TABLE 5.

Summary of the Norwegian society of rheumatology’s recommendations on diagnosis and treatment of patients with giant cell arteritis (GCA).

# of recommendation
1	Refer patients suspected of having GCA to a Fast-Track GCA clinic (19) or a rheumatologist within 24 h. Treatment should not be delayed while waiting for this evaluation.
2	Obtain a thorough history and perform clinical examination and laboratory work up.
3	In patients with high clinical suspicion of GCA and a positive diagnostic test (temporal artery biopsy or any imaging modality) no further test is required to confirm the diagnosis.
4	Perform ultrasound of temporal and axillary arteries using high-end ultrasound equipment. Ultrasound of facial artery increases the sensitivity (32). If ultrasound is not available or inconclusive, perform another diagnostic test.
5	Refer to ophthalmologist if visual manifestations.
6	Initiate treatment with 40 mg Prednisolone/day in patients without visual manifestations. Initiate treatment with Prednisolone 60 mg/day if visual manifestations are present, consider a single dose of 500 mg IV methylprednisolone.
7	Taper daily Prednisolone dose as described in Table 6.
8	In minor relapse: Increase Prednisolone dose to the most recent effective dosage. In refractory disease or major relapse: Initiate Methotrexate (MTX) 20 mg/week sc. Consider Tocilizumab (TCZ) 162 mg/week sc if the patient is not tolerating or has a refractory or relapsing disease while on MTX.
9	Patients with GCA and high risk for osteoporosis should receive treatment according to the Norwegian guidelines for osteoporosis diagnostics and treatment.
10	Acetylsalicylic acid should not be used routinely, and should be considered on individual indication.
11	A relapse should be confirmed by an imaging modality. Modified Kerr’s (NIH criteria) could be used to monitor disease activity (31).
12	Reevaluate the diagnosis in patients not responding to standard treatment.
13	Follow-up should be performed every month until remission is achieved, and then after 3 months, 6 months, and yearly.