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Giant Cell Arteritis: Practical Pearls and Updates

  • Secondary Headache (M Robbins, Section Editor)
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Abstract

Purpose of Review

The purpose of this review is to summarize recent updates and distill practical points from the literature which can be applied to the care of patients with suspected and confirmed giant cell arteritis (GCA).

Recent Findings

Contemporary thinking implicates a fundamental failure of T regulatory cell function in GCA pathophysiology, representing opportunity for novel therapeutic avenues. Tocilizumab has become the first Food and Drug Administration-approved treatment for GCA following demonstration of efficacy and safety in a phase 3 clinical trial.

Summary

There have been significant parallel advances in both our understanding of GCA pathophysiology and treatment. Tocilizumab, and other agents currently under investigation in phase 2 and 3 clinical trials, presents a new horizon of hope for both disease remission and avoidance of glucocorticoid-related complications.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Smith JH, Swanson JW. Giant cell arteritis. Headache. 2014;54(8):1273–89. https://doi.org/10.1111/head.12425.

    Article  PubMed  Google Scholar 

  2. Salvarani C, Gabriel SE, O’Fallon WM, Hunder GG. The incidence of giant cell arteritis in Olmsted County, Minnesota: apparent fluctuations in a cyclic pattern. Ann Intern Med. 1995;123(3):192–4. https://doi.org/10.7326/0003-4819-123-3-199508010-00006.

    Article  CAS  PubMed  Google Scholar 

  3. Aiello PD, Trautmann JC, McPhee TJ, Kunselman AR, Hunder GG. Visual prognosis in giant cell arteritis. Ophthalmology. 1993;100(4):550–5. https://doi.org/10.1016/S0161-6420(93)31608-8.

    Article  CAS  PubMed  Google Scholar 

  4. Hill CL, Black RJ, Nossent JC, Ruediger C, Nguyen L, Ninan JV, et al. Risk of mortality in patients with giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2017;46(4):513–9. https://doi.org/10.1016/j.semarthrit.2016.08.015.

    Article  PubMed  Google Scholar 

  5. Hunder GG, Bloch DA, Michel BA, Stevens MB, Arend WP, Calabrese LH, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990;33(8):1122–8.

    Article  CAS  PubMed  Google Scholar 

  6. Ma-Krupa W, Jeon MS, Spoerl S, Tedder TF, Goronzy JJ, Weyand CM. Activation of arterial wall dendritic cells and breakdown of self-tolerance in giant cell arteritis. J Exp Med. 2004;199(2):173–83. https://doi.org/10.1084/jem.20030850.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Watanabe R, Hosgur E, Zhang H, Wen Z, Berry G, Goronzy JJ, et al. Pro-inflammatory and anti-inflammatory T cells in giant cell arteritis. Joint Bone Spine. 2017;84(4):421–6. https://doi.org/10.1016/j.jbspin.2016.07.005.

    Article  CAS  PubMed  Google Scholar 

  8. •• Wen Z, Shimojima Y, Shirai T, Li Y, Ju J, Yang Z, et al. NADPH oxidase deficiency underlies dysfunction of aged CD8+ Tregs. J Clin Invest. 2016;126(5):1953–1967. CD8+ T regulatory cells appear to be deficient in patients with GCA, independent of treatment, potentially allowing for observed CD4+ T cell hyperimmunity. https://doi.org/10.1172/JCI84181.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Miyabe C, Miyabe Y, Strle K, Kim ND, Stone JH, Luster AD, et al. An expanded population of pathogenic regulatory T cells in giant cell arteritis is abrogated by IL-6 blockade therapy. Ann Rheum Dis. 2017;76(5):898–905. https://doi.org/10.1136/annrheumdis-2016-210070.

