Materiały źródłowe

• #1 Giant cell arteritis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/symptoms-causes/syc-20372758

  Giant cell arteritis frequently causes headaches, scalp tenderness, jaw pain and vision problems. […] Prompt treatment with corticosteroid medications usually relieves symptoms of giant cell arteritis and might prevent loss of vision. You’ll likely begin to feel better within days of starting treatment. But even with treatment, relapses are common. […] You’ll need to visit your doctor regularly for checkups and treatment of any side effects from taking corticosteroids. […] If you’re diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent vision loss.

• #2 Giant Cell Arteritis | Society for Vascular Surgery

  https://vascular.org/your-vascular-health/vascular-conditions/giant-cell-arteritis

  Both disorders are primarily treated with steroid medication. […] For temporal arteritis steroid medication is usually the only treatment needed. […] Additional immunosuppressive medication may be necessary for Takayasus arteritis. […] You may be able to stop steroid treatments after several months. However, these disorders can recur and long-term steroid treatment may be required. […] In rare cases of temporal arteritis, surgery is needed to repair the arteries. […] With Takayasus arteritis, stenting or surgery is more commonly needed. […] The key to a good outcome is early diagnosis and treatment. Women age 50+ and young Asian women should be attentive to the symptoms outlined above and seek medical help if they develop.

• #3 Giant Cell Arteritis (GCA): Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.giant-cell-arteritis-gca-care-instructions.zc1431

  Giant cell arteritis is an inflammation of blood vessels leading to your head and eyes. It usually affects people older than 50. It is more common in women. This condition is also called temporal arteritis. […] GCA is treated right away to prevent blindness. Your doctor will prescribe steroids that you take as pills. The steroids can also be given to you through a needle in your vein. Most symptoms should get better quickly, usually in 1 to 3 days. But if you have vision loss, it isn’t likely to improve with treatment. You may need to take medicine for more than 2 years to prevent problems. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #4 Giant cell arteritis: Current treatment and management

  https://www.wjgnet.com/2307-8960/full/v3/i6/484.htm

  Glucocorticoids remain the cornerstone of medical therapy in giant cell arteritis (GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. […] However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. […] The key issues in managing GCA after its diagnosis are prompt institution of correct therapy; recognition and amelioration of the adverse events related to immunosuppressant medications; and rapid identification of disease activity and flares. […] Induction treatment with high-dose pulsed intravenous (IV) methylprednisolone (15 mg/kg for 3 consecutive days followed by oral prednisone dose of 40 mg/d) has been suggested for all patients with GCA to allow faster tapering and a lower cumulative steroid dose in a double-blind, placebo-controlled, randomized trial involving 27 patients.

• #5 Giant Cell Arteritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/giant-cell-arteritis/

  Close coordination among the patients primary care provider, rheumatologist, ophthalmologist, and neurologist is required for optimal management of the disease. […] Careful observation with laboratory and clinical examinations can help manage GCA and its relapses, as well as prevent treatment-related complications.

• #6 Giant Cell Arteritis (Temporal Arteritis) | Doctor

  https://patient.info/doctor/giant-cell-arteritis-pro

  Giant cell arteritis is a medical emergency. Same-day secondary care referral should be made (usually to a rheumatologist) for an urgent specialist opinion and consideration of further investigations. […] Glucocorticoid therapy should be started if there is a clinical suspicion of giant cell arteritis, and should not be delayed whilst waiting for diagnostic imaging or a temporal artery biopsy. […] Urgent referral for specialist evaluation is recommended for all patients with suspected giant cell arteritis but this should not delay promptly starting high-dose steroid treatment. […] Once the diagnosis is suspected, treat with high-dose corticosteroid immediately: 40 mg prednisolone daily unless the patient has ischaemic symptoms (jaw or tongue claudication, or visual symptoms). […] Symptoms should improve rapidly after initiation of corticosteroids; if they do not, an alternative diagnosis should be considered.

• #7

  https://bpac.org.nz/bpj/2013/june/arteritis.aspx

  Giant cell arteritis should be strongly considered in older patients presenting with a new type of headache, jaw pain or visual disturbances […] Whenever there is a reasonable suspicion of the condition, discuss the patient with an Ophthalmologist or Rheumatologist (depending on local guidelines/protocols) to organise referral for a temporal artery biopsy, and initiate same-day treatment with corticosteroids. […] If the findings from the history and examination strongly indicate giant cell arteritis, after considering possible differential diagnoses, urgent treatment and referral should be initiated. The first steps for most patients should be to provide a prescription for corticosteroids and to contact either an Ophthalmologist or Rheumatologist (depending on local referral criteria) to organise a temporal artery biopsy.

