What specialty manages giant cell arteritis (GCA)?

From the Guidelines

Rheumatologists are the primary specialists responsible for managing temporal arteritis, also known as giant cell arteritis, due to their expertise in systemic inflammatory and autoimmune diseases affecting blood vessels. When temporal arteritis is suspected, patients should be referred urgently to rheumatology for evaluation and treatment, as stated in the 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and takayasu arteritis 1. Initial management typically involves high-dose corticosteroids, which should be started immediately, even before a definitive diagnosis is made, to prevent vision loss.

Key Management Points

• A temporal artery biopsy is often performed within 1-2 weeks of starting treatment to confirm the diagnosis, as it is conditionally recommended over magnetic resonance imaging (MRI) of the cranial arteries for establishing a diagnosis of GCA 1.
• Treatment typically continues for 1-2 years with a slow, careful taper of the steroids to prevent relapse, with the optimal duration of therapy guided by the patient’s values and preferences 1.
• Rheumatologists may add steroid-sparing agents such as methotrexate or tocilizumab in some cases to reduce steroid-related side effects, with the use of oral GCs with tocilizumab conditionally recommended over oral GCs alone 1.
• Ophthalmology consultation is also important if visual symptoms are present, and for patients with GCA who have critical or flow-limiting involvement of the vertebral or carotid arteries, adding aspirin is conditionally recommended 1. Some key considerations in the management of temporal arteritis include:
• The use of high-dose oral GCs over IV pulse GCs for patients without manifestations of cranial ischemia 1.
• The conditional recommendation against the use of an HMG-CoA reductase inhibitor (“statin”) specifically for the treatment of GCA 1.
• The importance of long-term clinical monitoring for patients with GCA in apparent clinical remission 1.

From the Research

Temporal Arteritis Management

The management of temporal arteritis typically involves the use of corticosteroids, with the goal of reducing inflammation and preventing complications.

• The specialty that manages temporal arteritis is typically rheumatology, as evidenced by the studies published in rheumatology journals 2, 3.
• Temporal arteritis is also sometimes managed by neurologists, particularly in cases where there are neurological symptoms or complications 4.
• The use of high-dose steroids is a common approach in the management of temporal arteritis, with the goal of quickly reducing inflammation and preventing complications 5, 6, 4.
• Steroid-sparing agents, such as methotrexate, may be used in some cases to reduce the need for long-term steroid use and minimize side effects 6, 3.
• The management of temporal arteritis requires careful monitoring of the patient's response to treatment, as well as regular follow-up to adjust the treatment plan as needed 2, 5, 4.