Page 351 - The Vasculitides, Volume 1: General Considerations and Systemic Vasculitis

Giant Cell Arteritis 325

Table 2. Prednisolone Dose Reduction Regimens

BSR Regimen* Bristol Royal Infirmary Regimen 2013*
? 40-60 mg prednisolone (not <0.75 ? 60 mg prednisolone for 4 weeks
mg/kg) continued for 4 weeks (until resolution ? Then reduce dose by 10 mg every 2
of symptoms and laboratory abnormalities). weeks to 20mg, then
? Then dose is reduced by 10mg every ? 17.5 mg for 4 weeks, then
2 weeks to20 mg. ? 15 mg for 4 weeks
? Then by 2.5 mg every 2-4 weeks to ? 12.5 mg for 4 weeks
10 mg. ? 10 mg for 1 year
? Then by 1 mg every 1-2 months ? Then reduce by 1mg per month
provided there is no relapse

*From [12]. Abbreviation: BSR, British Society of Rheumatology.

Conclusion

GCA is a common, serious and treatable vasculitis that affects older adults. Rapid access
and management care pathways ensure the early referral of untreated suspected patients for
readily available TAB especially warranted in those with low to moderate probability of
disease, and appropriate primary and secondary care to prevent excess morbidity and
mortality associated with empiric and often unwarranted high-dose glucocorticoid therapy.
Published guidelines for GCA diagnosis and management need to be rigorously examined to
assess the impact of CRP, TAUS signs, large vessel imaging, and TAB in any given patient,
especially those who warrant empiric high dose glucocorticoids due to impending visual loss.
Moreover, guidelines need to reflect a unified definition of clinical relapse. Studies assessing
the link between clinical symptoms, inflammatory markers, imaging techniques and
mimicking conditions will be very valuable. Finally, long-term vascular complications are
increasingly recognized in GCA, and this is blurring the margin between atherosclerosis and
vasculitis, which may improve our understanding of both these conditions [65].

References

[1] Ward TN, Levin N. Headache in giant cell arteritis and other arteritides. Neurol. Sci.,
2005; 26:S134–S137.

[2] Hutchinson J. Diseases of the arteries: on a peculiar form of thrombotic arteritis of the
aged which is sometimes productive of gangrene. Arch. Surg., 1890; 1:323–329.

[3] Horton BT, Magath TB, Brown GE. An undescribed form of arteritis of temporal
vessels. Mayo Clin. Proc., 1932; 7:700–701.

[4] Jennette JC, Falk RJ, Bacon PA, et al. 2012 Revised International Chapel Hill
Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013; 65:1–11.

[5] Ostberg G. Morphological changes in the large arteries in polymyalgia arteritica. Acta.
Med. Scand. Suppl., 1972; 533:135–159.

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