• #8 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  The universally accepted treatment of giant cell arteritis (GCA) is high-dose corticosteroid therapy. The major justification for the use of corticosteroids is the impending danger of blindness in untreated patients. Patients who present with visual symptoms have a 22-fold increased chance of visual improvement if therapy is started within the first day. Damage may be irreversible if treatment is delayed beyond 48 hours. […] Few studies exist regarding dosing protocols for corticosteroids in GCA. It is generally agreed that most patients with suspected GCA should be started on oral prednisone 40-60 mg/day, with a temporal artery biopsy performed within 1 week. Prednisone doses of 80-100 mg/day have been suggested for patients with visual or neurologic symptoms of GCA. Follow-up care within 72 hours after starting therapy should be arranged.

• #9

  https://www.healio.com/news/optometry/20140826/10_3928_1081_597x_20140101_00_1349943

  A 73-year-old white female presented to the office on an emergency basis because she could not see out of her right eye upon waking that morning. […] The patient was referred to a neuro-ophthalmologist immediately. […] Early diagnosis of GCA, accompanied by immediate administration of high-dose systemic corticosteroids, is critical for the prevention of further complications secondary to ischemia. […] The proper initiation of treatment allows for a dramatic reduction of pain usually occurring within hours to days from the initiation of treatment. […] Intravenous methylprednisolone should be considered in the presence of ocular signs and symptoms and is currently the standard of care. […] Following IV infusion, the patient should be placed on oral prednisone with a standard dose between 40 mg/d and 60 mg/day until a reduction in the inflammatory markers (ESR, CRP and platelets) becomes evident.

• #10 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  The main treatment for giant cell arteritis consists of high doses of a corticosteroid drug such as prednisone. Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy. […] You’ll likely begin to feel better within a few days of beginning treatment. If you have visual loss before starting treatment with corticosteroids, it’s unlikely that your vision will improve. However, your unaffected eye might be able to compensate for some of the visual changes. […] You may need to continue taking medication for one to two years or longer. After the first month, your doctor might gradually begin to lower the dosage until you reach the lowest dose of corticosteroids needed to control inflammation.

• #11 Management of Giant Cell Arteritis and Polymyalgia Rheumatica | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0401/p2061.html

  Giant cell arteritis and polymyalgia rheumatica are closely related disorders that affect persons more than 50 years of age and cause substantial morbidity. […] Both disorders are treated with corticosteroids: high dosages for giant cell arteritis (prednisone in a dosage of 40 to 60 mg per day) and lower dosages for polymyalgia rheumatica (prednisone in a dosage of 10 to 20 mg per day). […] After normalization of the ESR, the corticosteroid is tapered, with the patient monitored closely for symptom recurrence. […] Patients diagnosed as having giant cell arteritis should be started immediately on 40 to 60 mg of prednisone given once a day or in divided doses. Rapid initiation of therapy is thought to minimize the risk of blindness. […] Symptoms usually resolve quickly, often within two to three days of the initiation of the corticosteroid.

• #12 Giant cell arteritis: Current treatment and management

  https://www.wjgnet.com/2307-8960/full/v3/i6/484.htm

  Glucocorticoid reduction should be considered only in the absence of clinical symptoms, signs and laboratory abnormalities suggestive of active disease. […] During steroid tapering, flares occur in up to 50% of patients, requiring escalation of glucocorticoids and a more prolonged treatment course. […] The search for an effective disease-modifying agent for the treatment of GCA has proven elusive. […] Current BSR guidelines for the management of GCA recommend consideration of the early introduction of methotrexate or alternative immunosuppressant therapy following a relapse. […] The use of antiplatelet agents in GCA is controversial. […] Given the high doses and long term duration of glucocorticoid therapy in patients with GCA, gastrointestinal protection is recommended with proton pump inhibitors, especially if concomitant risk factors are present such as NSAID use, and older age. […] The frequency for patient follow-up should be guided by their clinical manifestations and adverse events.

