Materiały źródłowe

• #1 Giant Cell Arteritis – Symptoms, Causes and Treatments

  https://resources.healthgrades.com/right-care/vascular-conditions/giant-cell-arteritis

  It is generally not possible to prevent GCA. The exact cause of it is unclear and the risk factors for it are not modifiable. […] Sudden and permanent vision loss can occur. Seek prompt medical care for any symptoms of GCA or new, persistent headache. Starting treatment right away can prevent blindness. […] Low-dose aspirin therapy is another treatment approach. It can help prevent stroke, which is a possible complication of GCA.

• #2 Giant cell arteritis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000448.htm

  There is no known prevention.

• #3 Giant Cell Arteritis and Polymyalgia Rheumatica – familydoctor.org

  https://familydoctor.org/condition/giant-cell-arteritis-and-polymyalgia-rheumatica/

  There is no known way to prevent GCA or PMR because doctors aren’t sure what causes them.

• #4 The spectrum of giant cell arteritis through a rheumatology lens | Eye

  https://www.nature.com/articles/s41433-024-03153-7

  Treatment of giant cell arteritis (GCA) aims initially to prevent acute visual loss, and subsequently to optimise long-term quality of life. […] Initial prevention of acute visual loss in GCA is well-standardised with high-dose glucocorticoid therapy but in the longer term optimising quality of life requires tailoring of treatment to the individual. […] Preventing visual loss, which includes protecting the second eye if monocular visual loss has already occurred is a fundamental tenet of early treatment of GCA. […] When GCA is strongly suspected, therefore, high-dose glucocorticoid therapy is started as soon as possible. […] According to a literature review published in 2005, in the era before glucocorticoid therapy was available (before 1950), on average 49.9% of patients with GCA had some degree of vision loss, including partial visual loss, and 17.6% had bilateral blindness; once one eye was involved, 34% of patients developed complete visual loss.

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

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

  If you’re diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent vision loss. […] Prompt treatment with corticosteroid medications usually relieves symptoms of giant cell arteritis and might prevent loss of vision.

• #6 Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/15077317/

  At the time of the diagnosis of GCA, 36 patients (21%) had already been receiving low-dose aspirin (100 mg/day). […] These data suggest that low-dose aspirin decreases the rate of visual loss and CVAs in patients with GCA.

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

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

  Retrospective but impressive data from Nesher and colleagues support the use of low-dose aspirin (81 mg) in patients with GCA for prevention of visual loss and stroke. […] Patients on steroid therapy may receive prophylactic treatment with the following medications: Low-dose aspirin, 81 mg per day to decrease cranial ischemic complications. […] Long-term high-dose steroid therapy increases risk for peptic ulcer disease, particularly in patients older than 65 years, so prophylaxis with histamine-2 blockers, proton pump inhibitors, or antacids is justified, especially in patients who are also taking nonsteroidal anti-inflammatory drugs.

• #8 Giant cell arteritis: Current treatment and management

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

  Given the significant burden of morbidity associated with long term glucocorticoid treatment, current BSR guidelines for the management of GCA recommend consideration of the early introduction of methotrexate or alternative immunosuppressant therapy following a relapse. […] The search for an effective disease-modifying agent for the treatment of GCA has proven elusive. […] The use of low-dose aspirin (75-150 mg/d) is routinely recommended for patients with GCA in the absence of contraindications. […] The treatment of GCA requires both long-term and high dose glucocorticoid therapy. […] Gastrointestinal protection is recommended with proton pump inhibitors, especially if concomitant risk factors are present such as NSAID use, and older age. […] Despite the severe consequences of untreated GCA, such as blindness, there is no consensus on the optimal therapeutic strategies for this disease.

• #9 Giant Cell Arteritis (Temporal Arteritis) Guidelines: Guidelines Summary

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

  Nesher G, Berkun Y, Mates M, Baras M, Rubinow A, Sonnenblick M. Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum. 2004 Apr. 50(4):1332-7. [QxMD MEDLINE Link]. […] [Guideline] Mackie SL, Dejaco C, Appenzeller S, et al. British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis: executive summary. Rheumatology (Oxford). 2020 Mar 1. 59 (3):487-494. [QxMD MEDLINE Link]. [Full Text].

