Corticosteroid Usage in Giant Cell Arteritis

Kanakamedala, Amritha; Hussain, Muzna; Kini, Ashwini; Othman, Bayan Al; Lee, Andrew G.

doi:10.1080/01658107.2020.1767656

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…In a study by Kanakamedala et al, more than 70% of surveyed neuroophthalmologists reported that they would prescribe oral prednisone 1.0-1.5 mg/kg daily for patients with GCA without vision loss. 24 The same study reported than more than 70% would prescribe IV methylprednisolone 500-1000 mg daily for patients with vision loss. Salvarani et al recommended IV methylprednisolone 1000 mg daily for 3 days for patients with GCA and recent vision loss.…”

Section: Recommendations and Advantages Of Corticosteroid Usementioning

confidence: 97%

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Immunosuppressive Therapy in Giant Cell Arteritis: Do Steroids Still Reign Supreme?

Zhao¹,

Dhanani²,

Charoenkijkajorn³

et al. 2022

US Ophthalmic Review

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Giant cell arteritis (GCA) is the most common vasculitis in adults, and patients with GCA often present with vision loss that may progress to permanent blindness. For this reason, empirical treatment with corticosteroids is initiated when there is reasonable suspicion of GCA. Corticosteroids have remained the mainstay of treatment for GCA for the past 70 years due to their profound immunosuppressive effects. However, not all patients tolerate or respond adequately to corticosteroids, and prolonged dosages increase the risk for adverse side effects. There have also been recent advances and investigations into alternative immunosuppressive therapies for GCA; specifically, interleukin 6 inhibitors and other alternatives have been approved by the American College of Rheumatology and European League Against Rheumatism for adjunctive use with corticosteroids or for refractory GCA. However, it is unclear whether current immunosuppressive alternatives can conclusively replace corticosteroids in the treatment of GCA and prevention of vision loss. This article reviews the robust immunosuppressive mechanisms of corticosteroids and summarizes clinical investigations of alternative therapies for GCA.

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Section: Recommendations and Advantages Of Corticosteroid Usementioning

confidence: 97%

“…Salvarani et al recommended IV methylprednisolone 1000 mg daily for 3 days for patients with GCA and recent vision loss. 24,25 In 2018, the European League Against Rheumatism (EULAR) updated the recommendations for immunosuppressive treatment of GCA.…”

Section: Recommendations and Advantages Of Corticosteroid Usementioning

confidence: 99%

Immunosuppressive Therapy in Giant Cell Arteritis: Do Steroids Still Reign Supreme?

Zhao¹,

Dhanani²,

Charoenkijkajorn³

et al. 2022

US Ophthalmic Review

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“…The British Society of Rheumatology (BSR) recommends pulsed intravenous (IV) administration of up to five days of 1,000 mg methylprednisolone for patients with high-risk features ( 83 ). However there are no randomized controlled trials (RCTs) comparing outcomes of either route, thus clinical decision-making is largely consensus-based ( 84 ). The side effect profile of IV glucocorticoids, especially in the elderly populations where GCA is prevalent, should also be taken into consideration when selecting initial treatment.…”

Section: Managementmentioning

confidence: 99%

Current developments in the diagnosis and treatment of giant cell arteritis

Szekeres

Othman

2022

Front. Med.

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Giant cell arteritis is the most common vasculitis in adults above 50 years old. The disease is characterized by granulomatous inflammation of medium and large arteries, particularly the temporal artery, and is associated acutely with headache, claudication, and visual disturbances. Diagnosis of the disease is often complicated by its protean presentation and lack of consistently reliable testing. The utility of color doppler ultrasound at the point-of-care and FDG-PET in longitudinal evaluation remain under continued investigation. Novel techniques for risk assessment with Halo scoring and stratification through axillary vessel ultrasound are becoming commonplace. Moreover, the recent introduction of the biologic tocilizumab marks a paradigm shift toward using glucocorticoid-sparing strategies as the primary treatment modality. Notwithstanding these developments, patients continue to have substantial rates of relapse and biologic agents have their own side effect profile. Trials are underway to answer questions about optimal diagnostic modality, regiment choice, and duration.

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