• #13 Giant Cell Arteritis (Temporal Arteritis) | Doctor

  https://patient.info/doctor/giant-cell-arteritis-pro

  Once symptoms and abnormal test results resolve, prednisolone should be gradually tapered to zero over the next 12 to 18 months, providing there is no relapse of symptoms, signs, or laboratory markers of inflammation. […] Flare-ups and relapses usually respond to corticosteroid increases to the level at which symptoms previously were controlled. Protracted courses of therapy are often necessary. […] Glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Osteoporosis prophylaxis is required for patients on long-term steroid treatment. […] Tocilizumab (a monoclonal antibody against the interleukin-6 receptor) is an effective glucocorticoid-sparing therapy, demonstrating sustained glucocorticoid-free remission in 56% of patients receiving weekly tocilizumab compared with 18% of patients receiving a 52-week prednisone taper. […] Its use has expanded, however, and is used more widely in the initial treatment of giant cell arteritis (alongside corticosteroids), especially in patients who are at a high risk of glucocorticoid toxicity.

• #14 Giant Cell Arteritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/giant-cell-arteritis/

  Glucocorticoids are administered on a daily basis. […] The minimum effective dose of corticosteroids should be maintained, and weaning should be done gradually and adjusted according to the individual patient. […] Follow-up for large vessel complications should be performed for at least 2 years using chest radiography, echocardiography, MRI, or PET. […] A corticosteroid-sparing immunosuppressant such as cyclosporine, azathioprine, or methotrexate may be administered in individuals with steroid-resistant illness, although the efficacy of such treatment is unknown. […] Tocilizumab is a humanized recombinant anti-IL-6 receptor antibody that inhibits the binding of IL-6 to membrane-bound and soluble IL-6 receptors in a competitive manner. […] The US Food and Drug Administration (FDA) approved tocilizumab in May 2017 for the treatment of individuals with giant cell arteritis, and the European Commission approved it in September 2017, making it the first drug specifically approved for the treatment of giant cell arteritis.

• #15

  https://link.springer.com/article/10.1007/s11940-020-00660-2

  GCA is no longer a disease whose diagnosis is based exclusively on temporal artery biopsy and whose complications are prevented solely with the use of corticosteroids. […] Modern vascular imaging techniques and targeted immunologic therapies are heralding a new era for the disease, in which practitioners will hopefully be able to diagnosis it with greater accuracy and treat it with less ischemic complications and iatrogenic side effects. […] The GiACTA trial was the first study to provide evidence for a steroid-sparing agent in the management of giant arteritis based on prospective, placebo-controlled design. It has revolutionized the way we treat giant cell arteritis, as the use of the IL-6 inhibitor tocilizumab could lead to a significant reduction of steroid usage (and side effects) in the disease.

• #16 Giant Cell Arteritis (Temporal Arteritis) Treatment & Management: Approach Considerations, Alternatives to Corticosteroids, Diet and Activity

  https://emedicine.medscape.com/article/332483-treatment

  During corticosteroid therapy, monitoring for complications of long-term use of these drugs is indicated. Patients should be screened for diabetes, hypertension, and cataracts. […] Given the high risk of corticosteroid-induced osteoporosis, patients should have baseline bone densitometry at the start of therapy. All patients on corticosteroids need adequate calcium and vitamin D for protection against osteoporosis (1500 mg of calcium and 800 IU of vitamin D3 daily). […] Regular follow-up care after a successful initial management of the acute process is considered a standard of care. Routine follow-up should include asking about symptoms of upper extremity claudication or ischemia, listening for bruits, and taking blood pressure in both arms. Ongoing monitoring of symptoms and the erythrocyte sedimentation rate (ESR) is mandatory.

• #17 Giant Cell Arteritis (Temporal Arteritis): Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis

  Giant cell arteritis treatment should begin immediately to prevent vision loss. The primary treatment is a glucocorticoid, usually prednisone. You’ll likely start taking it at a dose of 40 mg to 60 mg per day (by mouth), and your provider will gradually reduce your dosage. If you already have vision loss or other vision symptoms, your provider may treat you with a high dose of glucocorticoids through a catheter in your vein (IV). […] Since glucocorticoids can cause serious side effects, your provider will monitor your response to these medications closely. Because glucocorticoids suppress your immune system, side effects can include more frequent and more severe infections. They can also make your bones thinner, which raises your risk of fractures. […] Your provider may want to test your bone density while you’re on glucocorticoids to monitor you for bone thinning. They might recommend treatments to keep your bones strong, like exercises, calcium and vitamin D supplements and possibly medications to prevent osteoporosis.

