://dx.doi.org/10.1056/NEJMra011913] [PMID:  12140303] 
[35] 
Rozen TD. Brief sharp stabs of head pain and giant cell arteritis. Headache  2010; 50(9): 1516-9.
[http://dx.doi.org/10.1111/j.1526-4610.2010.01718.x] [PMID:  20561065] 
[36] 
Huston KA, Hunder GG, Lie JT, Kennedy RH, Elveback LR. Temporal arteritis: a 25-year epidemiologic, clinical, and pathologic study. Ann Intern Med  1978; 88(2): 162-7.
[http://dx.doi.org/10.7326/0003-4819-88-2-162] [PMID:  626444] 
[37] 
Evans J, Hunder GG. The implications of recognizing large-vessel involvement in elderly patients with giant cell arteritis. Curr Opin Rheumatol  1997; 9(1): 37-40.
[http://dx.doi.org/10.1097/00002281-199701000-00007] [PMID:  9110132] 
[38] 
Morotti A, Liberini P, Padovani A. Bilateral optic perineuritis as the presenting feature of giant cell eritis.  BMJ Case Reports 2013 . 2013.
[39] 
McDonnell PJ, Moore GW, Miller NR, Hutchins GM, Green WR. Temporal arteritis. A clinicopathologic study. Ophthalmology  1986; 93(4): 518-30.
[http://dx.doi.org/10.1016/S0161-6420(86)33706-0] [PMID:  3703528] 
[40] 
Amor Dorado JC, Barreira Fernández Mdel P, Regueiro Villarin S, González-Gay MA. Manifestaciones audiovestibulares en las vasculitis sistémicas. Acta Otorrinolaringol Esp  2009; 60(6): 432-42.
[http://dx.doi.org/10.1016/j.otorri.2009.01.012] [PMID:  19909720] 
[41] 
Desser EJ. Miosis, trismus, and dysphagia. An unusual presentation of temporal arteritis. Ann Intern Med  1969; 71(5): 961-2.
[http://dx.doi.org/10.7326/0003-4819-71-5-961] [PMID:  5360315] 
[42] 
Cohen MD, Ginsburg WW, Allen GL. Facial swelling and giant cell arteritis. J Rheumatol  1982; 9(2): 325-7.
[PMID:  7097696] 
[43] 
Caselli RJ, Daube JR, Hunder GG, Whisnant JP. Peripheral neuropathic syndromes in giant cell (temporal) arteritis. Neurology  1988; 38(5): 685-9.
[http://dx.doi.org/10.1212/WNL.38.5.685] [PMID:  2834668] 
[44] 
Caselli RJ, Hunder GG, Whisnant JP. Neurologic disease in biopsy-proven giant cell (temporal) arteritis. Neurology  1988; 38(3): 352-9.
[http://dx.doi.org/10.1212/WNL.38.3.352] [PMID:  3347337] 
[45] 
González-Gay MA, Blanco R, Rodríguez-Valverde V, et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis: predictors and response to treatment. Arthritis Rheum  1998; 41(8): 1497-504.
[http://dx.doi.org/10.1002/1529-0131(199808)41:8<1497:AID-ART22>3.0.CO;2-Z] [PMID:  9704651] 
[46] 
Foroozan R, Danesh-Meyer H, Savino PJ, Gamble G, Mekari-Sabbagh ON, Sergott RC. Thrombocytosis in patients with biopsy-proven giant cell arteritis. Ophthalmology  2002; 109(7): 1267-71.
[http://dx.doi.org/10.1016/S0161-6420(02)01076-X] [PMID:  12093648] 
[47] 
Kermani TA, Schmidt J, Crowson CS, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum  2012; 41(6): 866-71.
[http://dx.doi.org/10.1016/j.semarthrit.2011.10.005] [PMID:  22119103] 
[48] 
Elling P, Olsson AT, Elling H. A reduced CD8+ lymphocyte subset distinguishes patients with polymyalgia rheumatica and temporal arteritis from patients with other diseases. Clin Exp Rheumatol  1998; 16(2): 155-60.
[PMID:  9536391] 
[49] 
Weyand CM, Fulbright JW, Hunder GG, Evans JM, Goronzy JJ. Treatment of giant cell arteritis: Interleukin-6 as a biologic marker of disease activity. Arthritis Rheum  2000; 43(5): 1041-8.
[http://dx.doi.org/10.1002/1529-0131(200005)43:5<1041:AID-ANR12>3.0.CO;2-7] [PMID:  10817557] 
[50] 
Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum  1990; 33(8): 1122-8.
