From the Guidelines
For suspected Giant Cell Arteritis (GCA), initiate high-dose corticosteroids immediately, even before confirming the diagnosis, with oral prednisone 40-60 mg daily or its equivalent, as recommended by the 2020 EULAR guidelines 1. The treatment approach should prioritize reducing the risk of morbidity, mortality, and improving quality of life.
- Key considerations in the management of GCA include:
- Initiating high-dose corticosteroids promptly to prevent irreversible complications such as vision loss
- Confirming the diagnosis with temporal artery biopsy within 1-2 weeks of starting treatment, although treatment should not be delayed for biopsy results
- Gradually tapering the steroid dose over several months, aiming to reduce prednisone to 10-15 mg daily within 3 months
- Considering the addition of a steroid-sparing agent like methotrexate (15-25 mg weekly) for long-term management
- Monitoring for steroid side effects and treating osteoporosis prophylactically with calcium, vitamin D, and bisphosphonates
- The 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of GCA and Takayasu arteritis also supports the use of high-dose oral glucocorticoids as the initial treatment, with the option to add tocilizumab for patients with active extracranial large vessel involvement 1.
- Regular follow-up is essential to assess symptoms and inflammatory markers (ESR, CRP) and adjust treatment based on clinical response and lab results, continuing treatment for at least 1-2 years, with some patients requiring lifelong therapy 1.
- The use of imaging modalities such as MRI of the cranial arteries can be helpful in establishing a diagnosis of GCA, but temporal artery biopsy remains the gold standard, as stated in the 2021 guideline 1.
- Aspirin (81 mg daily) may be added to reduce the risk of ischemic complications in patients with GCA, especially those with critical or flow-limiting involvement of the vertebral or carotid arteries 1.
- It is crucial to weigh the risk of relapse against the risk of glucocorticoid-related adverse events when tapering the steroid dose, as relapses are infrequent but can be severe 1.
From the FDA Drug Label
Rheumatic disorders: ... For the treatment of ... temporal arteritis ... The protocol for Giant Cell (GCA) arteritis, also known as temporal arteritis, involves the use of methylprednisolone as part of the treatment plan 2.
- The treatment is focused on managing the condition and reducing inflammation.
- Methylprednisolone is used as an adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation.
- The specific dosage and administration protocol may vary depending on the individual case and should be determined by a healthcare professional.
From the Research
Protocol for Giant Cell Arteritis (GCA)
The protocol for GCA involves prompt treatment with corticosteroids to prevent permanent loss of vision and other complications. The following steps are recommended:
- Immediate initiation of high-dose corticosteroids, such as prednisone 60 mg per day 3 or intravenous methylprednisolone (250 mg every 6 hours) for 3 to 5 days 4
- Laboratory studies, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC), should be obtained promptly 4
- Temporal artery biopsy should be performed for pathologic diagnosis 3, 4
- Adjunctive aspirin therapy may be started orally 4
- Corticosteroid treatment should be tapered gradually, guided by systemic symptoms, ESR, and CRP 5, 6, 7
Corticosteroid Dose Regimens
Different corticosteroid dose regimens have been studied, including:
- Starting dose of 30-40 mg/d of prednisone, with tapering to 10 mg/d within 6 months and to 5-7.5 mg/d within 1 year 7
- Higher dose regimens, such as > 40-60 mg/d or > 60 mg/d, may be associated with more steroid side effects 7
- Intravenous megadose steroid therapy may not be more effective than oral therapy in preventing visual deterioration 6
Monitoring and Follow-up
Patients with GCA should be monitored closely, with regular follow-up appointments to assess: