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Tocilizumab for Relapsing GCA — RACP Adult Medicine MCQ

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HardRheumatologyTocilizumab for Relapsing GCARACP Adult Medicine

A 72-year-old with giant cell arteritis repeatedly relapses during glucocorticoid taper and has developed diabetes, osteoporosis and cataracts. Infection screening is satisfactory and there is no contraindication to biologic therapy. Which steroid-sparing plan is most appropriate?

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Correct answer: E — Add tocilizumab with a structured glucocorticoid taper and assess relapse using symptoms, examination and targeted imaging

The best answer is “Add tocilizumab with a structured glucocorticoid taper and assess relapse using symptoms, examination and targeted imaging”. Relapsing giant cell arteritis with glucocorticoid toxicity supports tocilizumab plus a taper. Methotrexate and azathioprine have less established steroid-sparing benefit, abatacept is not routine standard therapy, and cyclophosphamide has disproportionate toxicity. IL-6 blockade can suppress inflammatory markers, so relapse assessment uses symptoms, examination and targeted imaging.

Reference: Australian Rheumatology Association: Tocilizumab: https://rheumatology.org.au/For-Patients/Adult-Medication-Information/S-Z/Tocilizumab