The Treatment of Giant Cell Arteritis in Different Clinical Settings

Abstract

This paper aims to raise awareness of the different disease courses, comorbidities, and therapy situations in patients with giant cell arteritis (GCA), which require a differentiated approach and often a deviation from current treatment guidelines. With the approval of tocilizumab (TOC), which specifically binds to both soluble and membrane-bound IL-6 receptor and inhibits IL-6 receptor-mediated signaling, the spectrum of available effective treatment options has been significantly broadened. TOC yields an extensive range of possible applications that go beyond a glucocorticoid-saving effect. In this context, the treatment of GCA is dependent on the disease course as well as the associated comorbidities. The different stages of GCA in association to co-morbidities require a detailed treatment strategy.

Refractory giant cell arteritis: the value of clinical symptoms and imaging

“…According to the clinical standard, a prednisolone therapy with 60 mg/day was initiated. 2 All symptoms disappeared. After tapering prednisone to 40 mg per day, the patient presented a new onset of pain and stiffness in the shoulder girdle with occipital headache with a normal CRP.…”

Riesenzellarteriitis: Aktuelle Erkenntnisse zu Epidemiologie, Pathogenese, Diagnostik und Therapie

“…Auch wenn qualitativ hochwertige Studien zur Festlegung der optimalen Steroiddosis als Start-und als Erhaltungsdosis nicht existieren, gibt es anerkannte Empfehlungen zur Steroidbehandlung [46]. Dabei wird zwischen einer unkomplizierten RZA und einer RZA mit Komplikationen unterschieden [47].…”

“…Hier werden deutlich höhere Prednisolon-Dosierungen empfohlen, z. B. die Bolusgabe von 250 bis 1000 mg über 3 Tage (Übersicht in [47]). Allerdings ist die Datenlage zu diesem Vorgehen lückenhaft, und eine Rückbildung einer einmal eingetretenen Erblindung dürfte ein seltenes Ereignis sein.…”

“…Bei nachgewiesener Aortitis sind ggf. längere Behandlungszeiten erforderlich (Übersicht in [47]). Es gibt keine Evidenz und keine Leitlinienempfehlungen zur Frage, ob die initiale Steroiddosis an die Ausdehnung des Gefäßbefalls angepasst werden sollte.…”

<p>Healthcare Costs of Potential Glucocorticoid-Associated Adverse Events in Patients with Giant Cell Arteritis</p>

“…Giant cell arteritis (GCA), which affects medium-to largesized blood vessels, is the most common form of systemic vasculitis. 1 Clinical symptoms include headache, scalp tenderness, jaw claudication, and transient or permanent vision loss; 2 permanent vision loss occurs in an estimated 10% to 20% of patients with GCA. 3,4 Markers of inflammation, including erythrocyte sedimentation rate and C-reactive protein levels, are elevated in patients with GCA.…”