Large Vessel Vasculitis Diagnosis and Management

Large vessel vasculitis encompasses a group of immune-mediated disorders characterised by inflammation of the aorta and its major branches, notably giant cell arteritis and Takayasu arteritis. Early recognition and accurate assessment of disease activity are critical to prevent vascular complications such as aneurysm formation, stenosis and ischaemic events. Diagnosis typically relies on a combination of clinical features, laboratory markers of systemic inflammation and imaging findings, while temporal artery biopsy remains the standard for giant cell arteritis. Advances in non-invasive imaging have transformed management, allowing direct visualisation of vessel wall inflammation and structural damage. Treatment centres on high-dose glucocorticoids to control acute inflammation, often supplemented by steroid-sparing agents such as tocilizumab or methotrexate to reduce relapse risk and minimise long-term corticosteroid toxicity. Ongoing disease monitoring integrates clinical assessment with serial imaging and biomarker evaluation to guide tapering of therapy and detect subclinical activity. Multidisciplinary care and emerging targeted immunotherapies are reshaping long-term outcomes and quality of life for patients affected by these potentially disabling conditions.

Research from Nature Portfolio

Recent studies have demonstrated the utility of simultaneous positron emission tomography with magnetic resonance imaging to monitor large vessel inflammation longitudinally. Functional uptake of glucose analogues on PET and high-resolution vessel wall imaging on MRI are combined to distinguish active from inactive disease. A novel composite scoring system, designed specifically for PET/MRI metrics, outperformed established criteria in accurately classifying disease status and detecting changes under treatment. Independent validation has shown that this integrated approach enhances clinicians’ confidence in managing therapy, supporting its potential role as a standard tool for real-time assessment of treatment response and disease evolution.

Large Vessel Vasculitis Diagnosis and Management publication trend

The graph below shows the total number of articles in large vessel vasculitis diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Large vessel vasculitis (LVV): A group of disorders causing inflammation of the aorta and its main branches.

Positron emission tomography (PET): A nuclear imaging technique that visualises metabolic activity using radioactive tracers.

Magnetic resonance imaging (MRI): An imaging modality employing magnetic fields to produce detailed anatomical and tissue-contrast images.

18F-fluorodeoxyglucose (FDG): A glucose analogue labelled with fluorine-18 used to detect areas of increased metabolic activity.

Halo sign: A concentric, hypoechoic thickening of the arterial wall seen on ultrasound indicating vasculitic oedema.

VAMP score: A composite index derived from PET/MRI measurements to quantify vasculitis activity and monitor treatment response.

Somatostatin receptor 2 (SST2): A cell surface receptor expressed by activated macrophages and perivascular cells, targeted by novel PET tracers.

References

1. Somatostatin Receptor PET/MR Imaging of Inflammation in Patients With Large Vessel Vasculitis and Atherosclerosis. Journal of the American College of Cardiology (2023).
2. 18F-FDG-PET/MR imaging to monitor disease activity in large vessel vasculitis. Nature Communications (2024).
3. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. European Journal of Nuclear Medicine and Molecular Imaging (2018).
4. Novel ultrasonographic Halo Score for giant cell arteritis: assessment of diagnostic accuracy and association with ocular ischaemia. Annals of the Rheumatic Diseases (2020).