• #18 Giant cell arteritis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/diagnosis-treatment/drc-20372764

  The following suggestions might help you manage your condition and cope with side effects of your medication: […] Get checkups. See your doctor regularly to check for side effects of treatment and development of complications. […] Ask your doctor about taking between 75 and 150 mg of aspirin daily. Taken daily, low-dose aspirin might reduce the risk of blindness and stroke. […] Learning everything you can about giant cell arteritis and its treatment can help you feel more in control of your condition. Your health care team can answer your questions, and online support groups might also be of help. Know the possible side effects of the medications you take, and report any changes in your health to your doctor.

• #19 Improving the quality of care for people with giant cell arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8313211/

  Giant cell arteritis (GCA) is a systemic vasculitis with numerous potential complications and societal costs. […] A comprehensive consensus pathway saw referral numbers rise from 19 to 135 from 2012 to 2019. […] The introduction of a vasculitis specialist nurse has resulted in improving education, contact and speed of access to our service. […] The deficiencies found in the care of patients with GCA are summarised as follows: Follow-up and monitoring: It was the usual practice for individuals with GCA to be discharged to primary care for ongoing management without monitoring of glucocorticoid toxicity, long-term disease-related complications or relapses. […] To empower patients through education about the disease, anticipated outcomes and a plan for tapering and eventual withdrawal of prednisolone.

• #20 British Journal of Nursing – Introducing an ANP-led temporal artery biopsy service for patients with suspected giant cell arteritis

  https://www.britishjournalofnursing.com/content/focus/introducing-an-anp-led-temporal-artery-biopsy-service-for-patients-with-suspected-giant-cell-arteritis/

  The ANP now receives the electronic referral, contacts the patient and undertakes a pre-assessment (either over the phone or face-to-face). […] Meeting the patient pre-operatively and having the opportunity to discuss the procedure, undertake an informed consent, allay fears and plan the procedure around the patient’s needs is important to them. […] The outcomes of this audit show that the ANP-led TAB service is beneficial in reducing patient waiting times and coordination of the biopsy and reduced complication rates against a previously purely medically led service. […] This appears to highlight the value of an ANP-led service and provides another example of where the ANP role can be developed within the medical/surgical model to improve patient care.

• #21 Improving the quality of care for people with giant cell arteritis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8313211/

  The appointment of a specialist nurse in November 2019 has meant that each patient has time to discuss their management in detail. […] All patients with suspected relapse undergo further ultrasonography to look at the state of the vessels and further immunosuppression is offered as appropriate sequentially with methotrexate and tocilizumab. […] We have managed to create a service worthy of a national award in the space of 10 years. […] The process of empowering patients started with the establishment of a formal GCA service which ensured that all patients received written information about the disease and the drugs, and a printed regimen tailored to their gender, height and weight. […] The total capital investment was for an ultrasound machine which costed less than 30,000 and was covered by charitable funds.

• #22 British Journal of Nursing – Introducing an ANP-led temporal artery biopsy service for patients with suspected giant cell arteritis

  https://www.britishjournalofnursing.com/content/focus/introducing-an-anp-led-temporal-artery-biopsy-service-for-patients-with-suspected-giant-cell-arteritis/

  Once GCA has been confirmed, the patient is likely to stay on prednisolone for 12 to 18 months, provided there are no significant side effects. […] Multidisciplinary monitoring will be required during the treatment period and the dose of steroids is likely to be tapered down over time. […] Calcium and vitamin D supplements are also prescribed during the glucocorticoid treatment due to the risk of osteoporosis caused by inhibition of calcium absorption and suppression of bone development instigated by the steroids. […] Some clinicians also advocate the use of aspirin in order to reduce the auto-immune effects of the disease and the potential damage to the artery walls; however, this remains controversial. […] The ANP, with the support of the neuro-ophthalmologist and rheumatologist teams proposed restructuring the service for patients requiring a TAB. […] A clinical proposal and evaluation of SMART objectives had the following key aims and objectives: Improvement of the service to achieve a consistent, high-quality, streamlined and enhanced patient experience.

