Initial treatment of giant cell arteritis (GCA)

GCA: giant cell arteritis; IV: intravenous; SUBQ: subcutaneous.

* Visual manifestations include amaurosis fugax or unilateral visual loss. Cerebrovascular events include stroke, transient ischemic attack, and diplopia.

¶ The approach to medical therapy for patients with large-vessel involvement is the same as for those with cranial arteritis.

Δ Patients at increased risk for developing glucocorticoid-related side effects or complications include those with osteoporosis, diabetes, uncontrolled hypertension, or glaucoma.

◊ Upadacitinib is an appropriate option for patients who have contraindications to tocilizumab (eg, gastrointestinal perforation, diverticulitis). Some experts would use either tocilizumab or upadacitinib for all patients with GCA; an accelerated glucocorticoid taper is appropriate only for patients using 1 of these agents. Refer to UpToDate for guidance on tocilizumab, upadacitinib, and accelerated glucocorticoid tapers for GCA.

§ Refer to UpToDate for guidance on standard glucocorticoid tapers for GCA.

¥ Refer to UpToDate content for details regarding the frequency of routine follow-up, laboratory testing, and imaging surveillance for large-vessel GCA. If there is evidence of disease flare with glucocorticoid taper, refer to algorithm on the treatment of relapsing GCA.

‡ The decision on when and whether to stop tocilizumab or upadacitinib therapy must be individualized; refer to UpToDate content for discussion.