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The Treatment of Giant Cell Arteritis

  • Neurologic Ophthalmology and Otology (RK Shin and DR Gold, Section Editors)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Giant cell arteritis (GCA) is a systemic inflammatory vasculitis affecting medium and large vessels with potentially sight and life-threatening complications. Early diagnosis and prompt treatment are imperative in order to prevent vision loss and progression of the disease. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are inflammatory markers which are elevated in the majority of patients and support the diagnosis of GCA among patients who present with typical symptoms. GCA is confirmed with superficial temporal artery biopsy which demonstrates characteristic pathological findings. Treatment of suspected ophthalmic involvement must be initiated urgently, even when diagnostic studies are pending. High dose corticosteroid therapy is the mainstay of treatment and is administered either intravenously or orally to prevent further vision loss and treat systemic vasculitis. Oral corticosteroid therapy is required for months to years with careful follow-up and periodic laboratory evaluations with ESR and CRP. Corticosteroids are tapered gradually over months and may be associated with complications such as hypertension, diabetes mellitus, osteoporosis, psychosis, peptic ulcer disease, and infection. Supplementation with calcium, vitamin D, bisphosphonate therapy, antimicrobial prophylaxis, and initiation of a proton pump inhibitor or Histamine H2-receptor antagonist should be considered. Recurrence of inflammation is common in GCA and necessitates an escalation of corticosteroid dose. Adjunctive immunomodulatory therapy may be considered in patients experiencing relapsing inflammation despite high doses of corticosteroids or those with corticosteroid-induced complications. Emerging evidence for adjunctive therapy with tocilizumab, methotrexate, aspirin, angiotensin receptor blockers, and statins is encouraging and may lead to a more mainstream role for these therapies among patients with GCA.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hoffman GS. Giant cell arteritis. Ann Intern Med. 2016;165(9):ITC65–80.

    Article  PubMed  Google Scholar 

  2. Weyand CM, Goronzy JJ. Giant-cell arteritis and polymyalgia rheumatica. Ann Intern Med. 2003;139(6):505–15.

    Article  PubMed  Google Scholar 

  3. Almarzouqi SJ, Morgan ML, Lee AG. Treatment of giant cell arteritis. Curr Opin Ophthalmol. 2015;26(6):469–75.

    Article  PubMed  Google Scholar 

  4. Simmons RJ, Cogan DG. Occult temporal arteritis. Arch Ophthalmol. 1962;68:8–18.

    Article  CAS  PubMed  Google Scholar 

  5. Hayreh SS, Podhajsky PA, Zimmerman B. Occult giant cell arteritis: ocular manifestations. Am J Ophthalmol. 1998;125(4):521–6.

    Article  CAS  PubMed  Google Scholar 

  6. Buttgereit F, Dejaco C, Matteson EL, Dasgupta B. Polymyalgia Rheumatica and Giant Cell Arteritis: A Systematic Review. JAMA. 2016;315(22):2442–58.

    Article  CAS  PubMed  Google Scholar 

  7. Hayreh SS. Anterior ischaemic optic neuropathy. Differentiation of arteritic from non-arteritic type and its management. Eye (Lond). 1990;4(Pt 1):25–41.

    Article  Google Scholar 

  8. • Kermani TA, Schmidt J, Crowson CS, Ytterberg SR, Hunder GG, Matteson EL, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum. 2012;41(6):866–71. This study demonstrates the utility of inflammatory markers in supporting the diagnosis of GCA.

    Article  CAS  PubMed  Google Scholar 

  9. Roberts WC, Zafar S, Ko JM. Morphological features of temporal arteritis. Proc (Baylor Univ Med Cent). 2013;26(2):109–15.

    PubMed  PubMed Central  Google Scholar 

  10. Bury D, Joseph J, Dawson TP. Does preoperative steroid treatment affect the histology in giant cell (cranial) arteritis? J Clin Pathol. 2012;65(12):1138–40.

