Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Department of Neurology, Ghent University Hospital, Ghent, Belgium.
J Headache Pain. 2020 Mar 17;21(1):28. doi: 10.1186/s10194-020-01093-7.
Giant cell arteritis (GCA) remains a medical emergency because of the risk of sudden irreversible sight loss and rarely stroke along with other complications. Because headache is one of the cardinal symptoms of cranial GCA, neurologists need to be up to date with the advances in investigation and management of this condition. The aim of this document by the European Headache Federation (EHF) is to provide an evidence-based and expert-based recommendations on GCA.
The working group identified relevant questions, performed systematic literature review and assessed the quality of available evidence, and wrote recommendations. Where there was not a high level of evidence, the multidisciplinary (neurology, ophthalmology and rheumatology) group recommended best practice based on their clinical experience.
Across Europe, fast track pathways and the utility of advanced imaging techniques are helping to reduce diagnostic delay and uncertainty, with improved clinical outcomes for patients. GCA is treated with high dose glucocorticoids (GC) as a first line agent however long-term GC toxicity is one of the key concerns for clinicians and patients. The first phase 2 and phase 3 randomised controlled trials of Tocilizumab, an IL-6 receptor antagonist, have been published. It is now been approved as the first ever licensed drug to be used in GCA.
The present article will outline recent advances made in the diagnosis and management of GCA.
巨细胞动脉炎（GCA）仍然是一种医学急症，因为它有突发、不可逆转的视力丧失风险，以及罕见的中风和其他并发症。由于头痛是颅 GCA 的主要症状之一，神经科医生需要及时了解该疾病的检查和治疗进展。欧洲头痛联合会（EHF）这份文件的目的是提供 GCA 的循证和专家建议。
工作组确定了相关问题，进行了系统的文献回顾，评估了现有证据的质量，并撰写了建议。在证据水平不高的情况下，多学科（神经科、眼科和风湿科）小组根据其临床经验推荐最佳实践。
在整个欧洲，快速通道和先进成像技术的使用有助于减少诊断的延迟和不确定性，改善了患者的临床结果。GCA 的一线治疗药物是高剂量糖皮质激素（GC），但长期 GC 毒性是临床医生和患者关注的关键问题之一。托珠单抗（一种 IL-6 受体拮抗剂）的两项 2 期和 3 期随机对照试验已经发表。它现在已被批准为 GCA 首个获批的药物。
本文将概述 GCA 的诊断和治疗方面的最新进展。
