The treatment of giant cell arteritis.
Although giant cell arteritis (GCA) is a well-known vasculitis sensitive to corticosteroid-mediated immunosuppression, numerous issues of long-term therapeutic management remain unresolved. Because GCA encompasses a broad spectrum of clinical subtypes, ranging from devastating visual loss and neurological deficits to isolated systemic symptoms, the treatment of GCA must be adjusted to each case, and recommendations vary widely in the literature. This article systematically reviews the treatment options for patients with neuro-ophthalmic and neurological complications of GCA, as well as the evidence for possible adjuvant therapies for patients with GCA. Although there is no randomized controlled clinical trial specifically evaluating GCA patients with ocular and neurological complications, we recommend that GCA patients with acute visual loss or brain ischemia be admitted to the hospital for high-dose intravenous methyl-prednisolone, close monitoring, and prevention of steroid-induced complications. Aspirin may also be helpful in these cases. The evidence supporting the use of steroid-sparing immunomodulatory agents such as methotrexate for long-term management remains debated.
Fraser
J Alexander
JA
Department of Clinical Neurological Sciences, University of Western Ontario School of Medicine, London, Ontario, Canada.
Weyand
Cornelia M
CM
Newman
Nancy J
NJ
Biousse
Valérie
V
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D004334:Drug Administration Schedule; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D013700:Giant Cell Arteritis / Q000145:classification / Q000150:complications / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D018917:Optic Neuropathy, Ischemic / Q000150:complications / Q000628:therapy*
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D005343:Fibrinolytic Agents; D007166:Immunosuppressive Agents; D008775:Methylprednisolone; D008727:Methotrexate