    Article  PubMed  Google Scholar 

  11. Nayar AK, Casciello M, Slim JN, Slim AM. Fatal aortic dissection in a patient with giant cell arteritis: a case report and review of the literature. Case Rep Vasc Med. 2013;2013:590721.

    PubMed  PubMed Central  Google Scholar 

  12. Houthuizen P, Polak PE, Edelbroek MA, Peels CH. Giant cell arteritis as a cardiovascular entity. Neth Hear J. 2009;17(7–8):281–3.

    Article  CAS  Google Scholar 

  13. Gonzalez-Gay MA, Blanco R, Rodriguez-Valverde V, Martinez-Taboada VM, Delgado-Rodriguez M, Figueroa M, et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis: predictors and response to treatment. Arthritis Rheum. 1998;41(8):1497–504.

    Article  CAS  PubMed  Google Scholar 

  14. Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. 2007;15(2):55–61.

    Article  PubMed  Google Scholar 

  15. Chevalet P, Barrier JH, Pottier P, Magadur-Joly G, Pottier MA, Hamidou M, et al. A randomized, multicenter, controlled trial using intravenous pulses of methylprednisolone in the initial treatment of simple forms of giant cell arteritis: a 1 year followup study of 164 patients. J Rheumatol. 2000;27(6):1484–91.

    CAS  PubMed  Google Scholar 

  16. Hayreh SS, Zimmerman B. Visual deterioration in giant cell arteritis patients while on high doses of corticosteroid therapy. Ophthalmology. 2003;110(6):1204–15.

    Article  PubMed  Google Scholar 

  17. Liu GT, Glaser JS, Schatz NJ, Smith JL. Visual morbidity in giant cell arteritis. Clinical characteristics and prognosis for vision. Ophthalmology. 1994;101(11):1779–85.

    Article  CAS  PubMed  Google Scholar 

  18. Mazlumzadeh M, Hunder GG, Easley KA, Calamia KT, Matteson EL, Griffing WL, et al. Treatment of giant cell arteritis using induction therapy with high-dose glucocorticoids: a double-blind, placebo-controlled, randomized prospective clinical trial. Arthritis Rheum. 2006;54(10):3310–8.

    Article  CAS  PubMed  Google Scholar 

  19. Chan CC, Paine M, O’Day J. Steroid management in giant cell arteritis. Br J Ophthalmol. 2001;85(9):1061–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. • Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, Gross W, et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2009;68(3):318–23. This document offers guidelines from the European League against Rheumatism on the use of corticosteroid therapy in ophthalmic GCA.

    Article  CAS  PubMed  Google Scholar 

  21. • Dasgupta B, Giant Cell Arteritis Guideline Development G. Concise guidance: diagnosis and management of giant cell arteritis. Clin Med (Lond). 2010;10(4):381–6. This document offers guidelines from the British Society for Rheumatology on the use of corticosteroid therapy in GCA.

    Article  PubMed  Google Scholar 

  22. • Labarca C, Koster MJ, Crowson CS, Makol A, Ytterberg SR, Matteson EL, et al. Predictors of relapse and treatment outcomes in biopsy-proven giant cell arteritis: a retrospective cohort study. Rheumatology (Oxford). 2016;55(2):347–56. This study describes the clinical characteristics among patients who experienced a relapse from GCA.

    Article  Google Scholar 

  23. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. 2002;347(4):261–71.

    Article  PubMed  Google Scholar 

  24. Gonzalez-Gay MA, Pina T. Giant cell arteritis and polymyalgia rheumatica: an update. Curr Rheumatol Rep. 2015;17(2):6.

    Article  PubMed  Google Scholar 

  25. Fraser JA, Weyand CM, Newman NJ, Biousse V. The treatment of giant cell arteritis. Rev Neurol Dis. 2008;5(3):140–52.

    PubMed  PubMed Central  Google Scholar 

  26. Alba MA, Garcia-Martinez A, Prieto-Gonzalez S, Tavera-Bahillo I, Corbera-Bellalta M, Planas-Rigol E, et al. Relapses in patients with giant cell arteritis: prevalence, characteristics, and associated clinical findings in a longitudinally followed cohort of 106 patients. Medicine (Baltimore). 2014;93(5):194–201.

