Oral and intravenous steroids in giant cell arteritis

Giant cell arteritis can result in devastating visual loss. Treatment with steroids does result in visual recovery in some patients but the exact percentage is unknown. Intravenous megadose steroids appear to offer some advantage over oral steroids presumably through non-genomic effects, which manifest at doses of 500 mg or more. Side-effects are more likely in the elderly especially those with renal and cardiac co-morbidities. The authors' current recommendation is that intravenous steroids should be given to patients with established visual loss or amaurosis fugax.