Treatment of giant cell arteritis (GCA)



1st Line Strategy - GC 0.7 mg/kg/day, except for:

 • Aortitis complicated by aneurysm and/or dissection - 1 mg/kg/day

 • Ischemic complications - 1 mg/kg/day (AION/CRAO, scalp necrosis, stroke)

Relapses - When to start GC-sparing agents?

 • 1st relapse: Incr GC if dose <7.5 mg/d, start MTX or TCZ in case of GC-dependence 27.5 mg/jd

 • 2nd relapse: MTX and/or TCZ if never received; or MTX -> TCZ or vice-versa

 • >2 relapses: discuss therapeutic trials if TCZ and MTX already received

Which GC-Sparing Agents?

 • Methotrexate : 7.5 to 15 mg (or 20 mg) per week orally or SC for > 1 year

 • Tocilizumab : 162 mg weekly SC for > 1 year



By Thibault Ghesquière via Dr. Benjamin Terrier @TerrierBen



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