What symptoms persist after treatment of giant cell arteritis (GCA)?

From the Guidelines

After treatment of temporal arteritis, patients may continue to experience persistent symptoms, including fatigue, headaches, muscle aches, joint pain, visual disturbances, jaw claudication, depression, and anxiety, despite therapy. These symptoms can be profound and long-lasting, and may fluctuate during treatment, making it essential to distinguish between medication side effects and disease activity 1. The most recent guidelines recommend that treatment selection in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) should be based on disease severity and activity, presence of relevant comorbidities, and potential predictors of outcome, and that treatment should be modified as needed during follow-up 1.

Some of the persistent symptoms that patients may experience include:

• Fatigue, which can be profound and long-lasting
• Headaches, which may be less severe than during active disease but still troublesome
• Muscle aches and joint pain (polymyalgia rheumatica symptoms), which often persist in about 30-40% of patients, particularly in the shoulders and hips
• Visual disturbances, if vision loss occurred before treatment began, as damage to the optic nerve is usually permanent
• Jaw claudication, which may occasionally persist, though typically at a reduced intensity
• Depression and anxiety, which are common persistent symptoms, partly related to the chronic nature of the disease and the side effects of long-term corticosteroid therapy

Regular monitoring of inflammatory markers like ESR and CRP is essential to determine whether persistent symptoms represent ongoing inflammation or residual damage 1. Patients should report any worsening symptoms promptly, as they may indicate disease relapse requiring adjustment of immunosuppressive therapy. The treat-to-target approach recommends that treatment should be aimed at achieving remission, and that disease activity and severity should be continuously assessed during follow-up 1.

From the Research

Symptoms Persisting After Treatment

• Visual symptoms, such as persistent visual deterioration, can continue despite corticosteroid treatment 2
• Risk factors for progressive visual loss include older age, elevated C reactive protein, and disc swelling 2
• Some patients may experience continuous visual symptoms, including visual loss, despite steroid therapy 2
• Other symptoms, such as polymyalgia rheumatica, new-onset headache, jaw claudication, and diplopia, may also persist in some cases, although the evidence is limited 3

Treatment-Related Symptoms

• Long-term treatment with corticosteroids can lead to serious side effects in about 60% of patients 4
• Steroid side effects, such as those experienced by patients in groups B and C in the study by 5, can be significant and may include a range of symptoms
• The use of immunosuppressive agents, such as methotrexate and azathioprine, may also be associated with adverse effects, although the evidence is limited 6, 4

Refractory Cases

• Some patients may experience refractory temporal arteritis, which can be treated with alternative therapies, such as adalimumab, a TNF-alpha inhibitor 4
• The efficacy of TNF-alpha inhibitors in resistant temporal arteritis should be studied in larger, controlled studies 4