- Visto: 718
Arteritis de células gigantes
Giant cell arteritis
Edición XXI Mayo - Agosto 2022
DOI: https://doi.org/10.55139/AGLK4119
APA (7ª edición)
Zamora, D., Solano, J.C., Goyenaga, A., Sittenfeld, R. (2022). Arteritis de células gigantes. Crónicas científicas, 21(21), 71-82. https://doi.org/10.55139/AGLK4119.
Vancouver
Zamora D., Solano JC., Goyenaga A., Sittenfeld R. Arteritis de células gigantes. Cron cient. 13 de mayo de 2022; 21(21): 71-82.
Dra. Daniela Zamora
Médico General
Investigadora Independiente
San José, Costa Rica.
Dr. Juan Carlos Solano
Médico General
Investigador Independiente
San José, Costa Rica.
Dr. Adrián Goyenaga
Médico General
Investigador Independiente
San José, Costa Rica.
Dr. Roberto Sittenfeld
Médico General
Investigador Independiente
San José, Costa Rica.
Resumen
La arteritis de células gigantes (ACG) es una vasculitis crónica granulomatosa de arterias de mediano y gran calibre, siendo esta la vasculitis sistémica más común en personas mayores de 50 años. La fisiopatología puede explicarse por la activación de células dendríticas en la capa adventicia que lleva a la producción de citoquinas inflamatorias, aunque la causa de este proceso no es clara. La variedad en afectación topográfica lleva a distintas presentaciones clínicas con afectación tanto del sistema nervioso central como extracraneal, siendo una causa importante de cefalea secundaria en el adulto mayor. El diagnóstico por medio de biopsia de la arteria temporal continúa siendo el estándar de oro, aunque el uso de estudios de imagen como el ultrasonido, resonancia magnética y tomografía computarizada de las arterias afectadas puede brindar orientación valiosa en casos con biopsias negativas. La terapia con glucocorticoides en altas dosis es el tratamiento de elección y no debe ser postergado a la espera de la confirmación histopatológica, debido al riesgo de complicaciones isquémicas tales como la pérdida de la visión. El uso de agentes ahorradores de esteroides es tema de discusión, sin embargo, es una opción válida dado el riesgo de toxicidad asociada a glucocorticoides. En este artículo, se realiza una revisión bibliográfica acerca de las generalidades de la ACG (Arteritis de Células Gigantes), así como de puntos claves e importantes para el abordaje y manejo.
Palabras claves
Arteritis de células gigantes, vasculitis, isquemia, glucocorticoides.
Abstract
Giant cell arteritis is a chronic granulomatous vasculitis of medium and large vessels, being the most common systemic vasculitis in people over 50 years of age. The pathogenesis can be explained by the activation of dendritic cells in the adventitial layer that leads to the production of inflammatory cytokines, however the cause of this process is not clear. The variety in topographic involvement leads to different clinical presentations with central nervous system and extracranial involvement, being an important cause of secondary headache in the elderly. The diagnosis by biopsy of the temporal artery remains the gold standard, although the use of imaging studies such as ultrasound, magnetic resonance imaging, and computed tomography of the affected arteries can provide valuable guidance in cases with negative biopsies. High-dose glucocorticoid therapy is the treatment of choice and should not be delayed pending histopathological confirmation due to the risk of ischemic complications such as vision loss. The use of steroid-sparing agents is a subject of discussion; however, it is a valid option given the risk of toxicity associated with glucocorticoids. In this article, a bibliographic review is made about the generalities of GCA, as well as important key points for the approach and management.
Keywords
Giant cell arteritis, vasculitis, ischemia, glucocorticoids.
Bibliografía
1. Lensen KD, Voskuyl AE, Comans EF, van der Laken CJ, Smulders YM. Extracranial giant cell arteritis: a narrative review. Neth J Med 2016;74:182-192.
2. Weyand CM, Liao YJ, Goronzy JJ. The immunopathology of giant cell arteritis: diagnostic and therapeutic implications. J Neuroophthalmol. 2012;32:259-265.
3. Mackie S, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-chiappe S et al. British Society for Rheumatology guideline on diagnosis and treatmet of giant cell arteritis. Rheumatology.2020;59:487-494.
