When glucocorticoids, started promptly at diagnosis of giant cell arteritis, do not bring the patient into remission, a structured next-step approach is needed. The transition point is unambiguous: persistent clinical symptoms or continuing elevation of acute-phase reactants despite regular reassessment.
Initial therapy with glucocorticoids (initiated immediately) did not meet the required goal: absence of clinical symptoms of giant cell arteritis and normalization of acute-phase reactants (ESR and CRP), assessed every 1–4 weeks. This unmet target is the trigger that escalates care to the next protocol.
The aim remains sustained remission — absence of clinical symptoms of giant cell arteritis and normalization of acute-phase reactants, particularly ESR and CRP. Once achieved, remission should be maintained at the minimal effective dose; drug-free remission may be possible in a proportion of patients.
DOI: 10.1136/ard-2022-223429
Methotrexate, in combination with GC, can be considered in the treatment of patients with GCA and PMR, even though data from clinical trials revealed conflicting results.
TCZ has been approved for treatment in GCA following the phase III study mentioned above, which demonstrated higher remission rates and better GC sparing than placebo.
Hence, these patients may benefit in particular from early administration of GC sparing agents.
The treatment target of GCA and PMR should be remission; remission is the absence of clinical symptoms and systemic inflammation.
Once remission is reached, it should be maintained with the minimal effective dose of medication; drug-free remission may be achieved in a proportion of patients.
View source ↗