How should I monitor a patient with Giant Cell Arteritis for potential complications during treatment?

Monitoring a patient with Giant Cell Arteritis (GCA) during treatment involves regular clinical and laboratory assessments to detect disease activity, treatment response, and potential complications.

• Patients should be reviewed by a clinician with appropriate expertise every 2–8 weeks during the first 6 months, every 12 weeks during the second 6 months, and every 12–24 weeks during the second year, with additional reviews if relapse occurs or during glucocorticoid tapering ¹.
• Each review should include a full history focusing on symptoms of disease control, relapse, and complications, a targeted physical examination, and blood tests including full blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to monitor inflammation and treatment response ¹.
• Close monitoring of blood pressure and blood glucose is particularly important after starting glucocorticoids, given the risk of hypertension and hyperglycaemia ¹.
• Assess for adverse effects of corticosteroids such as weight gain, dyspepsia, muscle weakness, skin thinning, and easy bruising, and provide the patient with a steroid treatment card ¹.
• Evaluate risk factors and monitor for glucocorticoid-related complications including infection risk (with chest X-ray and urine dipstick), osteoporosis (consider bone density testing and vitamin D), gastrointestinal protection (consider proton pump inhibitors if at risk), and ocular complications (screen for glaucoma if history or risk present) ¹.
• Advise patients to seek immediate medical attention if they develop visual disturbances (e.g., visual loss, double vision) or symptoms suggestive of relapse such as return of headache or jaw claudication ¹.
• Long-term follow-up may be arranged to monitor for late complications such as aortic aneurysm, usually coordinated by secondary care specialists ¹.