[http://dx.doi.org/10.1002/art.1780330810] [PMID:  2202311] 
[51] 
Strady C, Arav E, Strady A, et al. Diagnostic value of clinical signs in giant cell arteritis: Analysis of 415 temporal artery biopsy findings. Ann Med Interne (Paris)  2002; 153(1): 3-12.
[PMID:  11994684] 
[52] 
Prieto-González S, Arguis P, García-Martínez A, et al. Large vessel involvement in biopsy-proven giant cell arteritis: Prospective study in 40 newly diagnosed patients using CT angiography. Ann Rheum Dis  2012; 71(7): 1170-6.
[http://dx.doi.org/10.1136/annrheumdis-2011-200865] [PMID:  22267328] 
[53] 
Mahr A, Saba M, Kambouchner M, et al. Temporal artery biopsy for diagnosing giant cell arteritis: The longer, the better? Ann Rheum Dis  2006; 65(6): 826-8.
[http://dx.doi.org/10.1136/ard.2005.042770] [PMID:  16699053] 
[54] 
Narváez J, Bernad B, Roig-Vilaseca D, et al. Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis. Semin Arthritis Rheum  2007; 37(1): 13-9.
[http://dx.doi.org/10.1016/j.semarthrit.2006.12.005] [PMID:  17360027] 
[55] 
Dany F, Liozon F, Chaumont P, et al. Sensibilité et spécificité du Doppler temporal dans la maladie de Horton. J Mal Vasc  1989; 14(Suppl. C): 104-8.
[PMID:  2696766] 
[56] 
Vinckier L, Hatron PY, Gadenne C, Catteau MH, Gosset D, Devulder B. Intérêt du Doppler artériel dans la maladie de Horton. Etude prospective de 59 observations. J Mal Vasc  1989; 14(Suppl. C): 116-22.
[PMID:  2696768] 
[57] 
Puéchal X, Chauveau M, Menkès CJ. Temporal Doppler-flow studies for suspected giant-cell arteritis. Lancet  1995; 345(8962): 1437-8.
[http://dx.doi.org/10.1016/S0140-6736(95)92626-7] [PMID:  7760625] 
[58] 
Schmidt WA, Kraft HE, Vorpahl K, Völker L, Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med  1997; 337(19): 1336-42.
[http://dx.doi.org/10.1056/NEJM199711063371902] [PMID:  9358127] 
[59] 
Karassa FB, Matsagas MI, Schmidt WA, Ioannidis JP. Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med  2005; 142(5): 359-69.
[http://dx.doi.org/10.7326/0003-4819-142-5-200503010-00011] [PMID:  15738455] 
[60] 
Bley TA, Wieben O, Uhl M, Thiel J, Schmidt D, Langer M. High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. AJR Am J Roentgenol  2005; 184(1): 283-7.
[http://dx.doi.org/10.2214/ajr.184.1.01840283] [PMID:  15615989] 
[61] 
Besson FL, Parienti JJ, Bienvenu B, et al. Diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging  2011; 38(9): 1764-72.
[http://dx.doi.org/10.1007/s00259-011-1830-0] [PMID:  21559981] 
[62] 
Rana AQ, Saeed U, Khan OA. 1 Abdul Rehman M. Qureshi, and Dion Paul Giant cell arteritis or ten-sion-type headache?: A differential diagnostic dilemma. J Neurosci Rural Pract  2014; 5(4): 409-11.
[http://dx.doi.org/10.4103/0976-3147.140005] [PMID:  25288850] 
[63] 
Bhatti MT, Tabandeh H. Giant cell arteritis: diagnosis and management. Curr Opin Ophthalmol  2001; 12(6): 393-9.
[http://dx.doi.org/10.1097/00055735-200112000-00003] [PMID:  11734678] 
[64] 
Ferraccioli GF, Di Poi E, Damato R. Steroid sparing therapeutic approaches to polymyalgia rheumatica-giant cell arteritis. State of the art and perspectives. Clin Exp Rheumatol  2000; 18(4)(Suppl. 20): S58-60.
[PMID:  10948766] 
[65] 
Foroozan R, Deramo VA, Buono LM, et al. Recovery of visual function in patients with biopsy-proven giant cell arteritis. Ophthalmology  2003; 110(3): 539-42.
[http://dx.doi.org/10.1016/S0161-6420(02)01775-X] [PMID:  12623817] 
[66] 
Hunder GG, Sheps SG, Allen GL, Joyce JW. Daily and alternate-day corticosteroid regimens in treatment of giant cell arteritis: comparison in a prospective study. Ann Intern Med  1975; 82(5): 613-8.
