From the Guidelines
Temporal arteritis treatment should begin immediately with high-dose corticosteroids, such as prednisone 40-60mg daily, to prevent vision loss and other complications, as recommended by the 2021 American College of Rheumatology/Vasculitis Foundation guideline 1.
Key Considerations
- Treatment should start as soon as the diagnosis is suspected, even before biopsy confirmation, to prevent irreversible vision loss.
- The initial high dose of corticosteroids should be maintained for 2-4 weeks until symptoms resolve and inflammatory markers normalize.
- A slow taper of corticosteroids should follow over 12-24 months, reducing the dose by about 10% every 2-4 weeks while monitoring for symptom recurrence.
- Low-dose aspirin (81mg daily) may be added to reduce the risk of ischemic complications, as recommended by the EULAR guidelines 1.
Adjunctive Therapy
- For patients who cannot tolerate steroids or as steroid-sparing agents, tocilizumab (162mg subcutaneously weekly or every other week) may be added, as suggested by the 2021 American College of Rheumatology/Vasculitis Foundation guideline 1.
Monitoring and Prevention
- Regular monitoring of symptoms, inflammatory markers (ESR, CRP), and potential steroid side effects is essential throughout treatment.
- Calcium and vitamin D supplements should be prescribed to prevent osteoporosis, and prophylaxis against Pneumocystis pneumonia may be considered for patients on prolonged high-dose steroids.
Diagnosis and Biopsy
- A temporal artery biopsy should be performed whenever a diagnosis of giant cell arteritis is suspected, but this should not delay treatment, as recommended by the EULAR guidelines 1.
- The biopsy should be done as soon as possible, ideally within 1-2 weeks of starting glucocorticoid therapy, to minimize the risk of false-negative results.
From the FDA Drug Label
1.1 Rheumatoid Arthritis (RA) AVTOZMA® (tocilizumab-anoh) is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs (DMARDs). The FDA drug label does not answer the question about temporal arthritis treatment.
From the Research
Temporal Arthritis Treatment Overview
- Temporal arteritis, also known as giant cell arteritis, is a systemic vasculitis that requires prompt recognition and treatment to prevent visual loss and other complications 2, 3, 4, 5, 6.
- The diagnosis of temporal arteritis is typically confirmed by temporal artery biopsy, although laboratory values such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can indicate the presence of the disease 2, 3.
Treatment Options
- Corticosteroids are the primary treatment for temporal arteritis, and therapy is often required for a long time, monitored by parameters of inflammation (ESR, CRP) 2, 3, 6.
- Immunosuppressive agents may be used as secondary steroid-sparing drugs in some cases, particularly in steroid-resistant cases 6.
- Early recognition and treatment of temporal arteritis is essential to prevent permanent visual loss, which can occur in up to 50% of patients if left untreated 3, 4, 5.
Importance of Prompt Diagnosis and Treatment
- Temporal arteritis is considered a medical emergency, and prompt diagnosis and treatment are critical to preventing visual loss and other complications 4, 5.
- Maintenance of a high index of clinical suspicion is essential to institute prompt adequate treatment, especially in atypical cases 6.
- A wide range of healthcare professionals, including primary care physicians, optometrists, and ophthalmologists, should be aware of the clinical presentation, key investigations, and time-sensitive management of temporal arteritis to ensure prompt recognition and treatment 3, 5.