Large vessel vasculitis reframed: integrating conceptual shifts and evidence into practice for Takayasu arteritis and giant cell arteritis.

Large vessel vasculitis, encompassing giant cell arteritis and Takayasu arteritis, represents a spectrum of granulomatous aortitides with substantially similar clinical presentation, pathophysiology, and therapeutic response. Recent advances have redefined epidemiological trends, expanded the role of multimodal imaging, and clarified the genetic and immunological pathways that shape disease heterogeneity. This review integrates contemporary data on clinical phenotypes, vascular distribution, pathogenesis, and treatment strategies, with attention to unmet clinical needs in Korean practice. Imaging has assumed a central role in diagnosis and monitoring, supported by updated classification criteria and novel activity scores. Although glucocorticoids remain the therapeutic cornerstone, accumulating evidence indicates the use of targeted biologics, and emerging small molecules. However, the optimal sequencing and long-term outcomes remain unelucidated. Persistent gaps include a lack of validated composite outcome measures, limited availability of reliable biomarkers, and uneven implementation of imaging standards. Coordinated multicenter research and improved access to advanced therapies can support the next steps in patient care.