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

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

  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. […] Low-dose aspirin should be used as an adjunctive treatment to decrease the risk of ischemic events in patients with giant cell arteritis. […] Surveillance for osteoporosis and treatment with agents proven to increase bone mineral density and decrease fracture risk in patients with glucocorticoid-induced osteoporosis, such as alendronate and risedronate, are recommended. […] All patients should be monitored for long-term complications of high-dose corticosteroid use. […] Medications that protect patients from osteoporosis (such as bisphosphonates) and gastrointestinal ulcers (such as proton pump inhibitors) should be initiated. […] Immunization against pneumococcus and influenza is also necessary.

• #11 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. […] Treatment with high doses of glucocorticoids should be initiated as early as possible to prevent ischaemic manifestations, such as blindness (occurring in up to 20%). […] 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. […] The BSR has proposed a standard tapering scheme after 1 mo of treatment: reducing by 10 mg of prednisolone every 2 wk to 20 mg, then another 2.5 mg every 2-4 wk to 10 mg, followed by a decrease of 1 mg every 1-2 mo.

• #12

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

  Giant cell arteritis must be treated urgently, as it is associated with a significant risk of permanent visual loss, stroke, aneurysm and possible death. A low threshold for suspicion and prompt corticosteroid treatment are essential to prevent these complications. […] Whenever there is a reasonable suspicion of the condition, discuss the patient with an Ophthalmologist or Rheumatologist to organise referral for a temporal artery biopsy, and initiate same-day treatment with corticosteroids. Where there is a strong clinical suspicion of giant cell arteritis, a delay in treatment will almost always have greater consequences than an unnecessary dose of corticosteroids in someone who is later found to not to have the condition. […] Most guidelines recommend oral prednisone 40-60 mg, once daily, for patients with giant cell arteritis, with the higher dose used in patients with ischaemic symptoms.

• #13 The spectrum of giant cell arteritis through a rheumatology lens | Eye

  https://www.nature.com/articles/s41433-024-03153-7

  Treatment of giant cell arteritis (GCA) aims initially to prevent acute visual loss, and subsequently to optimise long-term quality of life. […] Initial prevention of acute visual loss in GCA is well-standardised with high-dose glucocorticoid therapy but in the longer term optimising quality of life requires tailoring of treatment to the individual. […] Preventing visual loss, which includes protecting the second eye if monocular visual loss has already occurred is a fundamental tenet of early treatment of GCA. […] When GCA is strongly suspected, therefore, high-dose glucocorticoid therapy is started as soon as possible. […] According to a literature review published in 2005, in the era before glucocorticoid therapy was available (before 1950), on average 49.9% of patients with GCA had some degree of vision loss, including partial visual loss, and 17.6% had bilateral blindness; once one eye was involved, 34% of patients developed complete visual loss.

• #14 The spectrum of giant cell arteritis through a rheumatology lens | Eye

  https://www.nature.com/articles/s41433-024-03153-7

  After glucocorticoid treatment became available, visual loss was reported in 29.2% and bilateral blindness in 5.8%. […] The authors noted higher rates of visual loss in reports from ophthalmology clinics than from rheumatology clinics. […] GCA patients presenting with a history of transient ischaemic visual symptoms are at higher risk of future visual loss; and GCA patients presenting with unilateral visual loss are at highest risk of progressing to bilateral visual loss. […] Strongly-suspected cranial GCA with ischaemic (especially visual) symptoms requires immediate treatment without even waiting for blood test results. […] A more diagnostically-ambiguous case of suspected GCA, in the absence of any ischaemic visual, jaw or tongue symptoms, might be better to defer glucocorticoid treatment until reviewed by a specialist, and/or until blood results are back, and/or until vascular ultrasound can be done the next working day.

• #15 The spectrum of giant cell arteritis through a rheumatology lens | Eye

  https://www.nature.com/articles/s41433-024-03153-7

  After glucocorticoid treatment became available, visual loss was reported in 29.2% and bilateral blindness in 5.8%. […] The authors noted higher rates of visual loss in reports from ophthalmology clinics than from rheumatology clinics. […] GCA patients presenting with a history of transient ischaemic visual symptoms are at higher risk of future visual loss; and GCA patients presenting with unilateral visual loss are at highest risk of progressing to bilateral visual loss. […] Strongly-suspected cranial GCA with ischaemic (especially visual) symptoms requires immediate treatment without even waiting for blood test results. […] A more diagnostically-ambiguous case of suspected GCA, in the absence of any ischaemic visual, jaw or tongue symptoms, might be better to defer glucocorticoid treatment until reviewed by a specialist, and/or until blood results are back, and/or until vascular ultrasound can be done the next working day.