• #23 Giant Cell Arteritis (Temporal Arteritis): Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis

  Living with GCA can be challenging. To manage your condition and the side effects that you may experience from glucocorticoids, make sure that you: Eat healthy, nutritious foods, like lean meats, whole grains and fresh fruits and vegetables; Get enough vitamin D and calcium to protect your bones; Stay active with some sort of physical activity for at least 30 minutes a day; Get at least seven to eight hours of sleep every night; Take your prescribed medications as directed; Visit your healthcare provider regularly; Take steps to reduce your risk of infection. […] There are certain things you should avoid if you have GCA. These include: Factors that increase your risk of getting sick. The medications used to treat GCA weaken your immune system, putting you at greater risk of infection. To avoid getting sick, make sure to wash your hands, stay away from people who are sick and ask your healthcare provider about other measures that may decrease your risk of infection.

• #24 Giant cell arteritis (GCA) | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/giant-cell-arteritis-gca/

  You shouldn’t stop taking your steroid tablets suddenly or alter the dose unless advised by your doctor, even if your symptoms have completely cleared up. […] If the inflammation in the blood vessels returns this is called a relapse, and your steroid dose may have to be increased to deal with this. Relapse is most common within the first 18 months of treatment. […] Your regular check-ups will help to identify any side effects so that they can be treated promptly. […] If you’re on steroids for longer than three months, you may need treatments to prevent thinning of the bones, including calcium and vitamin D supplements. […] Because steroids reduce the activity of the immune system, you may be more likely to develop infections, and they can be more serious. […] If you’re on steroid treatment, you should always carry a steroid card that says what dose you’re on. […] Steroids are the first-line treatment to get GCA under control and prevent any serious complications.

• #25 Giant Cell Arteritis (GCA): Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.giant-cell-arteritis-gca-care-instructions.zc1431

  Take your medicines exactly as prescribed. Call your doctor if you have any problems with your medicine. […] If you are on long-term steroids, talk to your doctor about taking a daily vitamin containing calcium and vitamin D. This can prevent bone thinning caused by the steroids. […] Get regular, gentle exercise to keep your bones strong and prevent bone loss. Walking is a good choice. Exercise can also help you cope with the illness. […] Make sure you get all recommended vaccines. Taking steroids can weaken your immune system, and vaccines can help protect you from getting sick. […] Tell any health professional that cares for you that you are taking steroids. You may want to wear medical alert jewelry that lists this medicine. You can buy this at most drugstores.

• #26 Giant Cell Arteritis (Temporal Arteritis) — Chelsea and Westminster Hospital NHS Foundation Trust

  https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/giant-cell-arteritis-temporal-arteritis

  If the diagnosis of GCA is confirmed, you will be followed up in the rheumatology clinic. You will need several follow-up appointments with your rheumatologist to monitor symptoms as they gradually reduce your steroid dose. You should keep taking the prescribed steroid dose even if symptoms improve as this can help prevent another episode. Steroid dose reduction can result in a relapse of the conditionif symptoms return, please follow the section on symptoms of recurrence. […] While on steroids, you should carry a steroid card at all times. This alerts doctors that you require steroids should you become unwell and need hospitalisation. […] During periods of illness, you must double your dose of steroid for the duration of your illness and speak to your doctor if unsure. This includes diarrhoea, vomiting, fever, flu and dehydration.

• #27 Giant Cell Arteritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/giant-cell-arteritis/

  GCA is a medical emergency and as such should be treated as soon as the diagnosis is suspected because it can lead to blindness. Care for giant cell arteritis focuses on protecting vision, limiting end-organ damage, and reducing toxicity and morbidity due to treatment with glucocorticoids. […] Patients with large vessel vasculitis should be given the best therapy possible, which should be based on shared decision-making among the patient and the rheumatologist and considering efficacy, safety, and cost. […] Acute treatment of complicated giant cell arteritis may necessitate admission to the hospital. […] Dietary or lifestyle adjustments have not been found to reduce the risk of giant cell arteritis complications. Patients on corticosteroids should be encouraged to exercise and limit their salt intake to minimize weight gain and fluid retention associated with the class of medication.

• #28 Giant Cell Arteritis – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/giant-cell-arteritis/

  Living with GCA can be challenging at times. […] Sharing your experience with family and friends, connecting with others through a support group, or talking with a mental health professional can help. […] There is no cure at this time for GCA, but with early treatment and careful monitoring, most patients with GCA have a good prognosis.