    Article  Google Scholar 

  27. • Kermani TA, Warrington KJ, Cuthbertson D, Carette S, Hoffman GS, Khalidi NA, et al. Disease relapses among patients with giant cell arteritis: a prospective longitudinal cohort study. J Rheumatol. 2015;42(7):1213–7. This study describes the clinical characteristics and utility of inflammatory markers among patients who experienced a relapse from GCA.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kim N, Trobe JD, Flint A, Keoleian G. Late ipsilateral recurrence of ischemic optic neuropathy in giant cell arteritis. J Neuroophthalmol. 2003;23(2):122-6.

  29. Mackie SL, Hensor EM, Morgan AW, Pease CT. Should I send my patient with previous giant cell arteritis for imaging of the thoracic aorta? A systematic literature review and meta-analysis. Ann Rheum Dis. 2014;73(1):143–8.

    Article  PubMed  Google Scholar 

  30. Bienvenu B, Ly KH, Lambert M, Agard C, Andre M, Benhamou Y, et al. Management of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA). Rev Med Interne. 2016;37(3):154–65.

    Article  CAS  PubMed  Google Scholar 

  31. Gutkowski K, Chwist A, Hartleb M. Liver injury induced by high-dose methylprednisolone therapy: a case report and brief review of the literature. Hepat Mon. 2011;11(8):656–61.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Proven A, Gabriel SE, Orces C, O’Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum. 2003;49(5):703–8.

    Article  CAS  PubMed  Google Scholar 

  33. • Briot K, Cortet B, Roux C, Fardet L, Abitbol V, Bacchetta J, et al. 2014 update of recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis. Joint Bone Spine. 2014;81(6):493–501. This paper offers guidance on the prevention and management of steroid-related osteoporosis.

    Article  PubMed  Google Scholar 

  34. Spies CM, Burmester GR, Buttgereit F. Methotrexate treatment in large vessel vasculitis and polymyalgia rheumatica. Clin Exp Rheumatol. 2010;28(5 Suppl 61):S172–7.

    CAS  PubMed  Google Scholar 

  35. Unizony S, Arias-Urdaneta L, Miloslavsky E, Arvikar S, Khosroshahi A, Keroack B, et al. Tocilizumab for the treatment of large-vessel vasculitis (giant cell arteritis, Takayasu arteritis) and polymyalgia rheumatica. Arthritis Care Res. 2012;64(11):1720–9.

    Article  CAS  Google Scholar 

  36. Roche NE, Fulbright JW, Wagner AD, Hunder GG, Goronzy JJ, Weyand CM. Correlation of interleukin-6 production and disease activity in polymyalgia rheumatica and giant cell arteritis. Arthritis Rheum. 1993;36(9):1286–94.

    Article  CAS  PubMed  Google Scholar 

  37. Emilie D, Liozon E, Crevon MC, Lavignac C, Portier A, Liozon F, et al. Production of interleukin 6 by granulomas of giant cell arteritis. Hum Immunol. 1994;39(1):17–24.

    Article  CAS  PubMed  Google Scholar 

  38. Beyer C, Axmann R, Sahinbegovic E, Distler JH, Manger B, Schett G, et al. Anti-interleukin 6 receptor therapy as rescue treatment for giant cell arteritis. Ann Rheum Dis. 2011;70(10):1874–5.

    Article  CAS  PubMed  Google Scholar 

  39. Seitz M, Reichenbach S, Bonel HM, Adler S, Wermelinger F, Villiger PM. Rapid induction of remission in large vessel vasculitis by IL-6 blockade. A case series. Swiss Med Wkly. 2011;141:w13156.

    PubMed  Google Scholar 

  40. Pazzola G, Padovano I, Boiardi L, Versari A, Pipitone N, Catanoso M, et al. Tocilizumab in glucocorticoid-naive large-vessel vasculitis. Clin Exp Rheumatol. 2013;31(1 Suppl 75):S59–61.

