Guidelines on the investigation, treatment, and follow-up of giant cell arteritis were released in March 2019 by the Swedish Society of Rheumatology.
The first-line treatment for giant cell arteritis remains glucocorticosteroids.
Treatment should not be delayed; for example, do not delay treatment while waiting for results from a temporal artery biopsy. This nondelay is vital.
The initial recommended prednisolone dose is 40-60 mg orally for 4 weeks, with a gradual taper thereafter.
If the patient experiences vision impairment or if other signs of serious vascular involvement are noted, consider administering intravenous methylprednisolone at 1000 mg once daily for 3 days. Follow this with oral prednisone as recommended above.
Tocilizumab is used in giant cell arteritis mainly for its glucocorticoid-sparing effect over the long-term. It is recommended as a supplemental treatment with prednisolone for patients who experience active or recurrent illnesses while on glucocorticoid treatment (in accordance with the criteria set outlined in the guidelines).
Tocilizumab can be considered in patients newly diagnosed with giant cell arteritis if a significant risk for future adverse effects from glucocorticoids is recognized and if there are pronounced clinical and laboratory signs of vascular inflammation.
Discontinue tocilizumab treatment after 1 year. The current available data do not support a recommendation for treatment for longer periods. In cases in which the inflammation persists while on tocilizumab treatment for longer than 1 year, it is recommended the treating physician make an individual assessment.
For more information go to Giant Cell Arteritis.
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Cite this: Investigation, Treatment, and Follow-Up of Giant Cell Arteritis Clinical Practice Guidelines (2019) - Medscape - Mar 22, 2019.