4. Ponte C, Martins-Martinho J, Luqmani RA. Diagnosis of giant cell arteritis. Rheumatology.2020;59:iii5-iii16.
5. Dinkin M, Johnson E. One Giant Step for Giant Cell Arteritis: Updates in Diagnosis and Treatment. Curr Treat Options Neurol. 2021;23:6.
6. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013; 65(1):1–11.
7. Weyand CM, Goronzy JJ. Giant-Cell Arteritis and Polymialgia Rheumatica. N Engl J Med.2014;371:50-57.
8. Dejaco C, Duftner C, Buttgereit F, Matteson EL, Dasgupta B. The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease. Rheumatology. 2017;56:506-515.
9. Camellino D, Matteson E, Buttgereit F, Dejaco C. Monitoring and al long-term management of giant cell arteritis and polymyalgia rheumatic. Nat Rev Rheumatol.2020;16:481-495.
10. Diamantopoulos AP, Haugeberg G, Lindland A, Myklebust G. The fast- track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis?. Rheumatology.2016; 55:66-70.
11. Baig IF, Pacoe AR, Kini A, Lee A. Giant cell arteritis: early diagnosis is key. Eye Brain.2019;11:1-12.
12. Hellmich B, Águeda AF, Luqmani R. Treatment of Giant Cell Arteritis and Takayasu Arteritis-Current and Future. Curr. Rheumatol. Rep.2020;22:84.
13. Ninan J, Lester S, Hill C. Giant cell arteritis. Best Pract Res Clin Rheumatol. 2016; 30:169-188.
14. González-Gay M, Ortego Jurado M, Ercole L, Ortego-Centeno N. Giant cell arteritis: is the clinical spectrum of the disease changing?.BMC Geriatr. 2019;19:200.
15. Ponte C, A´ gueda AF, Luqmani RA. Clinical features and structured clinical evaluation of vasculitis. Best Pract Res Clin Rheumatol. 2018;32:31-51.
16. Younger DS. Giant Cell Arteritis. Neurol Clin. 2019; 37(2):335-344.
17. Mackie S, Taylor JC, Haroon-Rashid L, Martin S, Dasgupta B, Gough A et al. Association of HLA-DRB1 amino acid residues with giant cell arteritis: genetic association study, metaanalysis and geo-epidemiological investigation. Arthritis Res Ther. 2015;17:195.
18. De Smit E, Palmer AJ, Hewitt AW. Projected worldwide disease burden from giant cell arteritis by 2050. J. Rheumatol. 2015; 42, 119-125.
19. Dejaco C, Brouwer E, Mason JC, Buttgereit F, Matteson E, Dasgupta B. Giant cell arteritis and polymyalgia rheumatic: current challenges and opportunities. Nat Rev Rheumatol. 2017;13(10): 578-592.
20. Samson M, Audia S, Fraszczak J, Trad M, Orneti P, Lakomy D et al. Th1 and Th17 lymphocytes expressing CD161 are implicated in giant cell arteritis and polymyalgia rheumatica pathogenesis. Arthritis Rheum. 2012;64:3788-3798.
21. Zhang H, Wutabe R, Berry G, Vaglio A, Liao YJ, Warrington K, et al. Immunoinhibitory checkpoint deficiency in medium and large vessel vasculitis. Proc. Natl Acad Sci. 2017;114: E970-E979.
22. Weyand CM, Younge BR, Goronzy JJ. IFN-γ and IL-17: the two faces of T-cell pathology in giant cell arteritis. Curr Opin Rheumatol. 2011;23(1):43-49.
23. Cid MC. Pathogenesis of giant cell arteritis. Rheumatology. 2014;53(2):i2–i3.
24. Nagel, M. A. et al. Analysis of Varicella–Zoster virus in temporal arteries biopsy positive and negative for giant cell arteritis. JAMA Neurol. 2015; 72: 1281-1287.
25. Peral-Cagigal B, Pérez-Villar A, Redondo-González LM, Garcia-Sierra C, Morante-Silva M, Madrigal-Rubiales V et al. Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis. Med Oral Patol Oral Cir Bucal 2018;23:290-294.
26. El-Dairi MA, Chang L, Proia AD, Cummings TJ, Stinnett SS, Bhatti MT. Diagnostic algorithm for patients with suspected giant cell arteritis. J Neuroophthalmol. 2015;35(3):246-253.