    Article  PubMed  Google Scholar 

  10. Weyand CM, Younge BR, Goronzy JJ. IFN-gamma and IL-17: the two faces of T-cell pathology in giant cell arteritis. Curr Opin Rheumatol. 2011;23(1):43–9. https://doi.org/10.1097/BOR.0b013e32833ee946.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Samson M, Corbera-Bellalta M, Audia S, Planas-Rigol E, Martin L, Cid MC, et al. Recent advances in our understanding of giant cell arteritis pathogenesis. Autoimmun Rev. 2017;16(8):833–44. https://doi.org/10.1016/j.autrev.2017.05.014.

    Article  CAS  PubMed  Google Scholar 

  12. Watad A, Bragazzi NL, Adawi M, Amital H, Toubi E, Porat BS, et al. Autoimmunity in the elderly: insights from basic science and clinics—a mini-review. Gerontology. 2017;63(6):515–23. https://doi.org/10.1159/000478012.

    Article  CAS  PubMed  Google Scholar 

  13. Lee HY, Oh BH. Aging and arterial stiffness. Circ J. 2010;74(11):2257–62. https://doi.org/10.1253/circj.CJ-10-0910.

    Article  PubMed  Google Scholar 

  14. Wang M, Monticone RE, Lakatta EG. Arterial aging: a journey into subclinical arterial disease. Curr Opin Nephrol Hypertens. 2010;19(2):201–7. https://doi.org/10.1097/MNH.0b013e3283361c0b.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Carmona FD, Vaglio A, Mackie SL, Hernández-Rodríguez J, Monach PA, Castañeda S, et al. A genome-wide association study identifies risk alleles in plasminogen and P4HA2 associated with giant cell arteritis. Am J Hum Genet. 2017;100(1):64–74. https://doi.org/10.1016/j.ajhg.2016.11.013.

    Article  CAS  PubMed  Google Scholar 

  16. Gilden D, Nagel MA. Varicella zoster virus triggers the immunopathology of giant cell arteritis. Curr Opin Rheumatol. 2016;28(4):376–82. https://doi.org/10.1097/BOR.0000000000000292.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Prior JA, Ranjbar H, Belcher J, Mackie SL, Helliwell T, Liddle J, et al. Diagnostic delay for giant cell arteritis—a systematic review and meta-analysis. BMC Med. 2017;15(1):120. https://doi.org/10.1186/s12916-017-0871-z.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Caselli RJ, Hunder GG, Whisnant JP. Neurologic disease in biopsy-proven giant cell (temporal) arteritis. Neurology. 1988;38(3):352–9. https://doi.org/10.1212/WNL.38.3.352.

    Article  CAS  PubMed  Google Scholar 

  19. Jimenez-Jimenez FJ, Garcia-Albea E, Zurdo M, Martinez-Onsurbe P, Ruiz de Villaespesa A. Giant cell arteritis presenting as cluster headache. Neurology. 1998;51(6):1767–8. https://doi.org/10.1212/WNL.51.6.1767.

    Article  CAS  PubMed  Google Scholar 

  20. Rozen TD. Brief sharp stabs of head pain and giant cell arteritis. Headache. 2010;50(9):1516–9. https://doi.org/10.1111/j.1526-4610.2010.01718.x.

    Article  PubMed  Google Scholar 

  21. Solomon S, Cappa KG. The headache of temporal arteritis. J Am Geriatr Soc. 1987;35(2):163–5. https://doi.org/10.1111/j.1532-5415.1987.tb01348.x.

    Article  CAS  PubMed  Google Scholar 

  22. Smetana GW, Shmerling RH. Does this patient have temporal arteritis? JAMA. 2002;287(1):92–101. https://doi.org/10.1001/jama.287.1.92.

    Article  PubMed  Google Scholar 

  23. Miller NR. Visual manifestations of temporal arteritis. Rheum Dis Clin N Am. 2001;27(4):781–797, vi. https://doi.org/10.1016/S0889-857X(05)70235-0.

    Article  CAS  Google Scholar 

  24. Gonzalez-Gay MA, Vazquez-Rodriguez TR, Gomez-Acebo I, Pego-Reigosa R, Lopez-Diaz MJ, Vazquez-Triñanes MC, et al. Strokes at time of disease diagnosis in a series of 287 patients with biopsy-proven giant cell arteritis. Medicine (Baltimore). 2009;88(4):227–35. https://doi.org/10.1097/MD.0b013e3181af4518.

    Article  Google Scholar 

  25. Wilkinson IM, Russell RW. Arteries of the head and neck in giant cell arteritis. A pathological study to show the pattern of arterial involvement. Arch Neurol. 1972;27(5):378–91. https://doi.org/10.1001/archneur.1972.00490170010003.

    Article  CAS  PubMed  Google Scholar 

  26. Ungprasert P, Wijarnpreecha K, Koster MJ, Thongprayoon C, Warrington KJ. Cerebrovascular accident in patients with giant cell arteritis: a systematic review and meta-analysis of cohort studies. Semin Arthritis Rheum. 2016;46(3):361–6. https://doi.org/10.1016/j.semarthrit.2016.07.005.

    Article  PubMed  Google Scholar 

  27. Pascuzzi RM, Roos KL, Davis TE Jr. Mental status abnormalities in temporal arteritis: a treatable cause of dementia in the elderly. Arthritis Rheum. 1989;32(10):1308–11. https://doi.org/10.1002/anr.1780321017.

    Article  CAS  PubMed  Google Scholar 

  28. Schon F. Involvement of smell and taste in giant cell arteritis. J Neurol Neurosurg Psychiatry. 1988;51(12):1594. https://doi.org/10.1136/jnnp.51.12.1594.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Dimant J, Grob D, Brunner NG. Ophthalmoplegia, ptosis, and miosis in temporal arteritis. Neurology. 1980;30(10):1054–8. https://doi.org/10.1212/WNL.30.10.1054.

    Article  CAS  PubMed  Google Scholar 

  30. Jay WM, Nazarian SM. Bilateral sixth nerve pareses with temporal arteritis and diabetes. J Clin Neuroophthalmol. 1986;6(2):91–5.

    CAS  PubMed  Google Scholar 

  31. Tamhankar MA, Biousse V, Ying GS, Prasad S, Subramanian PS, Lee MS, et al. Isolated third, fourth, and sixth cranial nerve palsies from presumed microvascular versus other causes: a prospective study. Ophthalmology. 2013;120(11):2264–9. https://doi.org/10.1016/j.ophtha.2013.04.009.

    Article  PubMed  Google Scholar 

  32. Roomet A, Allen JS. Temporal arteritis heralded by facial nerve palsy. JAMA. 1974;228(7):870–1. https://doi.org/10.1001/jama.1974.03230320040027.

    Article  CAS  PubMed  Google Scholar 

  33. Healey LA, Wilske KR. Presentation of occult giant cell arteritis. Arthritis Rheum. 1980;23(6):641–3. https://doi.org/10.1002/art.1780230605.

    Article  CAS  PubMed  Google Scholar 

  34. Calamia KT, Hunder GG. Giant cell arteritis (temporal arteritis) presenting as fever of undetermined origin. Arthritis Rheum. 1981;24(11):1414–8. https://doi.org/10.1002/art.1780241113.

    Article  CAS  PubMed  Google Scholar 

  35. Nuenninghoff DM, Hunder GG, Christianson TJ, McClelland RL, Matteson EL. Incidence and predictors of large-artery complication (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(12):3522–31. https://doi.org/10.1002/art.11353.

    Article  PubMed  Google Scholar 

  36. Garcia-Martinez A, Hernandez-Rodriguez J, Arguis P, et al. Development of aortic aneurysm/dilatation during the followup of patients with giant cell arteritis: a cross-sectional screening of fifty-four prospectively followed patients. Arthritis Rheum. 2008;59(3):422–30. https://doi.org/10.1002/art.23315.

    Article  CAS  PubMed  Google Scholar 

  37. Gonzalez-Gay MA, Garcia-Porrua C, Pineiro A, Pego-Reigosa R, Llorca J, Hunder GG. Aortic aneurysm and dissection in patients with biopsy-proven giant cell arteritis from northwestern Spain: a population-based study. Medicine (Baltimore). 2004;83(6):335–41. https://doi.org/10.1097/01.md.0000145366.40805.f8.

