Are steroids alone sufficient for the treatment of giant cell arteritis?

Nicolò Pipitone, Luigi Boiardi, Carlo Salvarani

Research output: Contribution to journalArticle

Abstract

Glucocorticosteroids are the cornerstone of treatment of giant cell arteritis. An initial dose of prednisone or its equivalent of at least 40-60 mg per day as single or divided dose is usually adequate. Glucocorticosteroids may prevent, but usually do not reverse, visual loss. A treatment course of 1-2 years is often required. Some patients, however, have a more chronic-relapsing course and may require low doses of glucocorticosteroids for several years. Glucocorticosteroid-related adverse events are common. In studies on immunosuppressant agents, methotrexate has been used as a glucocorticosteroid-sparing drug with conflicting results. This drug may, however, be given to patients who need high doses of glucocorticosteroids to control active disease and who have serious side effects. A recent pilot study found that infliximab was efficacious in patients with glucocorticosteroid-resistant giant cell arteritis. However, randomized controlled trials are required to define the role of anti-tumor necrosis factor-α agents in the treatment of giant cell arteritis. Finally, low-dose aspirin has been shown in a recent retrospective study to decrease the rate of cranial ischemic complications secondary to giant cell arteritis. It is conceivable that the definition of different patterns of inflammation in giant cell arteritis in the future might facilitate the design of differentiated therapeutic approaches.

Original languageEnglish
Pages (from-to)277-292
Number of pages16
JournalBest Practice and Research: Clinical Rheumatology
Volume19
Issue number2 SPEC. ISS.
DOIs
Publication statusPublished - Apr 2005

Keywords

  • Anti-TNF-α agents
  • Aspirin
  • Azathioprine
  • Glucocorticoids
  • Methotrexate
  • Temporal arteritis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Rheumatology

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