Giant cell arteritis treatment [Neurosurgery Wiki]

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====== Giant cell arteritis treatment ======

No known cure for [[giant cell arteritis]]. [[Steroid]]s can produce symptomatic relief and usually prevent [[blindness]] (progression of ocular problems 24–48 hrs after the institution of adequate steroids is rare). Totally blind patients or those with longstanding partial [[visual loss]] are unlikely to respond to any [[treatment]].

1. for most cases:

a) start with [[prednisone]], 40–60 mg/d PO divided BID-QID (qod dosing is usually not effective in
initial management)

b) if no response after 72 hrs, and diagnosis certain, ↑ to 10–25mg QID

c) once response occurs (usually within 3–7 days), give the entire dose as q AM dose for 3–6 weeks
until symptoms resolved and ESR normalizes (occurs in 87% of patients within ≈ 4 weeks) or
stabilizes at < 40–50 mm/hr

d) once quiescent, a gradual taper is performed to prevent exacerbations: reduce by 10 mg/d q
2–4 weeks to 40 mg/d, then by 5 mg/d q 2–4 wks to 20 mg/d, then by 2.5 mg/d q 2–4 wks to
5–7.5 mg/d which is maintained for several months, followed by 1 mg/d decrements q 1–3
mos (usual length of treatment is 6–24 mos; do not D/C steroids when ESR normalizes)

e) if symptoms recur during treatment, prednisone dose is temporarily increased until symptoms
resolve (isolated rise in ESR is not sufficient reason to increase steroids)

f) patients should be followed closely for ≈ 2 years

2. in severely ill patients: methylprednisolone, 15–20mg IV QID

3. anticoagulant therapy: controversial

4. acute blindness (onset within 24–36 hrs) in a patient with giant cell arteritis:

a) consider up to 500mg methylprednisolone IV over 30–60 mins (no controlled studies show
reversal of blindness)

b) some have used intermittent inhalation of 5% carbon dioxide and oxygen