Giant Cell Arteritis: Treatment Guidelines

Initial treatment of suspected giant cell arteritis

Uncomplicated (no jaw or tongue claudication or visual changes)

Prednisolone, 40 to 60 mg per day (but not < 0.75 mg per kg)

Complicated

Evolving visual loss or history of amaurosis fugax: intravenous methylprednisolone (Solu-Medrol), 500 mg to 1 g per day for three days, then oral prednisolone, 60 mg per day

Established visual loss: prednisolone, 60 mg per day

Taper (after four weeks of treatment and resolution of symptoms and normalization of ESR/CRP level)

Decrease by 10 mg every two weeks until 20 mg is reached, then decrease by 2.5 mg every two to four weeks until 10 mg is reached, then decrease by 1 mg every one to two months

Antiplatelet therapy

Low-dose aspirin, 81 mg per day (decreases cranial ischemic complications)

Gastrointestinal protection with proton pump inhibitor

Rheumatologists should be involved immediately in the treatment of suspected giant cell arteritis; treatment must be tailored to patient’s symptoms and inflammatory markers followed; in giant cell arteritis, persistence of ESR/CRP elevation may indicate underlying large vessel disease or other diagnosis.

Bone protection

Bisphosphonate, calcium, vitamin D