Giant cell arteritis: a systemic vascular disease

Abstract

Giant cell arterits (GCA) is increasingly being recognized as a systemic vascular disease, not confined to the cranial arteries. Epidemiological studies have shown that almost one-third of the patients with GCA develop serious peripheral vascular complications during long-term follow up, and there is growing evidence that unrecognized extracranial involvement may be even more common. GCA of large- and medium-sized peripheral arteries typically leads to long tapering and occlusion of the arterial lumen due to concentric intimal thickening, sometimes accompanied by spontaneous dissection. Depending on the extent of the arterial obliteration and on the anatomy of the involved arterial segment, this may result in severe ischemia of the limbs during the acute phase of the disease. GCA of the aorta usually remains asymptomatic for many years, and leads to a markedly increased risk of aneurysms and dissections, particularly of the thoracic aorta. Evolving vascular imaging techniques such as duplex ultrasound, computer tomography (CT), magnetic resonance imaging (MRI), and fluorine-18-desoxyglucose positron emission tomography (18F-FDG-PET) have greatly improved our ability to detect and study arterial changes in large-artery vasculitis. Boosted by these advances in vascular imaging, vascular specialists are increasingly involved in the early diagnosis, follow-up and treatment of patients with large-vessel vasculitis.

Keywords

duplex sonography extracranial involvement fluorine-18-desoxyglucose positron emission tomography giant cell arteritis large-vessel vasculitis magnetic resonance imaging

References

1 Salvarani C Cantini F Boiardi L Hunder GG . Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 2002; 347: 261 – 271 .

2 Weyand CM Goronzy JJ . Giant-cell arteritis and polymyalgia rheumatica. Ann Intern Med 2003; 139: 505 – 515 .

3 Lawrence RC Helmick CG Arnett FC . Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41: 778 – 799 .

4 Noltorp S Svensson B . High incidence of polymyalgia rheumatica and giant cell arteritis in a Swedish community. Clin Exp Rheumatol 1991; 9: 351 – 355 .

5 Franzén P Sutinen S von Knorrig J . Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984–1988. J Rheumatol 1992; 19: 273 – 276 .

6 Hunder GG . The early history of giant cell arteritis and polymyalgia rheumatica: first description to 1970. Mayo Clin Proc 2006; 81: 1071 – 1083 .

7 Hunder GG Ward LM Burbank MK . Giant-cell arteritis producing an aortic arch syndrome. Ann Intern Med 1967; 66: 578 – 582 .

8 Klein RG Hunder GG Stanson AW Sheps SG . Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med 1975; 83: 806 – 812 .

9 Perruquet JL Davis DE Harrington TM . Aortic arch arteritis in the elderly. Arch Intern Med 1986; 146: 289 – 291 .

10.

10 Neunninghoff DM Hunder GG Christianson TJH McClelland RL Matteson EL . Incidence and predictors of large-artery complications (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. Arthritis Rheum 2003; 48: 3522 – 3531 .

11.

11 Weyand CM Goronzy JJ . Medium- and large-vessel vasculitis. N Engl J Med 2003; 349: 160 – 169 .

12.

12 Barack A Martinez-Taboada V Stanson A Goronzy JJ Weyand CM . Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum 1999; 42: 311 – 317 .

13.

13 Arend WP Michel BA Bloch DA . The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990; 33: 1129 – 1134 .

14.

14 Kerr GS Hallahan CW Giordano J . Takayasu arteritis. Ann Intern Med 1994; 120: 919 – 929 .

15.

15 Michel BA Arend WP Hunder GG . Clinical differentiation between giant cell (temporal) arteritis and Takayasu’s arteritis. J Rheumatol 1996; 23: 106 – 111 .

16.

16 Lie JT . Aortic and extracranial large vessel giant cell arteritis: a review of 72 cases with histopathological documentation. Semin Arthritis Rheum 1995; 24: 422 – 431 .

17.

17 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: 502 – 507 .

18.

18 Evans JM Bowles CA Bjornsson J Mullany CJ Hunder GG . Thoracic aortic aneurysm and rupture in giant cell arteritis: a descriptive study of 41 cases. Arthritis Rheum 1994; 37: 1539 – 1547 .

19.

19 Bongartz T Matteson EL . Large-vessel involvement in giant cell arteritis. Curr Opin Rheumatol 2006; 18: 10 – 17 .

20.

20 O’Brien PK Pudden AJ . Peripheral arterial insufficiency due to giant cell arteritis. Can J Surg 1978; 21: 441 – 442 .

