What is the treatment for giant cell arteritis (GCA)?

From the Guidelines

Temporal arteritis requires immediate treatment with high-dose corticosteroids, specifically prednisone 40-60mg daily, to prevent vision loss and other complications, as recommended by the 2021 American College of Rheumatology/Vasculitis Foundation guideline 1. The standard initial treatment should be started immediately upon clinical suspicion, even before biopsy confirmation. This high dose should be maintained for 2-4 weeks until symptoms resolve and inflammatory markers normalize. Then, a slow taper can begin, typically reducing by 10% every 2 weeks until reaching 10mg daily, followed by a more gradual reduction of 1mg every 1-2 months. Most patients require 1-2 years of therapy. For severe cases or those with visual symptoms, initial IV methylprednisolone 500-1000mg daily for 3 days may be used before transitioning to oral prednisone. Some key points to consider in the treatment of temporal arteritis include:

• Adjunctive therapy with methotrexate (10-25mg weekly) or tocilizumab (162mg subcutaneously weekly) may be added as steroid-sparing agents, as suggested by the 2021 guideline 1.
• All patients should receive calcium (1200mg daily) and vitamin D (800-1000 IU daily) supplementation, along with bisphosphonates if on long-term steroids.
• Regular monitoring of symptoms, inflammatory markers (ESR, CRP), and steroid side effects is essential, as emphasized in the 2020 EULAR recommendations for the management of large vessel vasculitis 1.
• Corticosteroids work by suppressing the inflammatory cascade and granulomatous inflammation in the arterial walls, preventing the vascular damage that leads to ischemic complications. The 2021 American College of Rheumatology/Vasculitis Foundation guideline 1 provides the most recent and highest quality evidence for the treatment of temporal arteritis, and its recommendations should be prioritized in clinical practice.

From the FDA Drug Label

The following should be kept in mind when considering alternate day therapy: Basic principles and indications for corticosteroid therapy should apply. More severe disease states usually will require daily divided high dose therapy for initial control of the disease process The initial suppressive dose level should be continued until satisfactory clinical response is obtained, usually four to ten days in the case of many allergic and collagen diseases.

The treatment for temporal arteritis typically involves high-dose corticosteroids.

• The initial dose should be continued until a satisfactory clinical response is obtained, which is usually within 4 to 10 days.
• Daily divided high-dose therapy is usually required for initial control of the disease process. 2

From the Research

Temporal Arteritis Treatment

• Temporal arteritis, also known as giant cell arteritis (GCA), is a medical emergency that requires prompt treatment to prevent permanent loss of vision 3, 4, 5.
• The treatment of temporal arteritis typically involves high-dosage oral prednisone or intravenous prednisolone 4, 5.
• Patients with clinical symptoms of GCA should be treated aggressively, even if the erythrocyte sedimentation rate (ESR) is <50 mm/h or if the temporal artery biopsy is negative 3, 6.
• Corticosteroid therapy can lead to a dramatic improvement in symptoms within 24 hours of treatment, and withdrawal of treatment can lead to a relapse of symptoms 3, 6.
• C-reactive protein (CRP) can be a useful marker in following the adequacy of corticosteroid dosages in temporal arteritis, as it is more sensitive than ESR in some cases 7.

Diagnosis and Management

• The diagnosis of temporal arteritis is clinical and should not be discarded by a negative temporal artery biopsy (TABx) 6.
• A diagnostic work-up for temporal arteritis should include an ESR and a temporal artery biopsy, as well as a thorough clinical evaluation for symptoms such as headache, scalp tenderness, and visual disturbances 4, 5.
• Primary care physicians should be able to recognize the signs and symptoms of temporal arteritis and begin treatment rapidly to prevent permanent vision loss 5.