    Article  Google Scholar 

  38. Prieto-Gonzalez S, Arguis P, Garcia-Martinez 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. https://doi.org/10.1136/annrheumdis-2011-200865.

    Article  PubMed  Google Scholar 

  39. Grayson PC, Maksimowicz-McKinnon K, Clark TM, Tomasson G, Cuthbertson D, Carette S, et al. Distribution of arterial lesions in Takayasu’s arteritis and giant cell arteritis. Ann Rheum Dis. 2012;71(8):1329–34. https://doi.org/10.1136/annrheumdis-2011-200795.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Myklebust G, Gran JT. A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. Br J Rheumatol. 1996;35(11):1161–8.

    Article  CAS  PubMed  Google Scholar 

  41. Grayson PC, Tomasson G, Cuthbertson D, et al. Association of vascular physical examination findings and arteriographic lesions in large vessel vasculitis. J Rheumatol. 2012;39(2):303–9. https://doi.org/10.3899/jrheum.110652.

    Article  PubMed  Google Scholar 

  42. Tsianakas A, Ehrchen JM, Presser D, Fischer T, Kruse-Loesler B, Luger TA, et al. Scalp necrosis in giant cell arteritis: case report and review of the relevance of this cutaneous sign of large-vessel vasculitis. J Am Acad Dermatol. 2009;61(4):701–6. https://doi.org/10.1016/j.jaad.2008.11.913.

    Article  PubMed  Google Scholar 

  43. Husein-Elahmed H, Callejas-Rubio JL, Rios-Fernandez R, Ortego-Centeno N. Tongue infarction as first symptom of temporal arteritis. Rheumatol Int. 2012;32(3):799–800. https://doi.org/10.1007/s00296-009-1355-z.

    Article  PubMed  Google Scholar 

  44. Kermani TA, Schmidt J, Crowson CS, Ytterberg SR, Hunder GG, Matteson e, 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. https://doi.org/10.1016/j.semarthrit.2011.10.005.

    Article  CAS  PubMed  Google Scholar 

  45. Salvarani C, Hunder GG. Giant cell arteritis with low erythrocyte sedimentation rate: frequency of occurrence in a population-based study. Arthritis Rheum. 2001;45(2):140–5. https://doi.org/10.1002/1529-0131(200104)45:2<140::AID-ANR166>3.0.CO;2-2.

    Article  CAS  PubMed  Google Scholar 

  46. Miller A, Green M, Robinson D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J (Clin Res Ed). 1983:286–66.

  47. Gonzalez-Gay MA, Lopez-Diaz MJ, Barros S, Garcia-Porrua C, Sanchez-Andrade A, Paz-Carreira J, et al. Giant cell arteritis: laboratory tests at the time of diagnosis in a series of 240 patients. Medicine (Baltimore). 2005;84(5):277–90. https://doi.org/10.1097/01.md.0000180043.19285.54.

    Article  Google Scholar 

  48. Mahr A, Saba M, Kambouchner M, Polivka M, Baudrimont M, Brochériou I, et al. Temporal artery biopsy for diagnosing giant cell arteritis: the longer, the better? Ann Rheum Dis. 2006;65(6):826–8. https://doi.org/10.1136/ard.2005.042770.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Achkar AA, Lie JT, Hunder GG, O’Fallon WM, Gabriel SE. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med. 1994;120(12):987–92. https://doi.org/10.7326/0003-4819-120-12-199406150-00003.

    Article  CAS  PubMed  Google Scholar 

  50. Narvaez 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. https://doi.org/10.1016/j.semarthrit.2006.12.005.

    Article  CAS  PubMed  Google Scholar 

  51. Jia L, Couce M, Barnholtz-Sloan JS, Cohen ML. Is all inflammation within temporal artery biopsies temporal arteritis? Hum Pathol. 2016;57:17–21. https://doi.org/10.1016/j.humpath.2016.07.004.

