From the Guidelines
Temporal arteritis, also known as giant cell arteritis, requires immediate treatment with high-dose corticosteroids to prevent vision loss and other complications. Start with oral prednisone 40-60mg daily (or 1mg/kg/day) as soon as temporal arteritis is suspected, even before biopsy confirmation 1. For patients with visual symptoms, intravenous methylprednisolone 500-1000mg daily for 3 days may be given initially 1. The high-dose prednisone should be maintained for 2-4 weeks until symptoms resolve and inflammatory markers normalize, then gradually tapered over 12-24 months 1. Tapering typically involves reducing the dose by 10% every 2 weeks until reaching 10mg daily, then more slowly thereafter 1. Low-dose aspirin (81mg daily) is often added to reduce the risk of ischemic complications 1. For patients requiring prolonged steroid therapy, bone protection with calcium (1000-1200mg daily), vitamin D (800-1000 IU daily), and bisphosphonates should be considered 1. Steroid-sparing agents like methotrexate (10-25mg weekly) or tocilizumab (162mg subcutaneously weekly) may be added in refractory cases or to reduce steroid dependence 1. Regular monitoring of symptoms, inflammatory markers (ESR, CRP), and potential steroid side effects is essential throughout treatment 1. Prompt treatment is crucial as untreated temporal arteritis can lead to permanent blindness within days to weeks due to inflammation of the ophthalmic artery.
Some key points to consider in the treatment of temporal arteritis include:
- The importance of prompt treatment to prevent vision loss and other complications 1
- The use of high-dose corticosteroids as the initial treatment 1
- The potential need for steroid-sparing agents in refractory cases or to reduce steroid dependence 1
- The importance of regular monitoring of symptoms, inflammatory markers, and potential steroid side effects throughout treatment 1
- The need for bone protection in patients requiring prolonged steroid therapy 1
Overall, the treatment of temporal arteritis requires a comprehensive approach that takes into account the patient's individual needs and circumstances. By following these guidelines and considering the latest evidence, healthcare providers can provide effective treatment and improve outcomes for patients with temporal arteritis.
From the Research
Treatment Options for Temporal Arteritis
- Corticosteroids are the primary treatment for temporal arteritis, with an initial dose of 35 mg prednisone daily sufficient to control symptoms in most patients 2
- High-dose steroids should be started immediately when the diagnosis is considered, and a gradual tapering of the steroid dose should occur over at least 1 year 3
- The optimal corticosteroid dose regimen is still debated, but a starting dose of 30-40 mg/d of prednisone and tapering to 10 mg/d within 6 months and to 5-7.5 mg/d within 1 year may be effective and less toxic 4
Alternative Treatments
- In cases refractory to glucocorticoids or where a decrease in dose is desired due to adverse effects, individualized treatment with methotrexate or TNF blockers may be indicated 5
- Adalimumab, a fully human recombinant IgG1, anti-TNF-alpha monoclonal antibody, has been successfully used to treat resistant temporal arteritis in a case report 6
- Anti-platelet therapy with ASA may be considered in patients with vascular risk factors, and surgical treatment may be considered in selected cases with symptoms due to arterial stenosis 5
Considerations for Treatment
- Treatment should be individualized, taking into account the clinical variability of the disease and the special characteristics of the patient population, usually elderly and with systemic diseases 5
- Careful monitoring of the response, both clinically and with serial inflammatory markers, is required 3
- The use of steroid-sparing agents should be considered if iatrogenic steroid complications occur 3