• #16

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

  Giant cell arteritis must be treated urgently, as it is associated with a significant risk of permanent visual loss, stroke, aneurysm and possible death. A low threshold for suspicion and prompt corticosteroid treatment are essential to prevent these complications. […] Whenever there is a reasonable suspicion of the condition, discuss the patient with an Ophthalmologist or Rheumatologist to organise referral for a temporal artery biopsy, and initiate same-day treatment with corticosteroids. Where there is a strong clinical suspicion of giant cell arteritis, a delay in treatment will almost always have greater consequences than an unnecessary dose of corticosteroids in someone who is later found to not to have the condition. […] Most guidelines recommend oral prednisone 40-60 mg, once daily, for patients with giant cell arteritis, with the higher dose used in patients with ischaemic symptoms.

• #17

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

  Aspirin, 100 mg, daily, should be considered for patients without contraindications as there is some evidence that it decreases the rate of visual loss and other cerebrovascular complications. […] Vitamin D supplements and advice to maintain adequate calcium intake should be given to all patients in order to limit the adverse effects of long-term prednisone treatment. […] A follow-up consultation should be scheduled to ensure there are no signs or symptoms of relapse of giant cell arteritis, and to monitor the adverse effects of corticosteroid treatment.

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

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

  GCA is treated right away to prevent blindness. Your doctor will prescribe steroids that you take as pills. […] 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. […] Make sure you get all recommended vaccines. Taking steroids can weaken your immune system, and vaccines can help protect you from getting sick.

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

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

  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. […] Low-dose aspirin should be used as an adjunctive treatment to decrease the risk of ischemic events in patients with giant cell arteritis. […] Surveillance for osteoporosis and treatment with agents proven to increase bone mineral density and decrease fracture risk in patients with glucocorticoid-induced osteoporosis, such as alendronate and risedronate, are recommended. […] All patients should be monitored for long-term complications of high-dose corticosteroid use. […] Medications that protect patients from osteoporosis (such as bisphosphonates) and gastrointestinal ulcers (such as proton pump inhibitors) should be initiated. […] Immunization against pneumococcus and influenza is also necessary.

• #20 Giant Cell Arteritis | Tampa Rheumatology

  https://www.tamparheumatology.com/giant-cell-arteritis.php

  Giant cell arteritis is treated with high doses of corticosteroids, such as prednisone. […] Patients with giant cell arteritis may also be advised to begin a regimen of aspirin to increase blood flow and lessen the risk of aneurysm, blindness, or stroke. […] In order to counteract some of the possible side effects of corticosteroid treatments, patients are usually prescribed calcium and vitamin D supplements or other bone-preserving medications. […] They may also be advised to monitor their blood pressure, begin an exercise regimen, and alter their diet.

• #21 Giant cell arteritis treatment patterns and rates of serious infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10475312/

  Potential infectious risks of immunosuppressive treatment for GCA may be mitigated by preventive measures including vaccination and use of prophylactic anti-infective medications. […] The US Centers for Disease Control and Preventions Advisory Committee on Immunization Practices and the European Alliance of Associations for Rheumatology (EULAR) recommend pneumococcal vaccination and annual influenza vaccination for GCA patients; live-attenuated virus vaccination against herpes zoster is recommended for those using prednisone 20mg/day or less. […] Prophylaxis against Pneumocystis jiroveci pneumonia is commonly used in the care of patients with systemic rheumatic disease, with a number needed to treat of 19 when the risk of Pneumocystis jiroveci pneumonia is 6.2% or greater; however, data on the risk of Pneumocystis jiroveci pneumonia in GCA are lacking.

