Original article
Management of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA)

https://doi.org/10.1016/j.revmed.2015.12.015Get rights and content

Abstract

Purpose

Management of giant cell arteritis (GCA, Horton's disease) involves many uncertainties. This work was undertaken to establish French recommendations for GCA management.

Methods

Recommendations were developed by a multidisciplinary panel of 33 physicians, members of the French Study Group for Large Vessel Vasculitis (Groupe d’étude français des artérites des gros vaisseaux [GEFA]). The topics to be addressed, selected from proposals by group members, were assigned to subgroups to summarize the available literature and draft recommendations. Following an iterative consensus-seeking process that yielded consensus recommendations, the degree of agreement among panel members was evaluated with a 5-point Likert scale. A recommendation was approved when ≥ 80% of the voters agreed or strongly agreed.

Results

The 15 retained topics resulted in 31 consensus recommendations focusing on GCA nomenclature and classification, the role of temporal artery biopsy and medical imaging in the diagnosis, indications and search modalities for involvement of the aorta and its branches, the glucocorticoid regimen to prescribe, treatment of complicated GCA, indications for use of immunosuppressants or targeted biologic therapies, adjunctive treatment measures, and management of relapse and recurrence.

Conclusions

The recommendations, which will be updated regularly, are intended to guide and harmonize the standards of GCA management.

Section snippets

Study group

A panel of GEFA members developed the recommendations. The GEFA is mostly composed of teaching hospital physicians specialized in internal medicine who share an interest in managing and conducting research on GCA. An initial panel of 14 experienced “senior” GEFA members volunteered to participate in this project. After the “initial panel” had selected the topics to be addressed, it designated 7 “junior” physicians, all internists or trainees in internal medicine, whose specific task was to help

Results

The development of recommendations lasted from February 2014 to May 2015. The topics selected and their respective objectives, given in Table 1, covered terminology (1 topic), nomenclature and classification (1 topic), diagnostic methods (6 topics) and treatment guidelines (7 topics). The literature summaries for each topic treated are given in the following sections, followed by a short commentary highlighting the panel's opinion on the interpretation of available information.

The panel's

Discussion

The recommendations elaborated herein addressed 15 topics, mostly referring to diagnostic and therapeutic aspects, for which we perceived a need for harmonizing the standards of GCA management. Although the panel was essentially composed of university hospital physicians, these recommendations are also intended for management of patients with GCA seen in non-teaching hospitals and private practice. Except for possible differences across nations in healthcare systems or access to medications,

Disclosure of interest

The authors declare that they have no competing interest.

Acknowledgments

We thank Janet Jacobson for translating the manuscript into English, and the “Filière des maladies auto-immunes et auto-inflammatoires rares (FAI2R)” for logistic support of this work.

References (162)

  • T.A. Kermani et al.

    Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis

    Semin Arthritis Rheum

    (2012)
  • P.D. Aiello et al.

    Visual prognosis in giant cell arteritis

    Ophthalmology

    (1993)
  • E. Liozon et al.

    Risk factors for visual loss in giant cell (temporal) arteritis: a prospective study of 174 patients

    Am J Med

    (2001)
  • C.M. Weyand et al.

    Clinical practice. Giant-cell arteritis and polymyalgia rheumatica

    N Engl J Med

    (2014)
  • K. Chakravarty et al.

    A district audit on the management of polymyalgia rheumatica and giant cell arteritis

    Br J Rheumatol

    (1994)
  • B.T. Horton et al.

    An undescribed form of arteritis of temporal vessels

    Mayo Clin Proc

    (1932)
  • J.C. Jennette et al.

    Nosology of primary vasculitis

    Curr Opin Rheumatol

    (2007)
  • J.C. Jennette et al.

    Nomenclature of systemic vasculitides. Proposal of an international consensus conference

    Arthritis Rheum

    (1994)
  • J.C. Jennette et al.

    2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides

    Arthritis Rheum

    (2013)
  • G.G. Hunder et al.

    The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis

    Arthritis Rheum

    (1990)
  • K. Maksimowicz-McKinnon et al.

    Takayasu arteritis and giant cell arteritis: a spectrum within the same disease?

    Medicine (Baltimore)

    (2009)
  • R. Talarico et al.

    Isolated aortitis versus giant cell arteritis: are they really two sides of the same coin?

    Clin Exp Rheumatol

    (2014)
  • G.W. Smetana et al.

    Does this patient have temporal arteritis?