27. De Smith E, O´Sullivan E, Mackey D, Hewitt A. Giant cell arteritis: ophthalmic manifestations of a systemic disease. Arch Clin Exp Ophthalmol. 2016;254(12):2291-2306.
28. Hoffman GS. Giant cell arteritis. Ann Intern Med. 2016;165(9):ITC65.
29. Tang V, Fantaneanu T, Chakraborty S, Patel V, Dowlatshahi D. Intracranial non-occlusive thrombus and multiple strokes in giant cell arteritis. Can J Neurol Sci. 2012; 39(1):116-117.
30. Muratore F, Kermani TA, Crowson CS, Green AB, Salvarani C, Matteson E et al. Largevessel giant cell arteritis: a cohort study. Rheumatol. 2015;54:463-470.
31. Daumas A, Rossi P, Bernard-Guervilly F, Frances Y, Berbis J, Durand JM et al. Clinical, laboratory, radiological features, and outcome in 26 patients with aortic involvement amongst a case series of 63 patients with giant cell arteritis. Rev Med Interne. 2014;35(1):4-15.
32. Bienvenu B, Ly KH, Lambert M, Agard C, André M, Benhamou Y et al. Management of giant cell arteritis: recommendations of the French Study Group for Large Vessel Vasculitis (GEFA). Rev Med Interne. 2016;37:154-165.
33. Robson JC, Kiran A, Maskell J, Hutchings A, Arden N, Dasgupta B et al. The relative risk of aortic aneurysm in patients with giant cell arteritis compared with the general population of the UK. Ann Rheum Dis. 2015;74:129-135.
34. Mednick Z, Farmer J, Khan Z, Warder D, Ten Hove M. Coronary arteritis: an entity to be considered in giant cell arteritis. Can J Ophthalmol. 2016;51(1):e6-8.
35. Maz M, Chung SA, Abril A, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis. Arthritis Rheumatol 2021; 73:1349.
36. Kermani TA, Schmidt J, Crowson CS, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum. 2012;41:866-871.
37. Cavazza A, Muratore F, Boiardi L, et al. Inflamed temporal artery: histologic findings in 354 biopsies, with clinical correlations. Am J Surg Pathol 2014; 38:1360.
38. Rubenstein E, Maldini C, Gonzalez-Chiappe S, et al. Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: a systematic literature review and meta-analysis. Rheumatology (Oxford) 2020; 59:1011.
39. 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; 11:44.
40. Schmidt WA. Ultrasound in vasculitis. Clin Exp Rheumatol. 2014;32:S71.
41. Prieto-González S, Arguis P, Cid MC. Imaging in systemic vasculitis. Curr Opin Rheumatol. 2015(1):53-62.
42. Blockmans D. Diagnosis and extension of giant cell arteritis. Contribution of imaging techniques. Presse Med 2012; 41:948.
43. Klink T, Geiger J, Both M, Ness T, Heinzelmann S, Reinhard M, Holl-Ulrich K, Duwendag D, Vaith P, Bley TA. Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis-results from a multicenter trial. Radiology. 2014;273(3):844-52
44. Hayreh SS, Biousse V. Treatment of acute visual loss in giant cell arteritis: should we prescribe high-dose intravenous steroids or just oral steroids? J Neuroophthalmol 2012; 32:278.
45. Alba MA, García-Martínez A, Prieto-González S, et al. Relapses in patients with giant cell arteritis: prevalence, characteristics, and associated clinical findings in a longitudinally followed cohort of 106 patients. Medicine (Baltimore) 2014; 93:194.
46. Labarca C, Koster MJ, Crowson CS, et al. Predictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study. Rheumatology (Oxford) 2016; 55:347.
APA (7ª edición)
Zamora, D., Solano, J.C., Goyenaga, A., Sittenfeld, R. (2022). Arteritis de células gigantes. Crónicas científicas, 21(21), 71-82. https://doi.org/10.55139/AGLK4119.
Vancouver
Zamora D., Solano JC., Goyenaga A., Sittenfeld R. Arteritis de células gigantes. Cron cient. 13 de mayo de 2022; 21(21): 71-82.
Esta obra está bajo una licencia internacional Creative Commons: Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)

Realizar búsqueda
Última Edición
Ediciones