• #22 Giant cell arteritis treatment patterns and rates of serious infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10475312/

  Potential infectious risks of immunosuppressive treatment for GCA may be mitigated by preventive measures including vaccination and use of prophylactic anti-infective medications. […] The US Centers for Disease Control and Preventions Advisory Committee on Immunization Practices and the European Alliance of Associations for Rheumatology (EULAR) recommend pneumococcal vaccination and annual influenza vaccination for GCA patients; live-attenuated virus vaccination against herpes zoster is recommended for those using prednisone 20mg/day or less. […] Prophylaxis against Pneumocystis jiroveci pneumonia is commonly used in the care of patients with systemic rheumatic disease, with a number needed to treat of 19 when the risk of Pneumocystis jiroveci pneumonia is 6.2% or greater; however, data on the risk of Pneumocystis jiroveci pneumonia in GCA are lacking.

• #23 Giant cell arteritis treatment patterns and rates of serious infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10475312/

  Use of prophylaxis against Pneumocystis jiroveci pneumonia was uncommon in both cohorts (15%). Notably, the incidence rate for Pneumocystis jiroveci pneumonia was low in both cohorts (approximately 0.08 per 100 person-years). […] Annual influenza vaccination rates were suboptimal in both cohorts: 64.5% in Medicare and 27.7% in MarketScan in the year before index date, though information on vaccination may have been missing if patients received immunizations without billing through insurance.

• #24 Giant cell arteritis treatment patterns and rates of serious infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10475312/

  Potential infectious risks of immunosuppressive treatment for GCA may be mitigated by preventive measures including vaccination and use of prophylactic anti-infective medications. […] The US Centers for Disease Control and Preventions Advisory Committee on Immunization Practices and the European Alliance of Associations for Rheumatology (EULAR) recommend pneumococcal vaccination and annual influenza vaccination for GCA patients; live-attenuated virus vaccination against herpes zoster is recommended for those using prednisone 20mg/day or less. […] Prophylaxis against Pneumocystis jiroveci pneumonia is commonly used in the care of patients with systemic rheumatic disease, with a number needed to treat of 19 when the risk of Pneumocystis jiroveci pneumonia is 6.2% or greater; however, data on the risk of Pneumocystis jiroveci pneumonia in GCA are lacking.

• #25 Giant cell arteritis treatment patterns and rates of serious infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10475312/

  Use of prophylaxis against Pneumocystis jiroveci pneumonia was uncommon in both cohorts (15%). Notably, the incidence rate for Pneumocystis jiroveci pneumonia was low in both cohorts (approximately 0.08 per 100 person-years). […] Annual influenza vaccination rates were suboptimal in both cohorts: 64.5% in Medicare and 27.7% in MarketScan in the year before index date, though information on vaccination may have been missing if patients received immunizations without billing through insurance.

• #26 Is PJP Prophylaxis Indicated in Patients With Giant Cell Arteritis or Polymyalgia Rheumatica?

  https://www.hcplive.com/view/is-pjp-prophylaxis-indicated-in-patients-with-giant-cell-arteritis-or-polymyalgia-rheumatica-

  Results of a recent study showed that the risk of pneumocystis jiroveci pneumonia (PJP) is low in patients with giant cell arteritis (GCA) and polymyalgia rheumatica (PMR), therefore discouraging the routine prescribing of PJP prophylaxis for this patient population. […] Guidelines recommend PJP prophylaxis in patients with ANCA-associated vasculitis, but no formal recommendations exist for giant cell arteritis (GCA) or polymyalgia rheumatica (PMR). […] Ultimately, as rheumatologists we are balancing control of underlying disease and risks of immunosuppressive treatment. This data suggests the risk of PJP in patients with GCA or PMR are low, and it is important to recognize the potential range of adverse events from PJP prophylaxis are vast, including methemoglobinemia and agranulocytosis. Given these findings, the authors concluded these data do not support routine prescribing of PJP prophylaxis for patients with GCA or PMR.