    Article  PubMed  Google Scholar 

  52. Duhaut P, Pinede L, Bornet H, Demolombe-Rague S, Dumontet C, Ninet J, et al. Biopsy proven and biopsy negative temporal arteritis: differences in clinical spectrum at the onset of the disease. Groupe de Recherche sur l'Arterite a Cellules Geantes. Ann Rheum Dis. 1999;58(6):335–41. https://doi.org/10.1136/ard.58.6.335.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Arida A, Kyprianou M, Kanakis M, Sfikakis PP. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord. 2010;11(1):44. https://doi.org/10.1186/1471-2474-11-44.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Bley TA, Weiben O, Uhl M, Vaith P, Schmidt D, Warnatz K, et al. Assessment of the cranial involvement pattern of giant cell arteritis with 3T magnetic resonance imaging. Arthritis Rheum. 2005;52(8):2470–7. https://doi.org/10.1002/art.21226.

    Article  CAS  PubMed  Google Scholar 

  55. 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. https://doi.org/10.2214/ajr.184.1.01840283.

    Article  PubMed  Google Scholar 

  56. Geiger J, Ness T, Uhl M, Lagrèze WA, Vaith P, Langer M, et al. Involvement of the ophthalmic artery in giant cell arteritis visualized by 3T MRI. Rheumatology (Oxford). 2009;48(5):537–41. https://doi.org/10.1093/rheumatology/kep011.

    Article  Google Scholar 

  57. Besson FL, Parienti JJ, Bienvenu B, Prior JO, Costo S, Bouvard G, 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. https://doi.org/10.1007/s00259-011-1830-0.

    Article  PubMed  Google Scholar 

  58. Hauenstein C, Reinhard M, Geiger J, Markl M, Hetzel A, Treszl A, et al. Effects of early corticosteroid treatment on magnetic resonance imaging and ultrasonography findings in giant cell arteritis. Rheumatology (Oxford). 2012;51(11):1999–2003. https://doi.org/10.1093/rheumatology/kes153.

    Article  CAS  Google Scholar 

  59. Chmelewski WL, McKnight KM, Agudelo CA, Wise CM. Presenting features and outcomes in patients undergoing temporal artery biopsy. A review of 98 patients. Arch Intern Med. 1992;152(8):1690–5. https://doi.org/10.1001/archinte.1992.00400200120022.

    Article  CAS  PubMed  Google Scholar 

  60. Roth AM, Milsow L, Keltner JL. The ultimate diagnoses of patients undergoing temporal artery biopsies. Arch Ophthalmol. 1984;102(6):901–3. https://doi.org/10.1001/archopht.1984.01040030721028.

    Article  CAS  PubMed  Google Scholar 

  61. Nishino H, DeRemee RA, Rubino FA, Parisi JE. Wegener’s granulomatosis associated with vasculitis of the temporal artery: report of five cases. Mayo Clin Proc. 1993;68(2):115–21. https://doi.org/10.1016/S0025-6196(12)60157-8.

    Article  CAS  PubMed  Google Scholar 

  62. Genereau T, Martin A, Lortholary O, Noel V, Guillevin L. Temporal arteritis symptoms in a patient with hepatitis C virus associated type II cryoglobulinemia and small vessel vasculitis. J Rheumatol. 1998;25(1):183–5.

    CAS  PubMed  Google Scholar 

  63. Haugeberg G, Bie R, Johnsen V. Vasculitic changes in the temporal artery in polyarteritis nodosa. Scand J Rheumatol. 1997;26(5):383–5. https://doi.org/10.3109/03009749709065704.

    Article  CAS  PubMed  Google Scholar 

  64. Dasgupta B, Borg FA, Hassan N, Alexander L, Barraclough K, Bourke B, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010;49(8):1594–7. https://doi.org/10.1093/rheumatology/keq039a.

    Article  Google Scholar 

  65. Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, Gross W, et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2009;68(3):318–23. https://doi.org/10.1136/ard.2008.088351.