    CAS  PubMed  Google Scholar 

  41. Evans J, Steel L, Borg F, Dasgupta B. Long-term efficacy and safety of tocilizumab in giant cell arteritis and large vessel vasculitis. RMD Open. 2016;2(1), e000137.

    Article  PubMed  PubMed Central  Google Scholar 

  42. • Loricera J, Blanco R, Hernandez JL, Castaneda S, Mera A, Perez-Pampin E, et al. Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients. Semin Arthritis Rheum. 2015;44(6):717–23. This multicenter open-label study demonstrated the efficacy and complications associated with tocilizumab in refractory or steroid-intolerant GCA.

    Article  CAS  PubMed  Google Scholar 

  43. • Regent A, Redeker S, Deroux A, Kieffer P, Ly KH, Dougados M, et al. Tocilizumab in Giant Cell Arteritis: A Multicenter Retrospective Study of 34 Patients. J Rheumatol. 2016;43(8):1547–52. This multicenter rectrospective study demonstrated the efficacy and complications associated with tocilizumab in refractory or steroid-intolerant GCA.

    Article  PubMed  Google Scholar 

  44. •• Villiger PM, Adler S, Kuchen S, Wermelinger F, Dan D, Fiege V, et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2016;387(10031):1921–7. This is the first randomized, double-blind, placebo controlled trial which demonstrated the efficacy of tocilizumab in inducing and maintaining remission in GCA.

    Article  CAS  PubMed  Google Scholar 

  45. Devauchelle-Pensec V. Has the time come for biotherapies in giant cell arteritis and polymyalgia rheumatica? Joint Bone Spine. 2016;83(5):471–2.

    Article  PubMed  Google Scholar 

  46. Spiera RF, Mitnick HJ, Kupersmith M, Richmond M, Spiera H, Peterson MG, et al. A prospective, double-blind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol. 2001;19(5):495–501.

    CAS  PubMed  Google Scholar 

  47. Hoffman GS, Cid MC, Hellmann DB, Guillevin L, Stone JH, Schousboe J, et al. A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum. 2002;46(5):1309–18.

    Article  CAS  PubMed  Google Scholar 

  48. Jover JA, Hernandez-Garcia C, Morado IC, Vargas E, Banares A, Fernandez-Gutierrez B. Combined treatment of giant-cell arteritis with methotrexate and prednisone. a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2001;134(2):106–14.

    Article  CAS  PubMed  Google Scholar 

  49. • Mahr AD, Jover JA, Spiera RF, Hernandez-Garcia C, Fernandez-Gutierrez B, Lavalley MP, et al. Adjunctive methotrexate for treatment of giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum. 2007;56(8):2789–97. This meta-analysis demonstrated the utility of methotrexate as a steroid-sparing agent in GCA.

    Article  CAS  PubMed  Google Scholar 

  50. Sciascia S, Piras D, Baldovino S, Russo A, Naretto C, Rossi D, et al. Mycophenolate mofetil as steroid-sparing treatment for elderly patients with giant cell arteritis: report of three cases. Aging Clin Exp Res. 2012;24(3):273–7.

    Article  CAS  PubMed  Google Scholar 

  51. Adizie T, Christidis D, Dharmapaliah C, Borg F, Dasgupta B. Efficacy and tolerability of leflunomide in difficult-to-treat polymyalgia rheumatica and giant cell arteritis: a case series. Int J Clin Pract. 2012;66(9):906–9.

    Article  CAS  PubMed  Google Scholar 

  52. Quartuccio L, Maset M, De Maglio G, Pontarini E, Fabris M, Mansutti E, et al. Role of oral cyclophosphamide in the treatment of giant cell arteritis. Rheumatology (Oxford). 2012;51(9):1677–86.

    Article  CAS  Google Scholar 

  53. Loock J, Henes J, Kotter I, Witte T, Lamprecht P, Schirmer M, et al. Treatment of refractory giant cell arteritis with cyclophosphamide:a retrospective analysis of 35 patients from three centres. Clin Exp Rheumatol. 2012;30(1 Suppl 70):S70–6.

