Does giant cell arteritis impact celiac arteritis?

Giant Cell Arteritis and Celiac Arteritis

Giant cell arteritis can affect the celiac artery, potentially causing celiac arteritis and mesenteric ischemia, which requires prompt diagnosis and treatment to prevent serious complications. 1

Pathophysiology of Giant Cell Arteritis

• Giant cell arteritis (GCA) is a systemic vasculitis affecting medium and large vessels, characterized by arterial wall thickening, narrowed lumen, and presence of mononuclear inflammatory cells with media invasion 2
• Histopathological hallmarks include multinucleated giant cells in the media, though these are not always present 2, 3
• GCA primarily affects individuals over 50 years of age, with a lifetime risk of 1.0% for women and 0.5% for men 2
• The inflammatory process leads to destruction and remodeling of the arterial wall, resulting in intimal hyperplasia and progressive occlusion of the arterial lumen 3

Vascular Involvement in GCA

• While GCA classically affects cranial arteries, it can involve large vessels throughout the body, including the aorta and its primary branches 2, 4
• GCA may be complicated by large-vessel aneurysms and vascular stenoses beyond the cranial arteries 2, 5
• Imaging techniques such as ultrasound, MRI, PET, and CT can identify disease extent beyond the temporal arteries 2
• Vascular complications can occur both early (ischemic events) and late (aneurysms, dissections) in the disease course 4

Celiac Artery Involvement in GCA

• GCA can manifest as mesenteric ischemia due to involvement of the celiac and superior mesenteric arteries 1
• Imaging may reveal long, smooth stenosis of mesenteric vessels, including the celiac artery 1
• Celiac arteritis in GCA can present with abdominal pain, weight loss, and other symptoms of chronic mesenteric ischemia 1
• Involvement of the aorta and its proximal branches (which includes the celiac artery) is more common in GCA than previously appreciated 5

Diagnosis of GCA with Celiac Involvement

• Elevated inflammatory markers (ESR >40 mm/h and CRP) are present in >95% of GCA cases and support diagnosis 2, 6
• Temporal artery biopsy remains the gold standard for GCA diagnosis, but should not delay treatment 2, 7
• Imaging modalities including CT, MRI, and angiography can identify celiac artery stenosis or inflammation 1
• A high index of suspicion is needed when patients >50 years present with symptoms of mesenteric ischemia and elevated inflammatory markers 1

Treatment Implications

• High-dose glucocorticoid therapy is the cornerstone of treatment for GCA, including cases with celiac arteritis 2, 8
• Prompt initiation of treatment is crucial to prevent progression of vascular complications 2, 8
• Low-dose aspirin (75-150 mg/day) is recommended for all GCA patients to protect against cardiovascular and cerebrovascular events 2
• Tocilizumab has demonstrated efficacy in reducing glucocorticoid requirements and flare rates in GCA and may be considered as adjunctive therapy 2, 9
• Methotrexate may be considered as a steroid-sparing agent in patients with severe corticosteroid-related side effects 2, 7

Monitoring and Follow-up

• Clinical monitoring aided by inflammatory markers (ESR and CRP) should inform treatment decisions 2
• Periodic imaging may be necessary to assess disease activity and development of complications, especially in patients with known large-vessel involvement 2, 5
• All patients with GCA involving large vessels like the celiac artery will need long-term monitoring for potential vascular complications 2, 4
• Screening for aortic aneurysms and other large-vessel complications should be considered in GCA patients, particularly those with evidence of extra-cranial disease 5