Improving Diagnostic Precision and Long-Term Control in Large Vessel Vasculitis, with Anisha Dua, MD, MPH

Large vessel vasculitis remains one of the most diagnostically and therapeutically challenging areas in rheumatology, requiring clinicians to balance early detection with long-term disease control while minimizing treatment toxicity. In recent years, advances in imaging and targeted therapies have begun to shift that equation—particularly in giant cell arteritis (GCA) and Takayasu arteritis, where delayed diagnosis or prolonged glucocorticoid exposure can carry substantial consequences. As diagnostic tools evolve and steroid-sparing strategies expand, clinicians are navigating a rapidly changing landscape.

At the 2026 Rheumatology Winter Clinical Symposium, held in Maui, Hawaii, on February 11-14, Anisha Dua, MD, MPH, Professor, Feinberg School of Medicine at Northwestern University, gave a talk focused on progress in both diagnosis and management of large vessel vasculitis.¹ RheumatologyLive sat down with Dua during the meeting to learn more about how the field has shifted.

Dua emphasized that on the diagnostic front, imaging has taken center stage. In Takayasu arteritis, magnetic resonance angiography (MRA) remains foundational, reflecting the heavy reliance on vascular imaging to establish diagnosis. In GCA, CT angiography is frequently incorporated into evaluation. Increasingly, however, positron emission tomography (PET) imaging is emerging as a particularly dynamic area of development. Advances in tracer refinement, image acquisition efficiency, and interpretation standards are improving diagnostic confidence. Yet challenges persist, especially in monitoring disease activity over time. Determining whether vascular inflammation remains active in patients receiving therapy, and deciding when escalation is warranted, remains a critical and unresolved clinical question.

Therapeutically, the landscape has shifted most dramatically in GCA. The approval of tocilizumab marked a turning point, providing the first FDA-approved targeted therapy for the disease and offering a validated steroid-sparing strategy after decades of glucocorticoid-dominant management.² More recently, the approval of the JAK inhibitor upadacitinib has further expanded options, introducing an additional mechanism to help induce and maintain remission while reducing cumulative steroid exposure.³ In Takayasu arteritis, progress has been more incremental given the rarity of the condition, though TNF inhibitors and IL-6 inhibition remain important tools, particularly in refractory cases, with ongoing investigation into combination and emerging targeted approaches.

“I think one of the more exciting spaces is in PET scanning. So I talked a lot about that during my talk. How do we interpret it? I think there's been movement towards finding better tracers. How do we cut down the time in acquiring those images and what do we what do we do with the information we get from it? We have a lot of good things that are useful in making the diagnosis, but the hard part comes with monitoring it,” Dua said.

References

1. Dua A. Evidence based medicine: Progress in the diagnosis and treatment of vasculitides. Presented at: RWCS 2026, held February 11-14 in Maui, Hawaii.

2. FDA approves Actemra for giant cell arteritis. US FDA. Published May 22, 2017. https://www.fda.gov/news-events/press-announcements/fda-approves-actemra-giant-cell-arteritis

3. RINVOQ® (upadacitinib) Receives U.S. FDA Approval for Giant Cell Arteritis (GCA). News release. AbbVie. April 29, 2025. https://news.abbvie.com/2025-04-29-RINVOQ-R-upadacitinib-Receives-U-S-FDA-Approval-for-Giant-Cell-Arteritis-GCA