%0 Journal Article
%T The Thromboembolic Risk in Giant Cell Arteritis: A Critical Review of the Literature
%A A. Guida
%A A. Tufano
%A P. Perna
%A P. Moscato
%A M. T. De Donato
%A R. Finelli
%A D. Caputo
%A M. N. D. Di Minno
%J International Journal of Rheumatology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/806402
%X Giant cell arteritis is a systemic vasculitis characterized by granulomatous inflammation of the aorta and its main vessels. Cardiovascular risk, both for arterial and venous thromboembolism, is increased in these patients, but the role of thromboprophylaxis is still debated. It should be suspected in elderly patients suffering from sudden onset severe headaches, jaw claudication, and visual disease. Early diagnosis is necessary because prognosis depends on the timeliness of treatment: this kind of arteritis can be complicated by vision loss and cerebrovascular strokes. Corticosteroids remain the cornerstone of the pharmacological treatment of GCA. Aspirin seems to be effective in cardiovascular prevention, while the use of anticoagulant therapy is controversial. Association with other rheumatological disease, particularly with polymyalgia rheumatica is well known, while possible association with antiphospholipid syndrome is not established. Large future trials may provide information about the optimal therapy. Other approaches with new drugs, such as TNF-alpha blockades, Il-6 and IL-1 blockade agents, need to be tested in larger trials. 1. Introduction Vasculitis syndromes are inflammatory diseases affecting large-, medium-, or small-sized vessels, caused by various immunological processes and possibly triggered by infectious agents [1]. Thromboembolic disease is an increasing complication of several and rheumatic diseases. In Behcet¡¯s disease, thrombosis is a common clinical feature, while its role in ANCA associated vasculitis is emerging [2]. Temporal arteritis, also known as cranial arteritis or giant cell arteritis (GCA), is a chronic systemic inflammation of the medium- and large-size arteries characterized by granulomatous lesions; typically, it concerns one or more branches of the carotid artery, especially the temporal artery, involving aortic arch, axillary, iliac, and the femoral arteries as well [3]. Both venous and arterial events have been described in this setting; several case series of myocardial infarction and stroke have been reported [4]. Rare in individuals younger than 50 years, the peak of disease onset is in the 7th decade; female/male ratio is 3£¿:£¿1 [5]. The incidence varies from 10 to 29 cases per 100.000 inhabitants per year in the United States [6]; for GCA the prevalence reported is 8¨C10% people per 100.000 inhabitants, with a peak of 200 cases/100.000 inhabitants, over 50 years of age [7]; a higher incidence is reported in extreme northern latitudes [8]; it is rare among the Afro-American population [9]; familial cases
%U http://www.hindawi.com/journals/ijr/2014/806402/