21.

21 Garcia Vasquez JM Carreira JM Seoane C Vidal JJ . Superior and inferior limb ischemia in giant cell arteritis: angiography follow-up. Clin Rheumatol 1999; 18: 61 – 65 .

22.

22 Le Hello C Levesque H Jeanton M . Lower limb giant cell arteritis and temporal arteritis: follow-up of 8 cases. J Rheumatol 2001; 28: 1407 – 1412 .

23.

23 Tatò F Hoffmann U . Clinical presentation and vascular imaging in giant cell arteritis of the femoro-popliteal and tibio-peroneal arteries. J Vasc Surg 2006; 44: 176 – 182 .

24.

24 Weyand CM Wagner AD Bojornsson 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: 1642 – 1649 .

25.

25 Rodríguez-Pla A Bosch-Gil JA Rosselló-Urgell J Huguet-Redecilla H Stone JH Vilardell-Tarres M . Metalloproteinase-2 and -9 in giant cell arteritis. Involvement in vascular remodeling. Circulation 2005; 112: 264 – 269 .

26.

26 Kaiser M Weyand CM Bjornsson J Goronzy JJ . Platelet-derived growth factor, intimal hyperplasia, and ischemic complications in giant cell arteritis. Arthritis Rheum 1998; 41: 623 – 633 .

27.

27 Kaiser M Younge B Bjornsson J Goronzy JJ Weyand CM . Formation of new vasa vasorum in vasculitis: production of angiogenetic cytokines by multinucleated giant cells. Am J Pathol 1999; 155: 765 – 774 .

28.

28 Gabriel SE O’Fallon WM Achkar AA Lie JT Hunder GG . The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis. J Rheumatol 1995; 22: 93 – 96 .

29.

29 Salvarani C Silingardi M Ghirarduzzi A . Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis? Ann Intern Med 2002; 137: 231 – 238 .

30.

30 Lederle FA Simel DL . Does this patient have abdominal aortic aneurysm? JAMA 1999; 281: 77 – 82 .

31.

31 Hunder GG Bloch DA Michel BA . The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990; 33: 1122 – 1128 .

32.

32 Salvarani C Hunder GG . Giant cell arteritis with low erythrocyte sedimentation rate: frequency of occurrence in a population based study. Arthritis Rheum 2001; 45: 140 – 145 .

33.

33 Hayreh SS Podhajsky PA Raman R Zimmerman B . Giant cell arteritis: validity and reliability of various diagnostic criteria. Am J Ophthalmol 1997; 123: 285 – 296 .

34.

34 Parikh M Miller NR Lee AG . Prevalence of a normal C-reactive protein with an elevated erythrocyte sedimentation rate in biopsy-proven giant cell arteritis. Ophthalmology 2006; 113: 1842 – 1845 .

35.

35 Salvarani C Cantini F Boiardi L Hunder GG . Laboratory investigations useful in giant cell arteritis and Takayasu’s arteritis. Clin Exp Rheumatol 2003; 21(suppl 32): S23 – S28 .

36.

36 Weyand C 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: 1041 – 1048 .

37.

37 Schmidt WA Kraft HE Vorpahl K Volker L Gromnika-Ihle EJ . Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 1997; 337: 1336 – 1342 .

38.

38 Schmidt WA Gromnica-Ihle E . Duplex ultrasonography in temporal arteritis. Ann Intern Med 2003; 138: 609 .

39.

39 Karassa FB Matsagas MI Schmidt WA Ioannidis JPA . Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med 2005; 142: 359 – 369 .

40.

40 Schmidt WA Kraft HE Borkowski A Gromnika-Ihle EJ . Color duplex ultrasonography in large-vessel giant cell arteritis. Scand J Rheumatol 1999; 28: 374 – 376 .

41.

41 Schmidt WA Natusch A Moeller DE Vorpahl K Gromnika-Ihle EJ . Involvement of peripheral arteries in giant cell arteritis: a color Doppler sonography study. Clin Exp Rheumatol 2002; 20: 309 – 318 .

42.

42 Reinhard M Schmidt D Schumacher M Hetzel A . Involvement of the vertebral arteries in giant cell arteritis mimicking vertebral dissection. J Neurol 2003; 250: 1006 – 1009 .

43.

43 Kolossvary E Kollar A Pinter H . Bilateral axillobrachial and external carotid artery manifestation of giant cell arteritis: important role of color duplex ultrasonography in the diagnosis. Int Angiol 2005; 24: 202 – 205 .

