Advances in the diagnosis of large vessel vasculitis: identification of biomarkers and imaging studies

Depending on the geographic area and the affected age group, large vessel vasculitis (LVV) are one of the most frequent types of systemic vasculitidies. Whereas giant cell arteritis (GCA) occurs exclusively in elderly individuals and is more frequent in countries with European ancestry, Takayasu?s arteritis (TA) mainly affects young women from eastern countries. The diagnosis of these disorders has been based on the characteristic clinical picture, together with the typical histopathological features in the temporal artery of patients with GCA, and the angiography results in TA patients. During the last few years, no new biomarkers have substituted the traditional ones (ESR and CRP) in the diagnosis and monitoring of disease activity in LVV. Only the levels of circulating IL-6 have demonstrated a higher sensitivity compared with the classic acute phase reactants, but its utility is limited due to its lack of inclusion as a routine technique. On the other hand, imaging techniques play a relevant role in the diagnosis and follow-up of patients with LVV. The use of new non-invasive techniques such as MRI, Doppler ultrasound, PET scan or CT has helped to improve the understanding of these disorders, although the sensitivity and specificity of these new imaging techniques compared with the classic temporal artery biopsy or angiography for diagnosis and follow-up remains to be established.