• #27 Is PJP Prophylaxis Indicated in Patients With Giant Cell Arteritis or Polymyalgia Rheumatica?

  https://www.hcplive.com/view/is-pjp-prophylaxis-indicated-in-patients-with-giant-cell-arteritis-or-polymyalgia-rheumatica-

  Results of a recent study showed that the risk of pneumocystis jiroveci pneumonia (PJP) is low in patients with giant cell arteritis (GCA) and polymyalgia rheumatica (PMR), therefore discouraging the routine prescribing of PJP prophylaxis for this patient population. […] Guidelines recommend PJP prophylaxis in patients with ANCA-associated vasculitis, but no formal recommendations exist for giant cell arteritis (GCA) or polymyalgia rheumatica (PMR). […] Ultimately, as rheumatologists we are balancing control of underlying disease and risks of immunosuppressive treatment. This data suggests the risk of PJP in patients with GCA or PMR are low, and it is important to recognize the potential range of adverse events from PJP prophylaxis are vast, including methemoglobinemia and agranulocytosis. Given these findings, the authors concluded these data do not support routine prescribing of PJP prophylaxis for patients with GCA or PMR.

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

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

  Retrospective but impressive data from Nesher and colleagues support the use of low-dose aspirin (81 mg) in patients with GCA for prevention of visual loss and stroke. […] Patients on steroid therapy may receive prophylactic treatment with the following medications: Low-dose aspirin, 81 mg per day to decrease cranial ischemic complications. […] Long-term high-dose steroid therapy increases risk for peptic ulcer disease, particularly in patients older than 65 years, so prophylaxis with histamine-2 blockers, proton pump inhibitors, or antacids is justified, especially in patients who are also taking nonsteroidal anti-inflammatory drugs.

• #29 Giant cell arteritis: Current treatment and management

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

  Given the significant burden of morbidity associated with long term glucocorticoid treatment, current BSR guidelines for the management of GCA recommend consideration of the early introduction of methotrexate or alternative immunosuppressant therapy following a relapse. […] The search for an effective disease-modifying agent for the treatment of GCA has proven elusive. […] The use of low-dose aspirin (75-150 mg/d) is routinely recommended for patients with GCA in the absence of contraindications. […] The treatment of GCA requires both long-term and high dose glucocorticoid therapy. […] Gastrointestinal protection is recommended with proton pump inhibitors, especially if concomitant risk factors are present such as NSAID use, and older age. […] Despite the severe consequences of untreated GCA, such as blindness, there is no consensus on the optimal therapeutic strategies for this disease.

• #30 Steroid-Sparing Agents in Giant Cell Arteritis

  https://openrheumatologyjournal.com/VOLUME/13/PAGE/61/

  Given the substantial morbidity associated with long-term corticosteroid therapy, guidelines (e.g., from the European league against rheumatism [EULAR] and British Society for Rheumatology) recommend that steroid-sparing agents should be used […] Considering all the evidence available for choosing the most appropriate steroid-sparing agent in GCA, a large number of studies favoured TCZ. There is good evidence that it can safely be used for: […] The next best agent for steroid-sparing effect appears to be MTX. There is good quality evidence that supports the use of MTX to reduce flares in relapsing GCA and help in reducing the corticosteroid dose and adverse effects. […] Amongst anti-TNF agents, use of etanercept can be an option in corticosteroid refractory GCA to induce remission. Abatacept, a selective T cell co-stimulation modulator had shown promise in reducing relapse in GCA in RCTs involving a small number of GCA patients. […] Immunosuppressants like azathioprine, mycophenolate, and cyclophosphamide may be used in refractory GCA or large vessel vasculitis patients as third-line agents.

• #31 Steroid-Sparing Agents in Giant Cell Arteritis

  https://openrheumatologyjournal.com/VOLUME/13/PAGE/61/

  Given the substantial morbidity associated with long-term corticosteroid therapy, guidelines (e.g., from the European league against rheumatism [EULAR] and British Society for Rheumatology) recommend that steroid-sparing agents should be used […] Considering all the evidence available for choosing the most appropriate steroid-sparing agent in GCA, a large number of studies favoured TCZ. There is good evidence that it can safely be used for: […] The next best agent for steroid-sparing effect appears to be MTX. There is good quality evidence that supports the use of MTX to reduce flares in relapsing GCA and help in reducing the corticosteroid dose and adverse effects. […] Amongst anti-TNF agents, use of etanercept can be an option in corticosteroid refractory GCA to induce remission. Abatacept, a selective T cell co-stimulation modulator had shown promise in reducing relapse in GCA in RCTs involving a small number of GCA patients. […] Immunosuppressants like azathioprine, mycophenolate, and cyclophosphamide may be used in refractory GCA or large vessel vasculitis patients as third-line agents.

