Giant cell arteritis

Giant cell arteritis (GCA) is probably the commonest type of large-vessel vasculitis seen in the United States (with a possible involvement of medium-sized vessels as well). The exact etiopathogenesis of GCA is still not fully understood. Clinical manifestations of GCA can be vast and confusing. Up to 22.5% patients may have a ‘normal’ erythrocyte sedimentation rate (ESR) before treatment. Early detection (with a high index of suspicion) with early initiation of treatment can be ‘sight as well as life saving’. Treatment should not be delayed until the results of a temporal artery biopsy are obtained. Newer radiographic techniques including color-Doppler ultrasonography and contrast enhanced 3T MRA may facilitate/increase the yield; and may even obviate the need for a temporal artery biopsy (especially because temporal artery biopsy can be ‘read as negative’ in a significant proportion of cases). Some recent advances in genetics, pathophysiology, treatment and outcome are also reviewed in this article.