    JAMA

    (2002)
  • M. Brodmann et al.

    Tongue necrosis as first symptom of giant cell arteritis (GCA)

    Clin Rheumatol

    (2009)
  • J. Currey

    Scalp necrosis in giant cell arteritis and review of the literature

    Br J Rheumatol

    (1997)
  • J.T. Lie

    Illustrated histopathologic classification criteria for selected vasculitis syndromes. American College of Rheumatology Subcommittee on Classification of Vasculitis

    Arthritis Rheum

    (1990)
  • K. Jakobsson et al.

    Biopsy findings in giant cell arteritis: relationship to baseline factors and corticosteroid treatment

    Scand J Rheumatol

    (2013)
  • A. Chakrabarty et al.

    Temporal artery biopsy: is there any value in examining biopsies at multiple levels?

    J Clin Pathol

    (2000)
  • A. Cavazza et al.

    Inflamed temporal artery: histologic findings in 354 biopsies, with clinical correlations

    Am J Surg Pathol

    (2014)
  • M.J. Esteban et al.

    Small-vessel vasculitis surrounding a spared temporal artery: clinical and pathological findings in a series of 28 patients

    Arthritis Rheum

    (2001)
  • G. Restuccia et al.

    Small-vessel vasculitis surrounding an uninflamed temporal artery and isolated vasa vasorum vasculitis of the temporal artery: two subsets of giant cell arteritis

    Arthritis Rheum

    (2012)
  • T. Genereau et al.

    Temporal artery biopsy: a diagnostic tool for systemic necrotizing vasculitis

    Arthritis Rheum

    (1999)
  • P. Duhaut et al.

    Biopsy proven and biopsy negative temporal arteritis: differences in clinical spectrum at the onset of the disease

    Ann Rheum Dis

    (1999)
  • A. Rodriguez-Pla et al.

    Proposal to decrease the number of negative temporal artery biopsies

    Scand J Rheumatol

    (2007)
  • G.S. Breuer et al.

    Effect of biopsy length on the rate of positive temporal artery biopsies

    Clin Exp Rheumatol

    (2009)
  • A. Mahr et al.

    Temporal artery biopsy for diagnosing giant cell arteritis: the longer, the better?

    Ann Rheum Dis

    (2006)
  • R. Taylor-Gjevre et al.

    Temporal artery biopsy for giant cell arteritis

    J Rheumatol

    (2005)
  • E. Ypsilantis et al.

    Importance of specimen length during temporal artery biopsy

    Br J Surg

    (2011)
  • R.D. Niederkohr et al.

    A Bayesian analysis of the true sensitivity of a temporal artery biopsy

    Invest Ophthalmol Vis Sci

    (2007)
  • H.M. Habib et al.

    Color duplex ultrasonography of temporal arteries: role in diagnosis and follow-up of suspected cases of temporal arteritis

    Clin Rheumatol

    (2012)
  • M. Karahaliou et al.

    Colour duplex sonography of temporal arteries before decision for biopsy: a prospective study in 55 patients with suspected giant cell arteritis

    Arthritis Res Ther

    (2006)
  • G. Germano et al.

    Is colour duplex sonography-guided temporal artery biopsy useful in the diagnosis of giant cell arteritis?. A randomized study

    Rheumatology (Oxford)

    (2015)
  • A.A. Achkar et al.

    How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis?

    Ann Intern Med

    (1994)
  • E.W. Chong et al.

    Is temporal artery biopsy a worthwhile procedure?

    ANZ J Surg

    (2005)
  • W.A. Schmidt et al.

    Color duplex ultrasonography in the diagnosis of temporal arteritis

    N Engl J Med

    (1997)
  • A. Arida et al.

    The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis

    BMC Musculoskelet Disord

    (2010)
  • A.P. Diamantopoulos et al.

    Diagnostic value of color Doppler ultrasonography of temporal arteries and large vessels in giant cell arteritis: a consecutive case series

    Arthritis Care Res (Hoboken)

    (2014)
  • T.A. Bley et al.

    High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery

    AJR Am J Roentgenol

    (2005)
  • T. Klink et al.

    Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis-results from a multicenter trial

    Radiology

    (2014)
  • T. Bley et al.

    Comparison of duplex sonography and high-resolution magnetic resonance imaging in the diagnosis of giant cell (temporal) arteritis

    Arthritis Rheum

    (2008)
  • Cited by (0)

    View full text