18th January 2024

Management

All patients with suspected GCA should be referred for urgent specialist assessment, but this should not delay initiation of treatment.

Treatment involves steroids, as follows:

• 40mg Prednisolone daily, unless the patient has ischaemic symptoms
• 60mg Prednisolone daily in the presence of ischaemic symptoms, i.e. jaw claudication/visual loss
• Admission for IV Methylprednisolone may be indicated in the presence of visual symptoms (along with urgent ophthalmic assessment)

After resolution of symptoms, steroids can be tapered, and this is often a long and protracted process. Relapses are common and respond to increasing the dose back up to the last effective dose. If steroids are ineffective or not tolerated, methotrexate or tocilizumab (IL-6 inhibitor) may be considered by rheumatologists.