44.

44 Schmidt WA Blockmans D . Use of ultrasonography and positron emission tomography in the diagnosis and assessment of large-vessel vasculitis. Curr Opin Rheumatol 2005; 17: 9 – 15 .

45.

45 Park JH Chung JW Im JG Kim SK Park YB Han MC . Takayasu arteritis: evaluation of mural changes in the aorta and pulmonary artery with CT angiography. Radiology 1995; 196: 89 – 93 .

46.

46 Yamada I Nakagawa T Himeno Y Numano F Shibuya H . Takayasu arteritis: evaluation of the thoracic aorta with CT angiography. Radiology 1998; 209: 103 – 109 .

47.

47 Yoshida S Akiba H Tamakawa M . The spectrum of findings in supra-aortic Takayasu’s arteritis as seen on spiral CT angiography and digital subtraction angiography. Cardiovasc Intervent Radiol 2001; 24: 117 – 121 .

48.

48 Choe YH Han BK Koh EM Kim DK Do YS Lee WR . Takayasu’s arteritis: assessment of disease activity with contrast-enhanced MR imaging. AJR Am J Roentgenol 2000; 175: 505 – 511 .

49.

49 Tso E Flamm SD White RD Schwartzman PR Mascha E Hoffman GS . Takayasu arteritis. Utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum 2002; 46: 1634 – 1642 .

50.

50 Meller J Grabbe E Becker W Vosshenrich R . Value of F-18 FDG hybrid camera PET and MRI in early Takayasu aortitis. Eur Radiol 2003; 13: 400 – 405 .

51.

51 Desai MY Stone JH Foo TK Hellmann DB Lima JAC Bluemke DA . Delayed contrast-enhanced MRI of the aortic wall in Takayasu’s arteritis: initial experience. Am J Radiol 2005; 184: 1427 – 1431 .

52.

52 Narvaez J Narvaez JA Nolla JM Sirvent E Reina D Valverde J . Giant cell arteritis and polymyalgia rheumatica: usefulness of vascular magnetic resonance imaging studies in the diagnosis of aortitis. Rheumatology 2005; 44: 479 – 483 .

53.

53 Markl M Uhl M Wieben O . High resolution 3T MRI for the assessment of cervical and superficial cranial arteries in giant cell arteritis. J Magn Reson Imaging 2006; 24: 423 – 427 .

54.

54 Aluquin VP Albano SA Chan F . Magnetic resonance imaging in the diagnosis and follow up of Takayasu’s arteritis in children. Ann Rheum Dis 2002; 46: 1634 – 1642 .

55.

55 Bley TA Ness T Warnatz K . Influence of corticosteroid treatment on MRI findings in giant cell arteritis. Clin Rheumatol 2007; 26: 1541 – 1543 .

56.

56 Stanson AW Klein RG Hunder GG . Extracranial angiographic findings in giant cell (temporal) arteritis. AJR Am J Roentgenol 1976; 127: 957 – 963 .

57.

57 Slovut DP Olin JW . Fibromuscular dysplasia. N Engl J Med 2004; 350: 1862 – 1871 .

58.

58 Blockmans D Knockaert D Maes A . Clinical value of [18F]fluoro-deoxyglucose positron emission tomography for patients with fever of unknown origin. Clin Infect Dis 2001; 32: 191 – 196 .

59.

59 Turlakow A Yeung HWD Pui J . Fludeoxyglucose positron emission tomography in the diagnosis of giant cell arteritis. Arch Intern Med 2001; 161: 1003 – 1007 .

60.

60 Belhocine T Blockmans D Hustinx R Vandevivere J Mortelmans L . Imaging of large vessel vasculitis with 18FDG PET: illusion or reality? A critical review of the literature data. Eur J Nucl Med Mol Imaging 2003; 30: 1305 – 1313 .

61.

61 Webb M Chambers A Al-Nahhas A . The role of 18F-FDG PET in characterising disease activity in Takayasu arteritis. Eur J Nucl Med Mol Imaging 2004; 31: 627 – 634 .

62.

62 Brodmann M Lipp RW Passath A Seinost G Pabst E Pilger E . The role of 2-18F-fluoro-D-glucose positron emission tomography in the diagnosis of giant cell arteritis of the temporal arteries. Rheumatology 2004; 43: 241 – 242 .

63.