• #29 Giant Cell Arteritis Caregiver Resources | ACTEMRA® (tocilizumab)

  https://www.actemra.com/gca/living-with-gca/caregiver-support.html

  GCA can be challenging for the people who have it. You, and other family members, are the primary support system for your loved one. It can be rewarding to care for your loved one, but it can also be difficult. See below for tips and resources that may help make you and your loved ones journey a little easier. […] Taking care of a loved one can sometimes feel like a full-time job. Its important to take some time for yourself to relax and ease some stress. Set aside some time to get back into your personal hobbies. […] GCA can affect your loved one not just physically, but also emotionally. Symptoms, like constant headaches or fatigue, can lead to mood changes. Try not to take it personally if this happens. […] If you dont get proper support, taking care of your loved one can take a toll on you. Counseling can help you provide consistent, high-quality care to your loved one and help keep you from burning out. Skilled counselors can help you process your feelings, learn to set boundaries, and improve communication with your loved one. […] Your loved one may be seeing 2 or more healthcare specialists for multiple conditions. If so, ask them if theyre in touch with each other. Its important for them to discuss your loved ones prescriptions and treatment plans.

• #30 Step forward towards treat-to-target management of giant cell arteritis: patients stratification aiming to targeted remission – updated guidelines | Egyptian Rheumatology and Rehabilitation | Full Text

  https://erar.springeropen.com/articles/10.1186/s43166-024-00237-w

  The aim of this work is to develop guidelines for health care professionals in the giant cell arteritis diagnosis and management, based on patients stratification and targeted outcome measures. […] Patient stratification facilitate the initiation of an appropriate management approach for patients with giant cell arteritis aiming at achieving targeted disease remission state and prevention of visual loss and/or development of ischaemic events. Treat to Target approach is a new concept in giant cell arteritis management which aims to provide tight control to achieve and maintain disease remission. This work defined the treatment targets in relation to the disease stage. […] Management of GCA is multidisciplinary and led by a rheumatologist with experience in the management of GCA. Subject to the patients specific presentation, the multidisciplinary team include ophthalmologists, neurologists and plastic and vascular surgeons.

• #31 Giant Cell Arteritis: Examining Challenges in Diagnosis and Treatment – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/features/giant-cell-arteritis-examining-challenges-in-diagnosis-and-treatment/

  Improved biomarkers are needed to monitor disease activity effectively in giant cell arteritis. […] Diagnostic delay in patients with giant cell arteritis can lead to devastating consequences, including stroke or permanent blindness, making it imperative that clinicians maintain a high index of clinical suspicion for the disease. […] Glucocorticoids are the mainstay of treatment for giant cell arteritis. Following diagnosis, prednisone is usually initiated at a daily dose of 40 to 60 mg per day, with tapering generally attempted after the first 4 weeks of treatment. […] For patients whose disease is refractory to glucocorticoids, methotrexate may be used; however, it is associated with only a modest benefit. […] The main challenge of giant cell arteritis is its relapsing nature. […] Dr Unizony noted that there are important unmet needs remaining for patients with giant cell arteritis. First, we need more prednisone-sparing options for patients who do not tolerate tocilizumab or [who have a] flare on tocilizumab. […] So, we need better biomarkers in giant cell arteritis. […] We need to be sure that the medications that keep the symptoms of the disease controlled also prevent the development of these arterial complications.

• #32 Recognition and Management of Polymyalgia Rheumatica and Giant Cell Arteritis | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/1115/p676.html/1000

  Giant cell arteritis requires higher dosages of corticosteroids and urgent referral to a rheumatologist. […] The primary care physician’s coordination of care with a rheumatologist and with other subspecialists, if needed, is essential in the management of giant cell arteritis. […] Initial treatment of giant cell arteritis involves immediate initiation of high-dose corticosteroids followed by urgent referral to a rheumatologist, with additional attention given to prevention of corticosteroid-related conditions. […] 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.

