Giant cell arteritis. Epidemiology and treatment

Giant cell arteritis (GCA) was considered a rare disease 50 years ago; however, it is now known to be an important and significant cause of morbidity and mortality in elderly people. GCA is a generalised arteritis, although the aetiology and pathogenesis of this disorder are poorly understood. It is likely that there are environmental or genetic factors that significantly influence the risk for the disease in different populations. Epidemiological studies have shown the highest incidence in Northern Europe and in Minnesota, US; which are populations of the same descent. Much lower incidence figures have been reported from more Southern regions of Europe and elsewhere. Possibly, the incidence of the disease is increasing as suggested by recent surveys. Glucocorticosteroids are the drugs of choice in all clinical types of GCA. Most studies have been performed with prednisolone. There is no general agreement concerning the initial dosage, but 10 to 40 mg/day is commonly recommended. After a few months the majority of patients can be treated with a low maintenance dosage of prednisolone 5 to 7.5 mg/day. Because of the low dosage required, the frequency of corticosteroid-related adverse effects is relatively low. The median duration of treatment is about 5 years. Nonsteroidal anti-inflammatory drugs, in contrast to corticosteroids, have no proven preventive effect on vascular complications of GCA, and cannot be recommended.