    Article  CAS  PubMed  Google Scholar 

  66. Ray-Chaudhuri N, Kine DA, Tijani SO, et al. Effect of prior steroid treatment on temporal artery biopsy findings in giant cell arteritis. Br J Ophthalmol. 2002;86(5):530–2. https://doi.org/10.1136/bjo.86.5.530.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Hall S, Persellin S, Lie JT, O’Brien PC, Kurland LT, Hunder GG. The therapeutic impact of temporal artery biopsy. Lancet. 1983;2(8361):1217–20.

    Article  CAS  PubMed  Google Scholar 

  68. •• Kermani TA, Warrington KJ, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, et al. Disease relapses among patients with giant cell arteritis: a prospective, longitudinal cohort study. J Rheumatol. 2015;42(7):1213–1217. Approximately 1-in-5 GCA relapses will be associated with normal serum inflammatory markers. Headache and polymyalgia rheumatica are the most common symptoms at relapse presentation, with headache only uncommonly being an isolated symptom. https://doi.org/10.3899/jrheum.141347.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum. 2003;49(5):703–8. https://doi.org/10.1002/art.11388.

    Article  CAS  PubMed  Google Scholar 

  70. Grossman JM, Gordon R, Ranganath VK, Deal C, Caplan L, Chen W, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010;62(11):1515–26. https://doi.org/10.1002/acr.20295.

    Article  Google Scholar 

  71. •• Stone JH, Tuckwell K, Dimonaco S, Klearman M, Aringer M, Blockmans D, et al. Trial of tocilizumab in giant-cell arteritis. N Engl J Med. 2017;377(4):317–328. Subcutaneous tocilizumab given either weekly or every other week has been convincingly demonstrated in a phase 3 clinical trial to improve the rates of 52-week glucocorticoid-free remission in patients with GCA, leading to it being the first FDA-approved treatment for the disorder. https://doi.org/10.1056/NEJMoa1613849.

    Article  CAS  PubMed  Google Scholar 

  72. Langford CA, Cuthbertson D, Ytterberg SR, Khalidi N, Monach PA, Carette S, et al. A randomized, double-blind trial of abatacept (CTLA-4Ig) for the treatment of Giant cell arteritis. Arthritis Rheumatol. 2017;69(4):837–45. https://doi.org/10.1002/art.40044.

    Article  CAS  PubMed  Google Scholar 

  73. Mahr AD, Jover JA, Spiera RF, Hernández-García C, Fernández-Gutiérrez B, LaValley MP, et al. Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum. 2007;56(8):2789–97. https://doi.org/10.1002/art.22754.

    Article  CAS  PubMed  Google Scholar 

  74. Roche NE, Fulbright JW, Wagner AD, Hunder GG, Goronzy JJ, Weyand CM. Correlation of interleukin-6 production and disease activity in polymyalgia rheumatica and giant cell arteritis. Arthritis Rheum. 1993;36(9):1286–94. https://doi.org/10.1002/art.1780360913.

    Article  CAS  PubMed  Google Scholar 

  75. Villiger PM, Adler S, Kuchen S, Wermelinger F, Dan D, Fiege V, et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2016;387(10031):1921–7. https://doi.org/10.1016/S0140-6736(16)00560-2.

    Article  CAS  PubMed  Google Scholar 

  76. Guillevin L, Regent A. Treating giant-cell arteritis: is IL-6 the cytokine to target? Lancet. 2016;387(10031):1882–3. https://doi.org/10.1016/S0140-6736(16)30183-0.

    Article  PubMed  Google Scholar 

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  1. Department of Neurology, University of Kentucky, 740 S. Limestone, L445, Lexington, KY, 40536, USA

    Swati Pradeep & Jonathan H. Smith

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Pradeep, S., Smith, J.H. Giant Cell Arteritis: Practical Pearls and Updates. Curr Pain Headache Rep 22, 2 (2018). https://doi.org/10.1007/s11916-018-0655-y

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