6
Diagnosis
Treatment/Management of GCA
Table 4. Recommendations/Statements for Treatment
(Medical and Surgical Management) and Clinical/
Laboratory Monitoring in GCA
A. Medical Management Level of Evidence
In patients with newly diagnosed GCA without manifestations
of cranial ischemia, we conditionally recommend initiating
treatment with high dose oral glucocorticoids over pulse
intravenous glucocorticoids.
Very low / Low
In patients with newly diagnosed GCA with threatened vision
loss, we conditionally recommend initiating treatment with pulse
intravenous glucocorticoids over high dose oral glucocorticoids.
Very low
In patients with newly diagnosed GCA, we conditionally
recommend dosing oral glucocorticoids daily over an alternate day
schedule.
Low
In patients with newly diagnosed GCA, we conditionally
recommend initiating treatment with high dose oral
glucocorticoids over moderate dose oral glucocorticoids.
Very low / Low
In patients with newly diagnosed GCA, we conditionally
recommend using oral glucocorticoids with tocilizumab over oral
glucocorticoids alone.
Low / High
In patients with GCA with active extracranial large vessel
involvement, we conditionally recommend treatment with
oral glucocorticoids combined with a non-glucocorticoid
immunosuppressive agent over oral glucocorticoids alone.
Very low / Low
Ungraded Position Statement: e optimal duration of therapy
with glucocorticoids for GCA is not well-established and should
be guided by the patient's values and preferences.
Low / Moderate
In patients with newly diagnosed GCA, we conditionally
recommend against using an HMG-CoA reductase inhibitor
("statin") specifically for the treatment of GCA.
Very low
In patients with GCA who have critical or flow-limiting
involvement of the vertebral or carotid arteries, we conditionally
recommend adding aspirin.
Very low / Moderate
In patients with GCA who experience disease relapse while
on moderate or high dose glucocorticoids, we conditionally
recommend adding a non-glucocorticoid immunosuppressive drug.
Expert opinion
In patients with GCA who relapse with symptoms of cranial
ischemia, we conditionally recommend adding a non-
glucocorticoid immunosuppressive agent and increasing the dose of
glucocorticoids over increasing the dose of glucocorticoids alone.
Expert opinion
In patients with GCA who experience disease relapse with
symptoms of cranial ischemia while on glucocorticoids, we
conditionally recommend adding tocilizumab and increasing the
dose of glucocorticoids over adding methotrexate and increasing
the dose of glucocorticoids.
Expert opinion