• #33 Giant Cell Arteritis: Symptoms & Treatment | Massachusetts General Hospital

  https://www.massgeneral.org/medicine/rheumatology/treatments-and-services/giant-cell-arteritis

  The Giant Cell Arteritis Program is housed within the Vasculitis Program in the Rheumatology Unit at Massachusetts General Hospital. The aim of the program is to provide high-quality, rapid and longitudinal care to patients with giant cell arteritis and other large vessel vasculitides. […] Our providers aim to establish early diagnosis and implement treatment plans with the goal of rapidly controlling symptoms and preventing subsequent disease relapses. To maximize the effectiveness of treatment and to minimize medication side effects, our approach relies on developing a personalized treatment plan for each patient in a timely manner. […] Due to the concern for vision loss, rapid diagnosis and treatment of giant cell arteritis is imperative. Mass General offers a fast-track giant cell arteritis program that promptly evaluates patients suspected to have the disease. The key components of the program are a clinical evaluation by a provider with expertise in giant cell arteritis and a temporal artery ultrasound that is done at the point of care in the rheumatology office. […] The giant cell arteritis fast-track program was started in 2019 by Dr. Matza, who performs most temporal artery ultrasounds in office. Dr. Matza trained extensively to learn this technique and is one of the first rheumatologist in the United States to offer this diagnostic modality.

• #34 Giant Cell Arteritis Fast Track Clinic – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity/arthritis-and-joint-diseases-center/fast-track-clinic-for-giant-cell-arteritis

  Giant cell arteritis (GCA), also known as temporal arteritis, is the most common of the diseases referred to under the general term of vasculitis. […] The Fast Track Clinic for Giant Cell Arteritis features a multidisciplinary team of specialists with expertise in the diagnosis and treatment of giant cell arteritis. […] Because of the risk of permanent vision loss with giant cell arteritis, prompt diagnosis and treatment of the condition is essential. […] We provide immediate diagnosis, treatment, and if desired, close follow-up for patients diagnosed with giant cell arteritis. […] We also provide second opinions and offer transfer of care for patients with a prior diagnosis of giant cell arteritis.

• #35 British Journal of Nursing – Introducing an ANP-led temporal artery biopsy service for patients with suspected giant cell arteritis

  https://www.britishjournalofnursing.com/content/focus/introducing-an-anp-led-temporal-artery-biopsy-service-for-patients-with-suspected-giant-cell-arteritis/

  Giant cell arteritis (GCA) is an uncommon autoimmune inflammatory vasculopathy that can lead to the destruction and occlusion of various arteries that consequently can cause serious complications such as stroke or sight loss. It is seen as a medical emergency. […] This article discusses the introduction of an advanced nurse practitioner-led temporal artery biopsy service. […] If a patient attends with symptoms strongly suggestive of GCA, guidance advises that they should be immediately started on high-dose glucocorticoid (usually prednisolone 60 mg) until such time as a more definitive diagnosis can be elicited. […] NICE guidance suggests that a CDUS and/or TAB should be ordered to confirm the suspicion of GCA. […] Once started on oral glucocorticoids, the clinical response should be monitored for the first few days and to also check if there have been any undesirable side effects due to the steroids. […] Patients with acute visual loss may initially be given intravenous methylprednisolone 500-1000 mg once a day for 3 days and then started on oral glucocorticoids.

• #36 NHS Royal Devon | Giant cell arteritis

  https://www.royaldevon.nhs.uk/services/rheumatology-musculoskeletal-system-joints/conditions-we-treat/giant-cell-arteritis/

  We offer a fast track service to assess patients with suspected giant cell arteritis. You may have an ultrasound of your temporal arteries on the day you attend and/or you may be referred for a temporal artery biopsy which involves a return trip to hospital. […] If your GP has a strong suspicion of giant cell arteritis they will start you on steroid tablets. If we confirm the diagnosis you will normally stay on steroid tablets for between 12 and 18 months. […] Most patients will therefore also be given a calcium and vitamin D supplement and another tablet to prevent or treat osteoporosis, usually a “bisphosphonate” such as alendronic acid.

• #37 Step forward towards treat-to-target management of giant cell arteritis: patients stratification aiming to targeted remission – updated guidelines | Egyptian Rheumatology and Rehabilitation | Full Text

  https://erar.springeropen.com/articles/10.1186/s43166-024-00237-w

  GCA management should target control of the disease symptoms, avert any damage attributed to GCA, consider any relevant comorbidities and minimize treatment associated side effects. In the meantime, GCA management should aim to maximise the individual patients health-related quality of life. […] Regular follow-up and monitoring of disease activity should be tailored to the individual patients symptoms, clinical findings and disease activity laboratory measures. The follow-up visits frequency is decided in view of the disease activity status and current medications. […] Patients education plays a vital role in the management of GCA particularly for its key warning symptoms, possible complications and its treatment (including treatment-related complications). […] Management of GCA should be based on a shared decision between the patient and the rheumatologist, and should consider the outcome of management, targets, efficacy, safety and costs.

