From the Guidelines
Giant cell arteritis (GCA) should be treated immediately with high-dose corticosteroids, typically prednisone 40-60mg daily, to prevent vision loss and other complications, as recommended by the 2021 American College of Rheumatology/Vasculitis Foundation guideline 1.
Treatment Approach
The treatment approach for GCA involves the use of high-dose corticosteroids, with the option to add tocilizumab as a steroid-sparing agent. The initial dose of prednisone should be maintained for 2-4 weeks until symptoms resolve and inflammatory markers normalize, followed by a slow taper over 12-24 months.
- For patients with newly diagnosed GCA without manifestations of cranial ischemia, high-dose oral glucocorticoids (GCs) are recommended over intravenous (IV) pulse GCs 1.
- For patients with newly diagnosed GCA with threatened vision loss, IV pulse GCs are recommended over high-dose oral GCs 1.
- Tocilizumab can be added as a steroid-sparing agent at 162mg subcutaneously weekly or every other week 1.
Diagnosis and Monitoring
Patients should undergo temporal artery biopsy within 1-2 weeks of starting treatment for definitive diagnosis, though treatment should not be delayed awaiting biopsy results. Regular monitoring of symptoms, inflammatory markers (ESR/CRP), and potential steroid side effects is essential.
- Temporal artery biopsy is recommended over magnetic resonance imaging (MRI) of the cranial arteries for establishing a diagnosis of GCA 1.
- Long-term clinical monitoring is strongly recommended for patients with GCA in apparent clinical remission 1.
Prevention of Complications
Calcium and vitamin D supplementation should be provided to prevent osteoporosis, and prophylaxis against Pneumocystis pneumonia may be considered for patients on high-dose steroids.
- Aspirin can be added for patients with GCA who have critical or flow-limiting involvement of the vertebral or carotid arteries 1. GCA requires prompt treatment because the inflammation of cranial arteries can lead to permanent blindness if not addressed quickly.
From the Research
Giant Cell Arteritis Treatment
- The primary treatment for giant cell arteritis (GCA) is high-dose corticosteroid therapy, which can help reduce inflammation and prevent complications such as vision loss 2, 3, 4, 5, 6.
- The initial dose of prednisone can range from 0.5 to 1 mg/kg/day, depending on the severity of the disease and the patient's comorbidities 5.
- Methotrexate can be used as an adjunctive therapy to reduce the dose of corticosteroids and decrease the risk of relapses, but its efficacy is modest 2, 3, 4, 5.
- Other immunosuppressive drugs, such as tocilizumab, have shown promising results in reducing the frequency of relapses and the cumulative dose of prednisone 3, 4, 5.
- Aspirin may be beneficial for patients with ischemic complications or multiple cardiovascular risk factors, but its benefit-to-risk ratio needs to be further studied 5.
Treatment Goals
- The primary goal of treatment is to reduce inflammation and prevent complications such as vision loss 2, 3, 4, 5, 6.
- Treatment should be initiated promptly, even before diagnostic studies are completed, in patients with suspected ophthalmic involvement 4, 6.
- The treatment regimen should be tailored to the individual patient, taking into account the severity of the disease, comorbidities, and laboratory values 2, 3, 4, 5, 6.
Monitoring and Follow-up
- Patients with GCA require regular follow-up and monitoring of laboratory values, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), to adjust the treatment regimen as needed 2, 3, 4, 5, 6.
- Patients should be monitored for potential side effects of corticosteroid therapy, such as hypertension, diabetes mellitus, osteoporosis, and infection 4, 5, 6.
- Rheumatologic consultation and follow-up can be helpful in managing patients with GCA 6.