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

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

  Giant cell arteritis is the most important medical emergency in ophthalmology, because of the complication of visual loss. Blindness in temporal arteritis is preventable with early diagnosis, and immediate and aggressive treatment. […] 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. […] 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.

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

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

  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. […] Methotrexate is a potential alternative to tocilizumab as a glucocorticoid-sparing therapy to reduce relapse risk.

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

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

  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. […] Methotrexate is a potential alternative to tocilizumab as a glucocorticoid-sparing therapy to reduce relapse risk.

• #35 Steroid-Sparing Agents in Giant Cell Arteritis

  https://openrheumatologyjournal.com/VOLUME/13/PAGE/61/

  Given the substantial morbidity associated with long-term corticosteroid therapy, guidelines (e.g., from the European league against rheumatism [EULAR] and British Society for Rheumatology) recommend that steroid-sparing agents should be used […] Considering all the evidence available for choosing the most appropriate steroid-sparing agent in GCA, a large number of studies favoured TCZ. There is good evidence that it can safely be used for: […] The next best agent for steroid-sparing effect appears to be MTX. There is good quality evidence that supports the use of MTX to reduce flares in relapsing GCA and help in reducing the corticosteroid dose and adverse effects. […] Amongst anti-TNF agents, use of etanercept can be an option in corticosteroid refractory GCA to induce remission. Abatacept, a selective T cell co-stimulation modulator had shown promise in reducing relapse in GCA in RCTs involving a small number of GCA patients. […] Immunosuppressants like azathioprine, mycophenolate, and cyclophosphamide may be used in refractory GCA or large vessel vasculitis patients as third-line agents.

• #36 Can Beta-blockers Prevent Aortic Dilation in Patients with Giant Cell Arteritis and Large Vessel Vasculitis? – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/can-beta-blockers-prevent-aortic-dilation-in-patients-with-giant-cell-arteritis-and-large-vessel-vasculitis/

  We analyzed whether the use of beta-blockers in addition to conventional care in patients with Giant cell arteritis (GCA) and large vessel vasculitis (LVV) can help reduce the risk of aortic dilatation. […] This study is the first to suggest that beta-blockers in addition to conventional care in patients with GCA and LVV may help reduce the risk of aortic dilatation during follow-up, as in non-inflammatory aortic diseases.

• #37 Diagnosing and Treating Temporal Arteritis: An Overview

  https://conloneyeinstitute.com/understanding-temporal-arteritis/

  While there is no definitive way to prevent GCA, addressing modifiable risk factors such as smoking and maintaining a healthy lifestyle may help reduce the risk of developing the disease. Here are some steps you can take to prevent temporal arteritis potentially: […] Given the established link between smoking and a heightened likelihood of developing temporal arteritis, smoking cessation is particularly important for these patients. Moreover, smoking can exacerbate other conditions, such as diabetes mellitus and hypertension, which can aggravate the symptoms of temporal arteritis. […] Regular check-ups can also be advantageous for the early detection of temporal arteritis. During a physical examination, a physician can assess for tenderness, swelling, or diminished pulse in the temporal arteries, which are usual indications of temporal arteritis. Prompt treatment, facilitated by early recognition, can help avoid complications like vision loss.

• #38 Diagnosing and Treating Temporal Arteritis: An Overview

  https://conloneyeinstitute.com/understanding-temporal-arteritis/

  While there is no definitive way to prevent GCA, addressing modifiable risk factors such as smoking and maintaining a healthy lifestyle may help reduce the risk of developing the disease. Here are some steps you can take to prevent temporal arteritis potentially: […] Given the established link between smoking and a heightened likelihood of developing temporal arteritis, smoking cessation is particularly important for these patients. Moreover, smoking can exacerbate other conditions, such as diabetes mellitus and hypertension, which can aggravate the symptoms of temporal arteritis. […] Regular check-ups can also be advantageous for the early detection of temporal arteritis. During a physical examination, a physician can assess for tenderness, swelling, or diminished pulse in the temporal arteries, which are usual indications of temporal arteritis. Prompt treatment, facilitated by early recognition, can help avoid complications like vision loss.