    PubMed  Google Scholar 

  54. de Boysson H, Boutemy J, Creveuil C, Ollivier Y, Letellier P, Pagnoux C, et al. Is there a place for cyclophosphamide in the treatment of giant-cell arteritis? A case series and systematic review. Semin Arthritis Rheum. 2013;43(1):105–12.

    Article  PubMed  Google Scholar 

  55. Liozon F, Vidal E, Barrier J. Does dapsone have a role in the treatment of temporal arteritis with regard to efficacy and toxicity? Clin Exp Rheumatol. 1993;11(6):694–5.

    CAS  PubMed  Google Scholar 

  56. De Silva M, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study. Ann Rheum Dis. 1986;45(2):136–8.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Boureau AS, de Faucal P, Espitia O, De Decker L, Agard C. [Place of azathioprine in the treatment of giant cell arteritis]. Rev Med Interne. 2016.

  58. Nuenninghoff DM, Matteson EL. The role of disease-modifying antirheumatic drugs in the treatment of giant cell arteritis. Clin Exp Rheumatol. 2003;21(6 Suppl 32):S29–34.

    CAS  PubMed  Google Scholar 

  59. Schaufelberger C, Andersson R, Nordborg E. No additive effect of cyclosporin A compared with glucocorticoid treatment alone in giant cell arteritis: results of an open, controlled, randomized study. Br J Rheumatol. 1998;37(4):464–5.

    Article  CAS  PubMed  Google Scholar 

  60. Schaufelberger C, Mollby H, Uddhammar A, Bratt J, Nordborg E. No additional steroid-sparing effect of cyclosporine A in giant cell arteritis. Scand J Rheumatol. 2006;35(4):327–9.

    Article  CAS  PubMed  Google Scholar 

  61. Ahmed MM, Mubashir E, Hayat S, Fowler M, Berney SM. Treatment of refractory temporal arteritis with adalimumab. Clin Rheumatol. 2007;26(8):1353–5.

    Article  PubMed  Google Scholar 

  62. Cantini F, Niccoli L, Salvarani C, Padula A, Olivieri I. Treatment of longstanding active giant cell arteritis with infliximab: report of four cases. Arthritis Rheum. 2001;44(12):2933–5.

    Article  CAS  PubMed  Google Scholar 

  63. Hoffman GS, Cid MC, Rendt-Zagar KE, Merkel PA, Weyand CM, Stone JH, et al. Infliximab for maintenance of glucocorticosteroid-induced remission of giant cell arteritis: a randomized trial. Ann Intern Med. 2007;146(9):621-30.

  64. Martinez-Taboada VM, Rodriguez-Valverde V, Carreno L, Lopez-Longo J, Figueroa M, Belzunegui J, et al. A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effects. Ann Rheum Dis. 2008;67(5):625–30.

    Article  CAS  PubMed  Google Scholar 

  65. Seror R, Baron G, Hachulla E, Debandt M, Larroche C, Puechal X, et al. Adalimumab for steroid sparing in patients with giant-cell arteritis: results of a multicentre randomised controlled trial. Ann Rheum Dis. 2014;73(12):2074–81.

    Article  CAS  PubMed  Google Scholar 

  66. Bhatia A, Ell PJ, Edwards JC. Anti-CD20 monoclonal antibody (rituximab) as an adjunct in the treatment of giant cell arteritis. Ann Rheum Dis. 2005;64(7):1099–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Pountain G, Hazleman B, Cawston TE. Circulating levels of IL-1beta, IL-6 and soluble IL-2 receptor in polymyalgia rheumatica and giant cell arteritis and rheumatoid arthritis. Br J Rheumatol. 1998;37(7):797–8.

    Article  CAS  PubMed  Google Scholar 

  68. Hernandez-Rodriguez J, Segarra M, Vilardell C, Sanchez M, Garcia-Martinez A, Esteban MJ, et al. Tissue production of pro-inflammatory cytokines (IL-1beta, TNFalpha and IL-6) correlates with the intensity of the systemic inflammatory response and with corticosteroid requirements in giant-cell arteritis. Rheumatology (Oxford). 2004;43(3):294–301.

