Giant cell arteritis (GCA), also known as temporal arteritis, is a serious inflammatory condition that affects the large and medium-sized arteries, especially those in the head and neck. The inflammation can cause the arteries to narrow or become blocked, leading to symptoms such as headaches, scalp tenderness, jaw pain, and, most critically, vision problems that can result in permanent blindness if untreated. Because of the risk of severe complications, treating GCA promptly and effectively is crucial.
The cornerstone of treatment for giant cell arteritis is **corticosteroids**, which are powerful anti-inflammatory medications. The most commonly used corticosteroid is **prednisone**. When GCA is suspected, treatment usually begins immediately, even before a definitive diagnosis is confirmed, to prevent complications like vision loss. The initial dose of prednisone is typically high, often between 40 to 60 milligrams per day taken orally. This high dose helps to quickly reduce inflammation in the affected arteries and relieve symptoms.
In cases where GCA presents with visual symptoms or other neurological emergencies, treatment may involve **intravenous corticosteroids**, such as methylprednisolone, administered in a hospital setting. This approach delivers the medication more rapidly and at higher concentrations to control the inflammation aggressively and protect vision.
Once symptoms improve and inflammation is controlled, the prednisone dose is gradually tapered down over many months to minimize side effects while preventing relapse. This tapering process requires careful monitoring by healthcare providers because stopping corticosteroids too quickly can cause the disease to flare up again.
Long-term corticosteroid use, however, can cause significant side effects, including weight gain, high blood pressure, diabetes, osteoporosis, and increased risk of infections. Because of these risks, doctors often look for ways to reduce the total amount of corticosteroids a patient needs.
In recent years, **biologic therapies** have become an important addition to the treatment options for GCA. One such medication is **tocilizumab**, a drug that blocks a protein called interleukin-6 (IL-6), which plays a key role in the inflammation process of GCA. Tocilizumab is given as a subcutaneous injection, either by a prefilled syringe or an autoinjector device, and has been shown to help reduce the need for corticosteroids and maintain disease remission. Patients receiving tocilizumab require regular blood tests to monitor for side effects, such as changes in liver function or blood cell counts, because the drug affects the immune system.
Besides corticosteroids and biologics, other supportive treatments are important in managing GCA. For example, patients may be prescribed **calcium and vitamin D supplements** or medications to protect bone health, such as bisphosphonates, to counteract the bone-thinning effects of long-term steroid use. Regular monitoring for blood pressure, blood sugar, and eye health is also essential.
In some cases, if corticosteroids and biologics are not suitable or effective, other immunosuppressive drugs like methotrexate may be considered as steroid-sparing agents, although their use is less common and typically reserved for specific situations.
Because GCA is a chronic condition that can relapse, ongoing follow-up with healthcare providers is necessary. This includes regular clinical assessments and blood tests to check markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which help guide treatment adjustments.
In summary, the treatment of giant cell arteritis involves:
– Immediate initiation of **high-dose corticosteroids** to rapidly control inflammation and prevent complications.
– Use of **intravenous corticosteroids** in cases with visual or neurological symptoms.
– Gradual tapering of corticosteroids over months with close monitoring.
– Introduction of **biologic therapy (tocilizumab)** to reduc
