Giant cell arteritis: diagnosis and management (original) (raw)

2001, Current Opinion in Ophthalmology

Giant cell arteritis (GCA), also known as temporal or cranial arteritis, is a systemic vasculitis of adults that is the most common arteritis in western countries. 1 The general disease state has been known for over a century, after a "peculiar form of arteritis in the aged" was reported in 1890. 2 GCA was pathologically confirmed in 1932. 3 The disorder is generally a panarteritis limited to vessels with an internal elastic component, 4 and it usually affects the extracranial branches of the carotid artery, although it may extend to other vessels as well. 5-7 Temporal arteritis, which affects the temporal artery, is the most common form of GCA. 8 There is a wide array of clinical characteristics associated with the disease. The single greatest risk factor for GCA in its various forms is advancing age 9,10 ; the disease almost exclusively affects persons older than 50 years, with an average of onset of age 72 years and an average incidence of 1.54 per 100,000 persons during the sixth decade of life. 11 The annual incidence rises steadily after the sixth decade, reaching 20.7 per 100,000 persons by the eighth decade of life 11 and then 1100 per 100,000 persons by age 85 or older. 12 By gender, age-adjusted estimates indicate a female preponderance; for persons older than 50 years, the incidence in women is 24.2 per 100,000 and in men is 8.2 per 100,000. 13 These figures, combined with a recognition of the aging US population, 14 suggest the significant cost that the morbidity associated with the disorder represents. Although GCA affects patients in all cultural and racial groups, it has been reported as particularly common in patients with Scandinavian and other northern European backgrounds. 5 Prevalence increases as residence moves from southern latitudes to northern ones. 15 White persons are much more affected by the disease than are black, Hispanic, or Asian persons. The exact mechanism of the disease process in GCA is unknown but is thought to be T-cell dependent and