THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Experts discuss challenges in diagnosing
and treating large-vessel vasculitis

Large-vessel vasculitis is a group of vasculitides that includes giant cell arteritis (GCA) and Takayasu’s arteritis (TAK), disorders that often present a diagnostic and therapeutic challenge to healthcare providers in rheumatology. While GCA and TAK share similarities, they differ in many aspects, and novel approaches to evaluation and treatment for both have been the subject of recent research studies.

An ARHP session on Monday, Update: Large-Vessel Vasculitis, will feature two experts in GCA and TAK offering tips for evaluating and managing patients with these disorders. The session will be held from 11:00 am – 12:00 pm in Room 5 B.

Tanaz A. Kermani, MD
Tanaz A. Kermani, MD

Tanaz A. Kermani, MD, Assistant Clinical Professor in the Division of Rheumatology and Founder and Director of the Vasculitis Program at the University of California Los Angeles, will discuss GCA’s clinical manifestations and potential complications.

“It’s important to recognize that giant cell arteritis can affect arteries outside the temporal artery,” Dr. Kermani said. “There has been a lot of literature come out in the last few years suggesting that patients with giant cell arteritis are at risk for other cardiovascular events, including strokes, blood clots, and heart disease. This risk seems to be more pronounced in the first year of diagnosis, which is a newer finding, but there’s more and more literature building on that.”

The FDA recently approved the immunosuppressive tocilizumab for GCA treatment, Dr. Kermani said, and more potential treatments are in the pipeline.

“Preliminary data from a study on abatacept, which targets T cells, suggests some promise for giant cell arteritis, but it needs more investigation,” she said. “Still, this is one of the first times that any biologics or other treatments have shown any promise for effectively treating GCA.”

Antoine G. Sreih, MD
Antoine G. Sreih, MD

Antoine G. Sreih, MD, Assistant Professor of Clinical Medicine in the Division of Rheumatology at the University of Pennsylvania and Co-Director of the Penn Vasculitis Center in Philadelphia, will follow with a discussion on the diagnosis and treatment of TAK.

“Takayasu’s arteritis is one of the rarer vasculitides and is predominantly seen in women who are less than 40 years old,” Dr. Sreih said. “Patients with TAK can present initially with systemic symptoms, such as fever, malaise, fatigue, and weight loss, but can later develop manifestations of large vessel involvement and damage, such as loss of pulses, differences in blood pressure, and end organ involvement.”

He said that more serious damage can increase the risk of strokes and heart attacks and affect circulation to upper and lower extremities. TAK treatment options include glucocorticoids and immunosuppressive agents, but there is still very little data to support the efficacy of these options.

“Most therapies also come with some potentially serious side effects,” Dr. Sreih said. “There are some exciting new biomarkers and pathways involved in TAK pathogenesis on the horizon that may lead us to more effective diagnosis and therapies, but nothing that’s commercially available or approved yet.”