[http://dx.doi.org/10.7326/0003-4819-82-5-613] [PMID:  1137255] 
[67] 
Nesher G, Rubinow A, Sonnenblick M. Efficacy and adverse effects of different corticosteroid dose regimens in temporal arteritis: a retrospective study. Clin Exp Rheumatol  1997; 15(3): 303-6.
[PMID:  9177927] 
[68] 
Chevalet P, Barrier JH, Pottier P, et al. A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a one year followup study of 164 patients. J Rheumatol  2000; 27(6): 1484-91.
[PMID:  10852275] 
[69] 
Blumberg S, Giansiracusa DF, Docken WP, Kantrowitz FG. Recurrence of temporal arteritis. Clinical recurrence nine years after initial illness. JAMA  1980; 244(15): 1713.
[http://dx.doi.org/10.1001/jama.1980.03310150049032] [PMID:  7411831] 
[70] 
Kyle V. Treatment of polymyalgia rheumatica/giant cell arteritis. Baillieres Clin Rheumatol  991(5): 485-91.
[PMID:  1807823] 
[71] 
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): 318-23.
[http://dx.doi.org/10.1136/ard.2008.088351] [PMID:  18413441] 
[72] 
Hellmann DB. Low-dose aspirin in the treatment of giant cell arteritis. Arthritis Rheum  2004; 50(4): 1026-7.
[http://dx.doi.org/10.1002/art.20172] [PMID:  15077284] 
[73] 
Caporali R, Cimmino MA, Ferraccioli G, et al. Systemic vasculitis study group of the Italian Society for Rheumatology. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med  2004; 141(7): 493-500.
[http://dx.doi.org/10.7326/0003-4819-141-7-200410050-00005] [PMID:  15466766] 
[74] 
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): 625-30.
[http://dx.doi.org/10.1136/ard.2007.082115] [PMID:  18086726] 
[75] 
Salvarani C, Cantini F, Niccoli L, et al. Treatment of refractory polymyalgia rheumatica with infliximab: a pilot study. J Rheumatol  2003; 30(4): 760-3.
[PMID:  12672196] 
[76] 
Nesher G, Sonnenblick M. Steroid-sparing medications in temporal arteritis--report of three cases and review of 174 reported patients. Clin Rheumatol  1994; 13(2): 289-92.
[PMID:  8088076] 
[77] 
De Silva M, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study. Ann Rheum Dis  1986; 45(2): 136-8.
[http://dx.doi.org/10.1136/ard.45.2.136] [PMID:  3511861] 
[78] 
Nuenninghoff DM, Matteson EL. The role of disease-modifying antirheumatic drugs in the treatment of giant cell arteritis. Clin Exp Rheumatol  2003; 21(6)(Suppl. 32): S29-34.
[PMID:  14740425] 
[79] 
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): 621-30.
[http://dx.doi.org/10.7326/0003-4819-146-9-200705010-00004] [PMID:  17470830] 
[80] 
Langford CA, Cuthbertson D, Ytterberg SR, et al. Vasculitis Clinical Research Consortium. A randomized, double-blind trial of abatacept (CTLA4-IG) for the treatment of giant cell arteritis. Arthritis Rheumatol  2017; 69(4): 837-45.
[http://dx.doi.org/10.1002/art.40044] [PMID:  28133925] 
[81] 
Stone JH, Tuckwell K, Dimonaco S, et al. Trial of tocilizumab in giant-cell arteritis. N Engl J Med  2017; 377(4): 317-28.
[http://dx.doi.org/10.1056/NEJMoa1613849] [PMID:  28745999] 
[82] 
Spiera R, Spiera H. Inflammatory disease in older adults. Cranial arteritis. Geriatrics  2004; 59(12): 25-9.
[PMID:  15667019] 
[83] 
Danesh-Meyer H. Giant cell arteritis: managing the ophthalmic medical emergency. Clin Exp Ophthalmol  2003; 31(3): 173-5.
[http://dx.doi.org/10.1046/j.1442-9071.2003.00657.x] [PMID:  12786764] 
[84] 
Hachulla E, Boivin V, Pasturel-Michon U, et al. Prognostic factors and long-term evolution in a cohort of 133 patients with giant cell arteritis. Clin Exp Rheumatol  2001; 19(2): 171-6.
[PMID: 11326479] 
Cite As
Current Rheumatology Reviews

Giant Cell Arteritis (GCA): Pathogenesis, Clinical Aspects and Treatment Approaches

Abstract

Graphical Abstract