63 Blockmans D De Ceuninck L Vanderschuren S Knockaert D Mortelmans L Bobbaers H . Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 2006; 55: 131 – 137 .

64.

64 Knockaert DC Vanderschueren S Blockmans D . Fever of unknown origin in adults: 40 years on. J Intern Med 2003; 253: 263 – 275 .

65.

65 Meller J Strutz F Scheel A . Early diagnosis and follow-up of aortitis with 18F-FDG PET and MRI. Eur J Nucl Med Mol Imaging 2003; 30: 730 – 736 .

66.

66 Tatò F Weiss M Hoffmann U . [Takayasu’s arteritis without manifest arterial stenoses as a cause of fever of unknown origin.] Dtsch Med Wochenschr 2006; 131: 1727 – 1730 .

67.

67 Blockmans D Stroobants S Maes A Mortelmans L . Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 2000; 108: 246 – 249 .

68.

68 Yun M Yeh D Arujo LI Jang S Newberg A Alavi A . F-18 FDG uptake in the large arteries. A new observation. Clin Nucl Med 2001; 26: 314 – 319 .

69.

69 Lederman RJ Raylman RR Fisher SJ . Detection of atherosclerosis using a novel positron-sensitive probe and 18-fluorodeoxyglucose (FDG). Nucl Med Commun 2001; 22: 747 – 753 .

70.

70 Mazlumzadeh M Hunder GG Easley KA . Treatment of giant cell arteritis using induction therapy with high-dose glucocorticoids: a double-blind, placebo-controled, randomized, prospective clinical trial. Arthritis Rheum 2006; 54: 3071 – 3074 .

71.

71 Chan CC Paine M O’Day J . Steroid management in giant cell arteritis. Br J Ophthalmol 2001; 85: 1061 – 1064 .

72.

72 Hayreh SS Zimmerman B . Management of giant cell arteritis. Our 27-year clinical study: new light in old controversies. Ophthalmologica 2003; 217: 239 – 259 .

73.

73 Spiera RF Mitnick HJ Kupersmith M . A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol 2001; 19: 495 – 501 .

74.

74 Hoffman GS Cid MC Hellmann DB . for the International Network for the Study of Systemic Vasculitides (INSSYS). A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum 2002; 46: 1309 – 1318 .

75.

75 Jover JA Hernandez-Garcia C Morado IC Vargas E Banares A Fernandez-Gutierrez B . Combined treatment of giant cell arteritis with methotrexate and prednisone. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001; 134: 106 – 114 .

76.

76 Hoffman GS Merkel PA Brasington RD Lenschow DJ Liang P . Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum 2004; 50: 2296 – 2304 .

77.

77 Tatò F Rieger J Hoffmann U . Refractory Takayasu’s arteriitis successfully treated with the human, monoclonal anti-tumor necrosis factor antibody adalimumab. Int Angiol 2005; 24: 304 – 307 .

78.

78 Hoffman GS Cid MC Rendt-Zagar KE . Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis. Ann Intern Med 2007; 146: 621 – 630 .

79.

79 Nesher G Berkun Y Mates M Baras M Rubinow A Sonnenblick M . Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum 2004; 50: 1332 – 1337 .

80.

80 Lee MS Smith SD Galor A Hoffman GS . Antiplatelet and anticoagulant therapy in patients with giant cell arteritis. Arthritis Rheum 2006; 54: 3306 – 3309 .

81.

81 Weyand CM Kaiser M Yang H Younge B Goronzy JJ . Therapeutic effects of acetylsalicylic acid in giant cell arteritis. Arthritis Rheum 2002; 46: 457 – 466 .

82.

82 Liang P Hoffman GS . Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol 2005; 17: 16 – 24 .

83.

83 Fava MP Foradori GB Garcia CB . Percutaneous transluminal angioplasty in patients with Takayasu arteritis: five year experience. J Vasc Intervent Radiol 1993; 4: 649 – 652 .

84.

84 Both M Aries PM Muller-Hulsbeck S . Balloon angioplasty of arteries of the upper extremities in patients with extracranial giant-cell arteritis. Ann Rheum Dis 2006; 65: 1124 – 1130 .

85.

85 AbuRahma AF Thaxton L . Temporal arteritis: diagnostic and therapeutic considerations. Am Surg 1996; 62: 449 – 451 .

86.

86 Soury P Brisset D Saliou C . Arterial lesions of the upper limbs in horton disease. Surgical revascularization by bilateral carotid-humeral bypass. Presse Med 1997; 26: 1478 – 1480 .