title: Giant Cell Arteritis: Beyond Corticosteroids.
abstract: Giant cell arteritis (GCA) is a large-vessel vasculitis predominantly affecting older people, with a peak incidence between 70 and 79 years of age. If untreated, ischaemic complications can be catastrophic for the patient, including blindness. We review the current treatment paradigms for this condition, the mainstay of which is immediate high-dose glucocorticoid therapy with a gradual dose tapering. Adverse events of glucocorticoid therapy are often observed after 12-24 months and corticosteroid-sparing adjuvant therapies are used in severe disease, multiple flares or patients at high risk of prolonged therapy. The current understanding of the pathogenesis of GCA is explored. This has informed the identification of new potential targets and approaches to treatment. Blockade of interleukin (IL)-6 (tocilizumab) and IL-1 (gevokizumab) are being evaluated in phase III clinical trials. It is hoped that improved risk stratification of organ damage and relapses will be developed using imaging and biomarkers, allowing for individualised treatment for patients; however, there remains further work to be done before this becomes a reality.
authors.affiliation: Rheumatology, Southend University Hospital, Prittlewell Chase, Westcliff-on-sea, Essex, SS0 0RY, UK.
authors.forename: Lauren
authors.initials: L
authors.lastname: Steel
authors.forename: Asad
authors.initials: A
authors.lastname: Khan
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Dasgupta
mesh_terms: D000368:Aged; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007375:Interleukin-1 / Q000037:antagonists & inhibitors; D000093242:Interleukin-6 Inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D007375:Interleukin-1; D000093242:Interleukin-6 Inhibitors; C502936:tocilizumab; C547697:gevokizumab