[Diagnostics and treatment of giant cell arteritis]

Area of Science:

• Rheumatology
• Immunology
• Internal Medicine

Background:

• Giant cell arteritis (GCA) is the most common idiopathic systemic vasculitis affecting individuals over 50.
• Prompt diagnosis and treatment are crucial to prevent severe complications like vision loss and stroke.
• Prolonged glucocorticoid (GC) therapy, often necessary due to GCA's relapsing nature, carries significant long-term side effect risks.

Purpose of the Study:

• To review current treatment strategies for GCA.
• To highlight the need for glucocorticoid (GC)-sparing therapies.
• To discuss the role of tocilizumab and methotrexate (MTX) as adjunctive treatments.

Main Methods:

• Literature review of GCA treatment guidelines and clinical studies.
• Analysis of efficacy and safety data for established and emerging therapies.
• Focus on additive treatments to reduce long-term GC exposure.

Main Results:

• Glucocorticoids (GCs) remain a cornerstone of initial GCA management.
• Relapsing disease course necessitates prolonged GC treatment, increasing adverse event probability.
• Tocilizumab (anti-IL-6 receptor antibody) is approved for GCA treatment.
• Methotrexate (MTX) is utilized off-label as a GC-sparing agent.

Conclusions:

• Additive therapies are recommended for most GCA patients to minimize GC-related toxicity.
• Tocilizumab offers a targeted approach via subcutaneous injection.
• Methotrexate provides an alternative GC-sparing option, though used off-label.