Topical issues of timely diagnostics and tactics of care patients with signs of giant cell arteritis

Prof. A.P. Kuzmina

State institution Dnipropetrovsk Medical Academy of the Ministry of Healt of Ukraine

Giant cell arteritis (GCA) is a vasculitis affecting mainly large and medium-sized arteries, which the classification of systemic vasculitides refers to as those mainly involving the large vessels. GCA is typified by the involvement of extracranial aortic branches and intracranial vessels, the aorta and its large vessels are being affected most frequently. The paper considers the terminology, classification, prevalence, major pathogenic mechanisms, and morphology of GCA. GCA diagnosis was established according to American College of Rheumatology (ACR) and Chapel Hill Consensus conference (2012).A broad spectrum of its clinical subtypes is due to target vessel stenosis caused by intimal hyperplasia. In 40% of cases, GCA is shown to be accompanied by polymyalgia rheumatica that may either precede or manifest simultaneously with GCA, or follow this disease. The menacing complications of GCA may be visual loss or ischemic strokes at various sites depending on the location of the occluded vessel. Along with the gold standard verification of the diagnosis of GCA, namely temporal artery biopsy, the author indicates other (noninvasive) methods for detection of vascular lesions: color Doppler ultrasonography of the temporal arteries, fluorescein angiography of the retina, mag-netic resonance angiography, magnetic resonance imaging, and computed tomography to rule out aortic aneurysm. Dynamic 18F positron emission tomography is demonstrated to play a role in the evaluation of therapeutic effectiveness. Ten-year survival rate in GCA is 95%, but 11% of patients have ischemic complication during first five years of the disease. Factors of poor prognosis of GCA are low blood flow in short posterior ciliary arteries (OR 9,6), transient ischemic attack and acute myocardial infarction in the past (OR 3,6). new investigational methods are required for the prevention of the complications and for the proper evaluation and management of GCA.

Key Words: giant cell arteritis, terminology, classification, diagnosis, treatment.
Kuzmina AP. [Topical issues of timely diagnostics and tactics of care patients with signs of giant cell arteritis]. Shidnoevr. z. vnutr. simejnoi med. 2018;1:53-59. Russian.


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