What is the appropriate management protocol for a patient diagnosed with giant cell arteritis, including corticosteroid therapy?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Management protocol for giant cell arteritis (GCA) including corticosteroid therapy:

  • GCA is a medical emergency requiring immediate treatment to prevent serious complications such as irreversible vision loss .
  • If the patient has new visual loss (transient or permanent) or double vision, arrange an urgent same-day ophthalmology assessment. While awaiting transfer, a one-off high dose corticosteroid may be given in primary care .
  • For acute or intermittent visual loss due to GCA, intravenous glucocorticoid therapy (500–1000 mg methylprednisolone daily for up to 3 days) is recommended. If IV therapy is not possible, oral prednisolone 60–100 mg daily for up to 3 days should be given without delay .
  • For patients with GCA without visual symptoms, start high-dose oral prednisolone immediately at 40–60 mg daily .
  • Do not delay glucocorticoid initiation while awaiting blood test results if GCA is strongly suspected; however, blood tests such as full blood count, CRP, and ESR should be taken before or immediately after starting treatment to support diagnosis .
  • Urgently refer all suspected GCA cases to a specialist (usually rheumatologist) via a fast-track pathway, ideally for assessment on the same working day and within 3 working days at latest .
  • Confirm diagnosis in secondary care using temporal and axillary artery ultrasound or temporal artery biopsy .
  • Monitor treatment response closely; symptoms usually improve rapidly with corticosteroids. If response is poor, reconsider diagnosis .
  • Corticosteroid dose should be tapered very slowly over months; treatment typically lasts 1–2 years, with some patients requiring low doses for longer .
  • Assess and manage risks of corticosteroid adverse effects (e.g., infection, diabetes, osteoporosis) and consider preventative measures such as bone protection .
  • Follow-up reviews should be frequent initially (every 2–8 weeks for first 6 months), then less frequent, including clinical assessment and blood monitoring (FBC, ESR, CRP) .
  • Advise patients to seek immediate medical attention if visual symptoms or signs of relapse occur .

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