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

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 ¹.
• 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 ¹.
• 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 ¹.
• For patients with GCA without visual symptoms, start high-dose oral prednisolone immediately at 40–60 mg daily ¹.
• 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 ¹.
• 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 ¹.
• Confirm diagnosis in secondary care using temporal and axillary artery ultrasound or temporal artery biopsy ¹.
• Monitor treatment response closely; symptoms usually improve rapidly with corticosteroids. If response is poor, reconsider diagnosis ¹.
• Corticosteroid dose should be tapered very slowly over months; treatment typically lasts 1–2 years, with some patients requiring low doses for longer ¹.
• Assess and manage risks of corticosteroid adverse effects (e.g., infection, diabetes, osteoporosis) and consider preventative measures such as bone protection ¹.
• 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) ¹.
• Advise patients to seek immediate medical attention if visual symptoms or signs of relapse occur ¹.