Giant Cell Arteritis — SCE Rheumatology MCQ

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ModerateVasculitisGiant Cell ArteritisSCE Rheumatology

A 72-year-old woman with biopsy-proven giant cell arteritis has been on Prednisolone for 8 months. She has developed steroid-related diabetes and osteoporosis. She relapses each time the dose falls below 15 mg daily. Which steroid-sparing agent has the best evidence in GCA?

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Correct answer: D — Tocilizumab

Tocilizumab (IL-6 receptor inhibitor) is the only licensed biologic for GCA, supported by the GiACTA trial. NICE TA518 recommends Tocilizumab as an option for relapsing or refractory GCA to enable glucocorticoid tapering. Methotrexate has modest evidence as a steroid-sparing agent but is less effective than Tocilizumab. Azathioprine, Mycophenolate, and Leflunomide lack robust evidence in GCA.

Reference: NICE TA518 (2018) - Tocilizumab for treating giant cell arteritis; Villiger PM et al 2016 GiACTA trial