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. Author manuscript; available in PMC: 2011 Jan 4.
Published in final edited form as: Rev Neurol Dis. 2008 Summer;5(3):140–152.

Table 8.

Suggested Steps in the Management of Giant Cell Arteritis Complicated by Ocular or Brain Ischemia

Diagnosis

  • 1. Obtain baseline CBC, platelets, ESR, CRP, and temporal artery biopsy as soon as possible in any patient suspected of having GCA, but do not delay the initiation of treatment while waiting for the biopsy.

Initial Treatment

  • 2. Begin treatment with an induction dose of intravenous methylprednisolone, 15 mg/kg/d for 3 days for its steroid-sparing effects over the long term and its possible effects on visual recovery in the short-term.

  • 3. Subsequently begin prednisone 1 mg/kg/day.

  • 4. For prophylactic bone protection, begin calcium supplementation (1200 mg/d) and vitamin D (800 IU/d) and obtain a baseline bone density scan. In osteoporotic patients, begin a bisphosphonate as well.

  • 5. Begin daily low-dose aspirin unless contraindicated (aspirin may sometimes be delayed until after the temporal artery biopsy).

Initial Monitoring

  • 6. Monitor clinical symptoms and platelets, ESR, and CRP. Question the diagnosis of GCA if improvement of systemic symptoms does not begin to occur within the first few days.

Tapering and Relapses

  • 7. When disease control has been achieved (defined as normal ESR and CRP, and no systemic symptoms of GCA), begin to taper prednisone.

  • 8. Taper prednisone every month, if possible. The taper schedule must be individualized to each patient. Begin by decreasing large doses by 10 mg each month initially, then 5 mg each month, and then as little as 1 mg each month once a prednisone dose of 10-15 mg/d has been achieved. Do not use alternate daily dosing. Instruct the patient to seek medical attention immediately upon recurrence of symptoms, particularly visual symptoms.

  • 9. At each follow-up visit, obtain an ESR and CRP. If both are elevated above normal, increase the prednisone dose to the last level that maintained remission until the ESR and CRP have normalized again. Similarly, increase the prednisone dose when a patient has recurrence of GCA symptoms, even in the absence of elevated ESR and CRP.

Follow-up

  • 10. Schedule follow-up visits every 2-3 weeks while patient is on more than 40 mg/d of prednisone, then every 4-6 weeks until the patient has reached a low maintenance dose; then follow up every 3 months.

Discontinuing Steroids

  • 11. When a patient has been completely tapered off prednisone, follow the patient clinically and with ESR and CRP for at least 1 year further to guard against relapse.

CBC, complete blood count; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; GCA, giant cell arteritis.