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Giant Cell Arteritis

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

Giant cell arteritis (GCA) is a vasculitis of large- and medium-sized arteries. It is the most common form of systemic vasculitis in the population over the age of 50 years. The incidence increases with age. There is a predilection for the aorta, branches of the ophthalmic artery, and extracranial branches of the carotid arteries. The diagnosis of GCA is urgent because of the possibility of permanent vision loss, most commonly secondary to ischemic optic neuropathy and central retinal artery occlusion. Delays in diagnosis and initiation of treatment usually lead to the ischemic complications. Systemic symptoms are common and protean. The diagnosis is based on suggestive symptoms, elevated inflammatory marker levels, and typically a temporal artery biopsy, the sensitivity of which is only about 75%. The classic histologic changes include arterial wall inflammation, fragmentation of the internal elastic lamina, and intimal thickening. Multinucleated giant cells, from which the name is derived, are seen in only one-half of positive temporal artery biopsies. GCA is considered an ophthalmologic emergency since treatment usually prevents fellow eye involvement. Corticosteroids remain the mainstay of therapy. The long durations of steroid therapy and attendant complications have prompted development of steroid-sparing agents like tocilizumab.

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  1. Penn State University College of Medicine, Hershey, PA, USA

    William A. Cantore

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  1. William A. Cantore
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Correspondence to William A. Cantore .

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Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. Penn State College of Medicine, Penn State Eye Center, Hershey, Pennsylvania, USA

    Jeffrey M. Sundstrom

  2. Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, USA

    David A. Quillen

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Cantore, W.A. (2022). Giant Cell Arteritis. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_298

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