• #38 Giant Cell Arteritis Part 2: Treatment | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/giant-cell-arteritis-part-2-treatment/

  GCA is a form of large vessel vasculitis that can lead to significant morbidity. All patients with suspected GCA need urgent assessment for investigations, treatment, and for monitoring complications. Treatment with glucocorticoids should be initiated upon clinical suspicion of GCA. […] Prevention and appropriate management of relapses is an important aspect of caring for patients with GCA. Each relapse increases total glucocorticoid exposure, thus increasing the burden of adverse glucocorticoid effects. Overall, the treatment of GCA requires an individualized approach focussed on maintaining remission while mitigating the adverse effects of glucocorticoids. […] Treatment with high-dose glucocorticoids should be initiated immediately upon clinical suspicion of GCA. The treatment should not be delayed to facilitate the temporal artery biopsy. Glucocorticoids are the gold-standard agents for GCA.

• #39 Giant Cell Arteritis : Johns Hopkins Vasculitis Center

  https://www.hopkinsvasculitis.org/types-vasculitis/giant-cell-arteritis/

  Treatment decisions should probably be based on the patients symptoms, the hemoglobin, the ESR: ESR alone should not dictate therapy. Because compression fractures develop in one third of patients, prevention and treatment of osteoporosis should be part of initial management. Methotrexate, azathioprine, and cyclophosphamide have been used in rare patients who do not respond to adequate prednisone. Longterm followup is required to detect late recurrences (including the late onset of thoracic aortic aneurysms with aortic regurgitation, congestive heart failure, and aortic dissection). Patients with polymyalgia rheumatica but no symptoms of giant cell arteritis above the neck (such as jaw claudication, headache and visual symptoms) do not need temporal artery biopsy and respond to low-dose prednisone (10 to 20 mg/d orally).

• #40

  https://link.springer.com/article/10.1007/s11940-020-00660-2

  The recommendations of the EULAR that tocilizumab should be considered an add-on drug in patients with refractory or relapsing disease, or in whom a risk factor such as diabetes mellitus increases the risk of glucocorticoid-associated complications have put the findings of the GiACTA trial into practice.

• #41 CE Activity | Giant Cell Arteritis (Temporal Arteritis) | Nurses

  https://www.statpearls.com/nurse/ce/activity/104295

  Giant cell arteritis, prevalent among older individuals, affects medium to large arteries, exhibiting diverse clinical manifestations in both cranial and extracranial locations. […] Timely initiation of glucocorticoids is crucial to prevent blindness. This activity reviews the etiology, complex presentation, various diagnostic modalities, and treatment approaches for giant cell arteritis, empowering healthcare professionals with the necessary knowledge and tools to reduce morbidity and mortality and enhance patient outcomes. […] Implement best practices in the management of giant cell arteritis, incorporating a patient-centered approach and considering individualized treatment goals. […] Collaborate with multidisciplinary teams to improve care coordination for patients with GCA, ensuring a comprehensive approach to diagnosis and management.

• #42 Giant Cell Arteritis – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/giant-cell-arteritis/

  GCA is typically treated with high doses of glucocorticoids such as prednisone, and sometimes with other medications that also suppress the immune system, to control inflammation. […] Prompt treatment usually relieves symptoms, however GCA is a chronic condition with periods of relapse and remission, so ongoing medical care is usually necessary. […] Even with effective treatment, relapse of GCA is common. […] Regular doctor visits and ongoing monitoring of laboratory and imaging tests are important in detecting relapses early. […] Effective treatment of GCA may require the coordinated efforts and ongoing care of a team of medical providers and specialists. […] The best way to manage your disease is to actively partner with your health care providers. […] If you have concerns about your treatment plan, speak up.

• #43 Giant cell arteritis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/giant-cell-arteritis

  When giant cell arteritis is diagnosed and treated early, the prognosis is usually excellent. […] See your doctor regularly to check for side effects of treatment and development of complications. […] Learning everything you can about giant cell arteritis and its treatment can help you feel more in control of your condition.

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