Treatment of Giant Cell Arteritis

Abstract

Giant cell arteritis (GCA) is a vasculitis of medium to large-sized blood vessels and is most common in the elderly older than 50 years, in women and whites. 1 The reader is directed to earlier chapters in this manuscript for a detailed discussion on the clinical presentation and diagnostic investigations for GCA. This article will discuss the systemic therapies in GCA. CorticosteroidsUrgent administration of corticosteroids is critical in improving the chances of visual recovery in the affected eye and protecting vision in the fellow eye. After the first eye is involved due to GCA, if untreated, 50% of patients will experience vision loss in the fellow eye within days to weeks. 2 Rapid initiation of corticosteroids may offer a visual benefit to the affected eye as well. In one study, 58% of those who received treatment within 24 hours of developing visual symptoms experienced a symptomatic improvement in vision whereas only 6% of those who were treated in a delayed manner had visual improvement. 3 In those, who have systemic symptoms such as polymyalgia rheumatica, headaches, and jaw pain, can be started on oral prednisone 40 to 60 mg daily and typically respond rapidly to therapy 1 and then can be monitored with a periodic erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) that will help to guide steroid taper.Patients with transient visual disturbances from GCA or those presenting with permanent vision loss require higher doses of corticosteroids.