    Article  CAS  Google Scholar 

  69. Ly KH, Stirnemann J, Liozon E, Michel M, Fain O, Fauchais AL. Interleukin-1 blockade in refractory giant cell arteritis. Joint Bone Spine. 2014;81(1):76–8.

    Article  CAS  PubMed  Google Scholar 

  70. Stegbauer J, Lee DH, Seubert S, Ellrichmann G, Manzel A, Kvakan H, et al. Role of the renin-angiotensin system in autoimmune inflammation of the central nervous system. Proc Natl Acad Sci U S A. 2009;106(35):14942–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Dimitrijevic I, Malmsjo M, Andersson C, Rissler P, Edvinsson L. Increased angiotensin II type 1 receptor expression in temporal arteries from patients with giant cell arteritis. Ophthalmology. 2009;116(5):990–6.

    Article  PubMed  Google Scholar 

  72. • Alba MA, Garcia-Martinez A, Prieto-Gonzalez S, Espigol-Frigole G, Butjosa M, Tavera-Bahillo I, et al. Treatment with angiotensin II receptor blockers is associated with prolonged relapse-free survival, lower relapse rate, and corticosteroid-sparing effect in patients with giant cell arteritis. Semin Arthritis Rheum. 2014;43(6):772–7. This study demonstrated that use of ARBs in addition to corticosteroids was associated with a reduced relapse rate and prolonged disease free survival in GCA.

    Article  CAS  PubMed  Google Scholar 

  73. Montecucco F, Mach F. Update on statin-mediated anti-inflammatory activities in atherosclerosis. Semin Immunopathol. 2009;31(1):127–42.

    Article  CAS  PubMed  Google Scholar 

  74. Hegg R, Lee AG, Tagg NT, Zimmerman MB. Statin or nonsteroidal anti-inflammatory drug use is associated with lower erythrocyte sedimentation rate in patients with giant cell arteritis. J Neuroophthalmol. 2011;31(2):135–8.

    Article  PubMed  Google Scholar 

  75. Garcia-Martinez A, Hernandez-Rodriguez J, Grau JM, Cid MC. Treatment with statins does not exhibit a clinically relevant corticosteroid-sparing effect in patients with giant cell arteritis. Arthritis Rheum. 2004;51(4):674–8.

    Article  CAS  PubMed  Google Scholar 

  76. Schmidt J, Kermani TA, Muratore F, Crowson CS, Matteson EL, Warrington KJ. Statin use in giant cell arteritis: a retrospective study. J Rheumatol. 2013;40(6):910–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. • Pugnet G, Sailler L, Bourrel R, Montastruc JL, Lapeyre-Mestre M. Is statin exposure associated with occurrence or better outcome in giant cell arteritis? Results from a French population-based study. J Rheumatol. 2015;42(2):316–22. This study demonstrated that statin use was not associated with a change in the development of GCA but was associated with a more rapid steroid taper after the diagnosis of GCA.

    Article  CAS  PubMed  Google Scholar 

  78. Ruegg S, Engelter S, Jeanneret C, Hetzel A, Probst A, Steck AJ, et al. Bilateral vertebral artery occlusion resulting from giant cell arteritis: report of 3 cases and review of the literature. Medicine (Baltimore). 2003;82(1):1–12.

    Article  Google Scholar 

  79. Hellmann DB. Low-dose aspirin in the treatment of giant cell arteritis. Arthritis Rheum. 2004;50(4):1026–7.

    Article  PubMed  Google Scholar 

  80. Nesher G, Berkun Y, Mates M, Baras M, Rubinow A, Sonnenblick M. Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum. 2004;50(4):1332–7.

    Article  CAS  PubMed  Google Scholar 

  81. Lee MS, Smith SD, Galor A, Hoffman GS. Antiplatelet and anticoagulant therapy in patients with giant cell arteritis. Arthritis Rheum. 2006;54(10):3306–9.