• #39 Giant Cell Arteritis | Tampa Rheumatology

  https://www.tamparheumatology.com/giant-cell-arteritis.php

  Giant cell arteritis is treated with high doses of corticosteroids, such as prednisone. […] Patients with giant cell arteritis may also be advised to begin a regimen of aspirin to increase blood flow and lessen the risk of aneurysm, blindness, or stroke. […] In order to counteract some of the possible side effects of corticosteroid treatments, patients are usually prescribed calcium and vitamin D supplements or other bone-preserving medications. […] They may also be advised to monitor their blood pressure, begin an exercise regimen, and alter their diet.

• #40 How to Manage Patients with Giant Cell Arteritis and Polymyalgia Rheumatica – Page 3 of 3 – The Rheumatologist

  https://www.the-rheumatologist.org/article/manage-patients-giant-cell-arteritis-polymyalgia-rheumatica/3/

  Weve all seen what happens to our patients on high-dose steroids, she said. They lose muscle. They gain fat, they are weak, fatigued and tired. So early prescription of an exercise program for strengthening and fall prevention is important for GCA and PMR. […] Accurate diagnosis and prompt initiation of therapy are of great importance to prevent serious complications, with the most feared being […] Patients with polymyalgia rheumatica (PMR) or peripheral arthritis may require extra vigilance during treatment because of a suspected link to giant cell arteritis (GCA) and, potentially, permanent vision loss.

• #41

  https://www.healio.com/news/rheumatology/20230403/eular-recommendations-for-giant-cell-arteritis-pmr-prioritize-remission-as-target

  The treatment target for patients with giant cell arteritis or polymyalgia rheumatica should be remission, with vascular damage prevention taking priority in patients with GCA, according to treat-to-target recommendations from EULAR. […] Additionally, GCA therapy should focus on preventing tissue ischemia and vascular damage. […] The primary treatment target for GCA and PMR is remission, defined as the absence of clinical symptoms and systemic inflammation. […] Remission should be maintained using the smallest, effective possible doses of medication.

• #42

  https://www.healio.com/news/rheumatology/20230403/eular-recommendations-for-giant-cell-arteritis-pmr-prioritize-remission-as-target

  The treatment target for patients with giant cell arteritis or polymyalgia rheumatica should be remission, with vascular damage prevention taking priority in patients with GCA, according to treat-to-target recommendations from EULAR. […] Additionally, GCA therapy should focus on preventing tissue ischemia and vascular damage. […] The primary treatment target for GCA and PMR is remission, defined as the absence of clinical symptoms and systemic inflammation. […] Remission should be maintained using the smallest, effective possible doses of medication.

• #43 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

  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. […] 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. […] GCA treatment strategy should be guided by disease stratification. This can be achieved through using clinical, biomarkers, histology, and imaging parameters as well as the presence of associated comorbidities and possible medical therapy associated complications.

• #44 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

  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. […] 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. […] GCA treatment strategy should be guided by disease stratification. This can be achieved through using clinical, biomarkers, histology, and imaging parameters as well as the presence of associated comorbidities and possible medical therapy associated complications.

• #45 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

  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). As GCA and PMR are interlinked, patients should receive information on both conditions. The patients should be aware of the risk of relapse and possible ischaemic complications should they stop glucocorticoids therapy abruptly on their own. […] 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.

• #46 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

  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). As GCA and PMR are interlinked, patients should receive information on both conditions. The patients should be aware of the risk of relapse and possible ischaemic complications should they stop glucocorticoids therapy abruptly on their own. […] 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.

• #47 Antiplatelet therapy to prevent ischemic events in giant cell arteritis: protocol for a systematic review and meta-analysis | Systematic Reviews | Full Text

  https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-024-02599-w

  Giant cell arteritis (GCA) is the most common systemic vasculitis in adults. […] Oral antiplatelet therapy has been hypothesized to reduce GCA-related ischemic events. […] Antiplatelet agents are affordable, accessible, and could be effective for the prevention of these events. […] Assessing the efficacy of antiplatelet therapy to prevent these events is critically important. […] The objective of this systematic review and meta-analysis is to assess the safety and efficacy of antiplatelet therapy for the prevention of ischemic events in adults with GCA. […] The findings of this review are anticipated to assist advocacy groups and task teams to develop practice guidelines, which will optimize the management in GCA and hopefully assist in preventing ischemic complications.

