Treatment of Giant Cell Arteritis
The treatment of giant cell arteritis is aimed at reducing arterial inflammation, preventing irreversible complications such as vision loss and stroke, and minimising long-term treatment side effects. Because giant cell arteritis is a medical emergency when visual symptoms appear, treatment typically begins immediately, even before the diagnosis is confirmed.
Corticosteroids are the mainstay of treatment, but newer therapies now offer more options for long-term disease control and steroid reduction. With prompt and appropriate management, most people can achieve disease remission and avoid the most serious consequences.
Immediate Treatment Goals
The urgent priorities in treating GCA are:
Preserving vision in patients with visual symptoms
Preventing stroke or other vascular complications
Controlling systemic inflammation
Alleviating symptoms such as headache, jaw pain, and fatigue
Doctors typically begin treatment on the same day they suspect the diagnosis, especially if the patient presents with:
Visual disturbances
New-onset headache with elevated inflammatory markers
Jaw claudication
Corticosteroids: First-Line Therapy
1. High-Dose Prednisolone
For patients without vision symptoms: 40–60 mg daily orally
For patients with visual symptoms or transient loss: 500–1000 mg of intravenous methylprednisolone daily for 3 days, followed by high-dose oral steroids
Corticosteroids typically produce a rapid clinical response, often within 24–72 hours. Inflammatory markers such as ESR and CRP begin to normalise, and systemic symptoms improve.
However, the treatment does not cure the disease outright. Doctors use a slow tapering regimen, often lasting 12–18 months or longer, to prevent relapse.
2. Steroid Tapering
Once symptoms and lab markers are stable for several weeks:
Doctors gradually reduce the dose—for example, by 10 mg every 2 weeks until reaching 20 mg, then taper more slowly
Doctors must individualise tapering based on symptom recurrence and inflammatory markers
Relapses may occur and require dose adjustment
Sudden reduction in steroid dose or rapid withdrawal can lead to flare-ups and increase risk of complications.
Managing Steroid Side Effects
Long-term steroid use can cause numerous side effects:
Weight gain, fluid retention, and mood changes
High blood pressure and diabetes
Osteoporosis and fractures
Increased infection risk
Cataracts and glaucoma
To counter these risks:
Prescribe calcium and vitamin D supplements
Consider bisphosphonates for bone protection
Monitor blood glucose and blood pressure
Schedule regular eye exams
Encourage lifestyle changes such as low-sodium diets and physical activity
Steroid-Sparing Therapy
To reduce long-term steroid exposure, doctors increasingly use immunosuppressive or biologic agents, particularly in:
Patients with frequent relapses
Those with significant steroid side effects
Individuals at high risk of complications from steroids
1. Tocilizumab (Actemra)
An interleukin-6 (IL-6) receptor antagonist
Administered weekly or monthly (subcutaneous or intravenous)
Helps induce remission and allows faster steroid tapering
Proven efficacy in clinical trials
Tocilizumab is now widely accepted as a first-line steroid-sparing agent in GCA and may be used from the start in selected patients.
2. Methotrexate
Taken weekly, often as a tablet or injection
Modestly effective at reducing relapse and steroid dose
Considered for patients intolerant to tocilizumab or with mild-to-moderate disease
Doctors rarely use agents like azathioprine, leflunomide, or cyclophosphamide, reserving them for refractory or atypical cases.
Monitoring and Follow-Up
Regular follow-up is essential during treatment:
Inflammatory markers (ESR and CRP) are checked every few weeks
Blood pressure, glucose, and bone health are monitored regularly
Eye exams are scheduled, particularly if vision symptoms were present
Imaging (e.g. ultrasound or MRI) may be repeated if large-vessel involvement is suspected
Doctors define relapse as the recurrence of symptoms and/or a rise in inflammatory markers. Doctors treat it by increasing the steroid dose and reassessing the treatment plan.
Patient Education and Lifestyle Support
Helping Patients Take Control of GCA
Supporting patients is very important when dealing with a long-term illness like Giant Cell Arteritis (GCA). Here are some simple ways to help:
- Teach them how to spot signs of a flare-up, such as a new headache, changes in vision, or feeling very tired.
- Remind them to stick to their medication plan and attend regular check-ups.
- Encourage a healthy lifestyle, including eating well and staying active.
- Talk about emotional well-being, since ongoing illness and medication can affect mood and overall happiness.
- Suggest support groups or rheumatology teams, as they can offer helpful advice and comfort.
Treatment in Different Patient Groups
1. Older Adults
- They are more likely to have side effects from steroid medicine.
- They may need to reduce steroids more slowly and might require extra care.
- Starting other treatments early (to lower the need for steroids) can be helpful.
2. People with Polymyalgia Rheumatica (PMR)
- PMR often occurs alongside GCA.
- Doctors usually give lower doses of steroids but must watch carefully for signs of GCA.
- Some people first diagnosed with PMR may later be found to have GCA.
3. Large-Vessel GCA
They must also keep an eye out for serious problems like aneurysms or vessel damage.
This form may need treatment for a longer time.
Doctors use scans like CT, MRI, or PET-CT to check blood vessels.
Treatment of Giant Cell Arteritis
The treatment of giant cell arteritis requires a multidisciplinary, patient-centred approach. With timely intervention and modern therapies, most individuals achieve suspension and retain their quality of life.
