Large vessel vasculitides

Giant cell arteritis (GCA) and Takayasu's arteritis (TA) are the two primary large vessel vasculitides. They are idiopathic systemic inflammatory conditions characterized by granulomatous inflammation of large and medium-sized arteries. TA affects a younger age group, predominantly involves the aorta and its main branches, and tends to be a two-phase disease with inflammatory and occlusive stages. In contrast, GCA affects an older age group and classically involves the temporal and other cranial arteries, although it can affect the aorta and its primary branches (large vessel GCA). Constitutional symptoms are a feature of both diseases, and vascular symptoms depend on the pattern of arterial involvement. Temporal artery biopsy and angiography remain the gold standards for diagnosis of GCA and TA, respectively. New imaging modalities are challenging this practice and have the potential to allow early diagnosis and monitoring of disease activity. Treatment has seen major advances over the last decade. With the advent of vigorous immunosuppressive therapy, new biological therapies and intervention with percutaneous transluminal angioplasty supported by stenting, the prognosis of patients with large vessel vasculitis seems likely to improve.