Temporal arteritis medical therapy: Difference between revisions
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High-dose steroid therapy should be maintained only long enough for symptoms to resolve. Steroids should then be tapered slowly to the lowest dose required to suppress symptoms. | High-dose steroid therapy should be maintained only long enough for symptoms to resolve. Steroids should then be tapered slowly to the lowest dose required to suppress symptoms. | ||
==References== | ==References== |
Revision as of 19:36, 8 April 2018
Temporal Arteritis Microchapters |
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Temporal arteritis medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
- Pharmacologic medical therapies for temporal arteritis is high-dose corticosteroid therapy. [53, 22, 8, 136, 137]
- Damage may be irreversible if treatment is delayed beyond 48 hours.
- should be started on oral prednisone 40-60 mg/day, with a temporal artery biopsy performed within 1 week. [104] Prednisone doses of 80-100 mg/day have been suggested for patients with visual or neurologic symptoms of GCA. [138] Follow-up care within 72 hours after starting therapy should be arranged.
- patients with acute visual changes from GCA can be started on intravenous (IV) methylprednisolone at a dose of 1,000 mg daily for 3 days. Limited data suggest that initial high-dose IV corticosteroid treatment (eg, methylprednisolone, 15 mg/kg of ideal body weight/day) may reduce remission rates. [139, 140]
- use of low-dose aspirin (81 mg) in patients with GCA for prevention of visual loss and stroke. [141]
British guidelines recommend the following schedule for tapering of standard-regimen corticosteroids [53] :
Continue prednisolone, 40-60 mg (not <0.75 mg/kg) for 4 weeks (or until symptoms and laboratory abnormalities resolve), then Reduce dose by 10 mg every 2 weeks to 20 mg, then Reduce dose by 2.5 mg every 2-4 weeks to 10 mg, then Reduce dose by 1 mg every 1-2 months, provided no relapse occurs
The guidelines recommend that patients on steroid therapy receive prophylactic treatment with the following medications [53] :
Low-dose aspirin, 81 mg per day – To decrease cranial ischemic complications Proton pump inhibitor – For gastrointestinal protection Bisphosphonate, calcium, and vitamin D – For bone protection
It may be reasonable to maintain the patient on treatment for 2 years to lessen the chances for relapses. Even then, relapses have been reported. [142]
Long-term corticosteroid therapy has frequent and potentially serious consequences, including diabetes mellitus, vertebral compression fractures, steroid myopathy, steroid psychosis, and immunosuppression-related infections. [143]
US Food and Drug Administration (FDA) expanded the indications for use of tocilizumab for use in GCA. Tocilizumab had previously been approved for use in rheumatoid arthritis. [146]
Improvement of systemic symptoms (eg, headache, lethargy) typically occurs within 72 hours of initiation of therapy. The elevation in erythrocyte sedimentation rate (ESR) and ischemic manifestations (eg, temporal headache, jaw claudication) diminish in several days.
High-dose steroid therapy should be maintained only long enough for symptoms to resolve. Steroids should then be tapered slowly to the lowest dose required to suppress symptoms.