What is the treatment for Giant Cell Arthritis (Giant Cell Arteritis)?

From the Guidelines

For giant cell arteritis, the recommended initial dose of prednisone is 40-60 mg daily, which should be maintained for 2-4 weeks until symptoms resolve and inflammatory markers normalize, then gradually tapered over many months (typically 12-24 months) 1.

Treatment Overview

The treatment of giant cell arteritis (GCA) involves the use of high-dose corticosteroids to prevent vision loss and other complications.

• The initial dose of prednisone should be 40-60 mg daily, or 1 mg/kg/day.
• This high dose should be maintained for 2-4 weeks until symptoms resolve and inflammatory markers normalize.
• For patients with visual symptoms or complications, methylprednisolone 500-1000 mg IV daily for 3 days may be given before starting oral prednisone 1.

Tapering and Monitoring

• The dose of prednisone should be gradually tapered over many months (typically 12-24 months) to minimize the risk of relapse and steroid-related side effects.
• Patients should be monitored for steroid side effects with bone density testing, vitamin D and calcium supplementation, and possibly bisphosphonates for osteoporosis prevention.
• Regular monitoring of symptoms and inflammatory markers (ESR, CRP) is essential to guide treatment duration and tapering 1.

Steroid-Sparing Agents

• Steroid-sparing agents like tocilizumab (162 mg subcutaneously weekly) may be added in refractory cases or to reduce steroid exposure.
• Low-dose aspirin (81 mg daily) is often recommended to reduce the risk of ischemic complications.

Special Considerations

• For patients with suspected GCA, temporal artery biopsy is conditionally recommended over magnetic resonance imaging (MRI) of the cranial arteries for establishing a diagnosis of GCA 1.
• The optimal duration of therapy with GCs for GCA is not well established and should be guided by the patient’s values and preferences 1.

From the Research

Treatment of Giant Cell Arteritis

The treatment of giant cell arteritis (GCA) typically involves the use of corticosteroids, with the goal of reducing inflammation and preventing complications.

• High-dose corticosteroid therapy is the mainstay of treatment, with oral prednisone being the most commonly used medication 2, 3, 4, 5.
• The initial dose of prednisone is typically 40-60 mg/day, with the goal of rapidly improving symptoms and reducing the risk of irreversible visual loss 3.
• In cases of suspected GCA with acute visual or neurologic signs or symptoms, therapy may be initiated with high-dose intravenous methylprednisolone sodium succinate, followed by oral prednisone 2, 6.
• The duration of treatment with corticosteroids can be several months to years, with careful follow-up and periodic laboratory evaluations to monitor for signs of relapse 2, 5.

Adjunctive Therapies

In addition to corticosteroids, several adjunctive therapies may be considered in the treatment of GCA, including:

• Methotrexate, which may help reduce the risk of relapse and decrease the cumulative dose of corticosteroids 3, 4, 5.
• Tocilizumab, an anti-IL-6 receptor antibody that has been shown to improve clinical symptoms and reduce the frequency of relapses in GCA patients 3, 5.
• Aspirin, which may be beneficial in patients with ischemic complications or multiple cardiovascular risk factors 4, 5.

Monitoring and Follow-up

Regular monitoring and follow-up are essential in the management of GCA, with the goal of:

• Monitoring for signs of relapse, such as increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels 2, 5.
• Adjusting the dose of corticosteroids as needed to maintain disease control and minimize side effects 2, 5.
• Managing potential side effects of corticosteroid therapy, such as hypertension, diabetes mellitus, osteoporosis, and infection 5.