Giant cell arteritis - Treating giant cell arteritis

Steroid medication (corticosteroids) is the preferred treatment for giant cell arteritis (GCA). A type of steroid medicine called prednisolone is usually prescribed.

Prednisolone

If your vision is at risk, you may be given an initial prednisolone injection. After this, prednisolone tablets will be prescribed.

If your vision isn't at risk, you'll be prescribed prednisolone tablets or capsules straight away. You'll probably start on a relatively high dose, which will gradually be reduced every two to four weeks, depending on how well you respond to treatment.

You may need to take prednisolone for up to two years to prevent your symptoms returning. Your symptoms should improve significantly within a few days of starting treatment. However, there's a chance they'll return (relapse) once treatment stops.

Don't suddenly stop taking steroid medication unless you're told by a doctor that it's safe to do so. Suddenly stopping steroid treatment can make you feel very ill.

Side effects

About 1 in 20 people who take prednisolone will experience changes in their mental state when they take the medication.

For example, you may feel very depressed and suicidal, very anxious, or very confused. Some people also experience hallucinations (feeling, seeing or hearing things that aren't there). Contact your GP as soon as possible if you experience changes to your mental state. 

Other side effects of prednisolone include:

• increased appetite, which often leads to weight gain
• increased blood pressure
• mood changes, such as becoming aggressive or irritable with people
• weakening of the bones (osteoporosis)
• stomach ulcers 
• increased risk of infection – particularly to the virus that causes chickenpox and shingles (varicella-zoster virus). 

Seek immediate medical advice if you think you've been exposed to the varicella-zoster virus, or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dosage of prednisolone is decreased.

See side effects of corticosteroids for more information about how these side effects may affect you and how they're treated.

Low-dose aspirin

Low-dose aspirin is increasingly being recommended for people with a history of giant cell arteritis. It has been found to be effective in preventing complications of giant cell arteritis, such as heart attacks or stroke.

If you're prescribed steroid medication and low-dose aspirin, another medication called omeprazole may also be recommended. Omeprazole belongs to a class of medicines called proton-pump inhibitors, and it can be used to help protect your stomach from stomach ulcers.

Immunosuppressants

Some people with giant cell arteritis may benefit from treatment with immunosuppressants, such as methotrexate or leflunomide, which are taken along with prednisolone. Omeprazole may also be recommended to help prevent stomach ulcers.

Immunosuppressants are a type of medication used to suppress the immune system (the body's defence against infection and illness). Using immunosuppressants can allow steroid medication to be reduced, and can help prevent the condition recurring.

Common side effects of immunosuppressant medication include nausea, vomiting, diarrhoea, and skin rashes.

Follow-up

The doctor in charge of your care will ask you to attend regular follow-up appointments so they can check how well you're responding to treatment. They'll assess whether your dosage of prednisolone needs to be adjusted and how well you're coping with the side effects of the medication.

Follow-up appointments are usually recommended on a weekly or fortnightly basis for the first two or three months of your treatment, and then every three months after that.

During these appointments, you'll have further blood tests to check the levels of inflammation inside your body. If you had a CRP test that indicated high levels of inflammation, you may have another one four weeks after starting steroid treatment.

The second CRP test should show that the inflammation has dropped to normal levels. You may also be referred for scans to assess how strong your bones are.

If you experience a return of your symptoms during any part of your treatment, contact your doctor as your dosage may need to be adjusted.