Giant cell arteritis (GCA) is a large vessel vasculitis usually seen in older adults over the age of 50. Arterial inflammation may lead to vascular damage which can result in stenosis, occlusions and even aneurysms. Additionally, the arterial inflammation may lead to serious loss of function including visual loss, limb anoxia and stroke. Suspicion of giant cell arteritis is a medical emergency and patients need to be quickly diagnosed and treated to prevent irreversible consequences of vessel inflammation. (Winkler et al, 2018).
Treatment should be started as soon as the clinical diagnosis has been made. The clinician should not delay treatment by waiting to confirm the diagnosis by biopsy or imaging to prevent blindness and other irreversible consequences.
Prednisolone 40–60 mg should be initiated and given daily for the first month then the dose should be tapered by 10 mg steps every 1 to 2 weeks. Tocilizumab is a steroid sparing agent and it is FDA approved in the USA for use in GCA.
https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/symptoms-causes/syc-20372758
Winkler A, True D. Giant Cell Arteritis: 2018 Review. Mo Med. 2018 Sep-Oct;115(5):468-470. PMID: 30385998; PMCID: PMC6205276.
Ness T, Bley TA, Schmidt WA, Lamprecht P. The diagnosis and treatment of giant cell arteritis. Dtsch Arztebl Int. 2013 May;110(21):376-85; quiz 386. doi: 10.3238/arztebl.2013.0376. Epub 2013 May 24. PMID: 23795218; PMCID: PMC3679627.
Petri, H., Nevitt, A., Sarsour, K., Napalkov, P. and Collinson, N. (2015), Incidence of Giant Cell Arteritis and Characteristics of Patients: Data-Driven Analysis of Comorbidities. Arthritis Care & Research, 67: 390-395. https://doi.org/10.1002/acr.22429