    Article  PubMed  Google Scholar 

  82. Narvaez J, Bernad B, Gomez-Vaquero C, Garcia-Gomez C, Roig-Vilaseca D, Juanola X, et al. Impact of antiplatelet therapy in the development of severe ischemic complications and in the outcome of patients with giant cell arteritis. Clin Exp Rheumatol. 2008;26(3 Suppl 49):S57–62.

    CAS  PubMed  Google Scholar 

  83. Salvarani C, Della Bella C, Cimino L, Macchioni P, Formisano D, Bajocchi G, et al. Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis. Rheumatology (Oxford). 2009;48(3):250–3.

    Article  CAS  Google Scholar 

  84. Berger CT, Wolbers M, Meyer P, Daikeler T, Hess C. High incidence of severe ischaemic complications in patients with giant cell arteritis irrespective of platelet count and size, and platelet inhibition. Rheumatology (Oxford). 2009;48(3):258–61.

    Article  CAS  Google Scholar 

  85. Gonzalez-Gay MA, Pineiro A, Gomez-Gigirey A, Garcia-Porrua C, Pego-Reigosa R, Dierssen-Sotos T, et al. Influence of traditional risk factors of atherosclerosis in the development of severe ischemic complications in giant cell arteritis. Medicine (Baltimore). 2004;83(6):342–7.

    Article  Google Scholar 

  86. • Martinez-Taboada VM, Lopez-Hoyos M, Narvaez J, Munoz-Cacho P. Effect of antiplatelet/anticoagulant therapy on severe ischemic complications in patients with giant cell arteritis: a cumulative meta-analysis. Autoimmun Rev. 2014;13(8):788–94. This study demonstrated that antiplatelet or anticoagulant therapy prior to the diagnosis of GCA was not associated with a reduction in severe ischemic complications but showed a marginal benefit when used with corticosteroid therapy in patients with established GCA.

    Article  CAS  PubMed  Google Scholar 

  87. Mollan SP, Sharrack N, Burdon MA, Denniston AK. Aspirin as adjunctive treatment for giant cell arteritis. Cochrane Database Syst Rev. 2014;8, CD010453.

    Google Scholar 

  88. Weisman SM, Graham DY. Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Arch Intern Med. 2002;162(19):2197–202.

    Article  CAS  PubMed  Google Scholar 

  89. Caspi D, Lubart E, Graff E, Habot B, Yaron M, Segal R. The effect of mini-dose aspirin on renal function and uric acid handling in elderly patients. Arthritis Rheum. 2000;43(1):103–8.

    Article  CAS  PubMed  Google Scholar 

  90. Buono LM, Foroozan R, de Virgiliis M, Savino PJ. Heparin therapy in giant cell arteritis. Br J Ophthalmol. 2004;88(2):298–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  91. Staunton H, Stafford F, Leader M, O’Riordain D. Deterioration of giant cell arteritis with corticosteroid therapy. Arch Neurol. 2000;57(4):581–4.

    Article  CAS  PubMed  Google Scholar 

  92. Gilden D, Nagel MA. Varicella zoster virus triggers the immunopathology of giant cell arteritis. Curr Opin Rheumatol. 2016;28(4):376–82.

    Article  CAS  PubMed  Google Scholar 

  93. Gilden D, White T, Khmeleva N, Heintzman A, Choe A, Boyer PJ, et al. Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis. Neurology. 2015;84(19):1948–55.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. The Scheie Eye Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Imran Jivraj BSc, MD, FRCSC & Madhura Tamhankar MD

  2. Scheie Eye Institute, Penn Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA, 19104, USA

    Imran Jivraj BSc, MD, FRCSC

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  1. Imran Jivraj BSc, MD, FRCSC
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Jivraj, I., Tamhankar, M. The Treatment of Giant Cell Arteritis. Curr Treat Options Neurol 19, 2 (2017). https://doi.org/10.1007/s11940-017-0440-y

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  • DOI: https://doi.org/10.1007/s11940-017-0440-y

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