• #48 Antiplatelet therapy to prevent ischemic events in giant cell arteritis: protocol for a systematic review and meta-analysis | Systematic Reviews | Full Text

  https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-024-02599-w

  Giant cell arteritis (GCA) is the most common systemic vasculitis in adults. […] Oral antiplatelet therapy has been hypothesized to reduce GCA-related ischemic events. […] Antiplatelet agents are affordable, accessible, and could be effective for the prevention of these events. […] Assessing the efficacy of antiplatelet therapy to prevent these events is critically important. […] The objective of this systematic review and meta-analysis is to assess the safety and efficacy of antiplatelet therapy for the prevention of ischemic events in adults with GCA. […] The findings of this review are anticipated to assist advocacy groups and task teams to develop practice guidelines, which will optimize the management in GCA and hopefully assist in preventing ischemic complications.

• #49 Point-of-Care Ultrasound With Artificial Intelligence–Driven Diagnostics in Giant Cell Arteritis: Blindness Prevention on a Global Scale | The Journal of Rheumatology

  https://www.jrheum.org/content/51/10/1040?rss=1

  Giant cell arteritis (GCA) is the most common autoimmune systemic vasculitis of older adults. […] Fast-tracking diagnostic pathways and raising public awareness to complications of preventable blindness and stroke from GCA need to be done akin to get with the guidelines (GWTG) stroke quality improvement measures created by the American Heart Association and the American Stroke Association. […] It is therefore time to move GCA to a stroke of the eye category or risk blindness in a significant percentage of patients owing to delayed treatment or diagnosis. To date, there is not a single protocol for prevention of blindness in GCA anywhere across Europe or North America. A universal protocol based on a centralized cloud-based data collection system modeled on POCUS data acquisition and an artificial intelligence (AI)-driven diagnostic platform that provides instantaneous results for a clinician are urgently needed to prevent blindness.

• #50 Point-of-Care Ultrasound With Artificial Intelligence–Driven Diagnostics in Giant Cell Arteritis: Blindness Prevention on a Global Scale | The Journal of Rheumatology

  https://www.jrheum.org/content/51/10/1040?rss=1

  Giant cell arteritis (GCA) is the most common autoimmune systemic vasculitis of older adults. […] Fast-tracking diagnostic pathways and raising public awareness to complications of preventable blindness and stroke from GCA need to be done akin to get with the guidelines (GWTG) stroke quality improvement measures created by the American Heart Association and the American Stroke Association. […] It is therefore time to move GCA to a stroke of the eye category or risk blindness in a significant percentage of patients owing to delayed treatment or diagnosis. To date, there is not a single protocol for prevention of blindness in GCA anywhere across Europe or North America. A universal protocol based on a centralized cloud-based data collection system modeled on POCUS data acquisition and an artificial intelligence (AI)-driven diagnostic platform that provides instantaneous results for a clinician are urgently needed to prevent blindness.

• #51 Point-of-Care Ultrasound With Artificial Intelligence–Driven Diagnostics in Giant Cell Arteritis: Blindness Prevention on a Global Scale | The Journal of Rheumatology

  https://www.jrheum.org/content/51/10/1040?rss=1

  Currently, there are no consistent guidelines for general practitioners, rheumatologists, neurologists, or ophthalmologists that recommend a specific pathway to use ultrasound as a screening tool for patients with symptoms suggestive of GCA in adult patients (age 50 yrs). Patients with GCA symptoms are a treatable clinical emergency if the symptoms are correctly identified.

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

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

  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. […] Low-dose aspirin should be used as an adjunctive treatment to decrease the risk of ischemic events in patients with giant cell arteritis. […] Surveillance for osteoporosis and treatment with agents proven to increase bone mineral density and decrease fracture risk in patients with glucocorticoid-induced osteoporosis, such as alendronate and risedronate, are recommended. […] All patients should be monitored for long-term complications of high-dose corticosteroid use. […] Medications that protect patients from osteoporosis (such as bisphosphonates) and gastrointestinal ulcers (such as proton pump inhibitors) should be initiated. […] Immunization against pneumococcus and influenza is also necessary.

• #53 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

  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). As GCA and PMR are interlinked, patients should receive information on both conditions. The patients should be aware of the risk of relapse and possible ischaemic complications should they stop glucocorticoids therapy abruptly on their own. […] 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.

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