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Treatments and drugs
By Mayo Clinic staffTreatment for GCA 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 should start feeling better within just a few days, but you may need to continue taking medication for one to two years or longer. After the first month, your doctor may gradually begin to lower the dosage until you reach the lowest dose of corticosteroids needed to control inflammation as measured by sed rate and CRP tests. Some of your symptoms may return during this tapering period.
What are corticosteroids?
Corticosteroids are powerful anti-inflammatory drugs whose effects mimic those of hormones produced by your adrenal glands. The drugs can effectively relieve pain, but prolonged use — especially at high doses — can lead to a number of serious side effects.
Older adults, who are most likely to be treated for giant cell arteritis, are particularly at risk of side effects because they're more prone to certain conditions that also may be caused by corticosteroids. These include:
- Osteoporosis
- High blood pressure
- Muscle weakness
- Glaucoma
- Cataracts
Other possible side effects of corticosteroid therapy include:
- Weight gain
- Increased blood sugar levels, sometimes leading to diabetes
- Thinning skin and increased bruising
- Decreased function of your immune system, leading to delayed healing
To counter the potential side effects of corticosteroid treatment, your doctor is likely to monitor your bone density and may prescribe calcium and vitamin D supplements or other medications to help prevent bone loss. Your doctor is also likely to monitor your blood pressure and may recommend an exercise program, diet changes and medication to keep blood pressure within a normal range. Most side effects go away when the corticosteroid treatment is stopped.
Emerging treatments
Researchers are trying to find therapies that work as well as corticosteroids but cause fewer side effects.
One drug under investigation is methotrexate, which is often used to treat certain cancers and some inflammatory conditions such as rheumatoid arthritis. The hope is that by using both methotrexate and prednisone to treat people with GCA, it would be possible to use less prednisone. Preliminary research results are conflicting, so more research is needed.
Ask your doctor about taking between 81 and 100 milligrams of aspirin daily (anti-platelet therapy). Taken on a daily basis, aspirin may reduce the risk of blindness and stroke.
- Giant cell arteritis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec04/ch033/ch033e.html. Accessed May 25, 2010.
- Giant cell arteritis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/giantcellarteritis.asp. Accessed May 25, 2010.
- Unwin B, et al. Polymyalgia rheumatica and giant cell arteritis. American Family Physician. 2006;74:1547.
- Polymyalgia rheumatica and giant cell arteritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Polymyalgia/default.asp. Accessed May 25, 2010.
- Salvarani C, et al. Polymyalgia rheumatica and giant cell arteritis. Lancet. 2008;372:234.
- Gonzalez-Gay MA, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatic. Arthritis & Rheumatism. 2009;61:1454.
- Hunder GG. Treatment of giant cell (temporal) arteritis. http://www.uptodate.com/home/index.html. Accessed May 25, 2010.
- Hunder GG. Diagnosis of giant cell (temporal) arteritis. http://www.uptodate.com/home/index.html. Accessed May 25, 2010.
- Chang-Miller A (expert opinion). Mayo Clinic, Rochester, Minn. June 2, 2010.
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