Temporal arteritis
This article offers a comprehensive understanding of Giant Cell Arteritis (GCA), a systemic vasculitis primarily affecting older individuals. It delves into the clinical manifestation, diagnostic criteria, and management strategies for GCA. The importance of timely diagnosis through histopathology or imaging and the critical role of glucocorticoid therapy in management are emphasized. The article also discusses treatment approaches for patients with negative biopsies and imaging, as well as strategies for managing and monitoring patients on long-term glucocorticoid therapy.
Introduction to Giant Cell Arteritis (GCA)
Giant cell arteritis (GCA) or temporal arteritis is the most common of the systemic vasculitides. GCA virtually never occurs in individuals younger than 50 years of age. GCA manifests with headache, abrupt onset of visual disturbances, especially transient monocular visual loss, jaw claudication, and/or fever. The diagnosis of GCA is based on histopathology (temporal artery biopsy) or imaging exams (colour Doppler ultrasound (CDUS) of the head, neck, and upper extremities, CT with angiography (CTA), or MR angiography (MRA)).
Management Based on Biopsy or Imaging Results
Management differs between patients with positive biopsy or imaging and those with negative biopsy and imaging. Systemic glucocorticoid therapy is the mainstay of therapy and should be instituted promptly once the diagnosis of giant cell arteritis (GCA) is strongly suspected, especially in patients with recent or threatened visual loss. Patients with negative biopsy require extensive imaging to exclude alternative diagnoses (malignancy and infection).
Glucocorticoid Therapy
For glucocorticoid therapy, an optimal regimen for a starting dose and subsequent taper has not been formally evaluated. Patients without visual loss at diagnosis require initial treatment with prednisolone 1 mg/kg/day (maximum 60 mg). Those with threatened or established visual loss at diagnosis need methylprednisolone (500- 1000 mg intravenously daily for three days, followed by oral therapy with prednisolone 1 mg/kg/day (maximum of 60 mg/day)).
Adjunctive Treatment for GCA
Adjunctive treatment for giant cell arteritis (GCA) may be used in situations where glucocorticoid- related toxicities have ensued, with glucocorticoid-sparing strategies which include tocilizumab (162 mg once every week, subcutaneous; in combination with a tapering course of glucocorticoids) or methotrexate (10- 15 mg per week).
Monitoring and Intervention
Monthly follow-up visits for the first six months of treatment are desirable. Patients should be monitored for glucocorticoid-related adverse effects including osteoporosis, opportunistic infection, diabetes, and ocular complications.
References
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