Temporal arteritis medical therapy: Difference between revisions
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*Pharmacologic medical therapies for temporal arteritis is high-dose corticosteroid therapy. | *Pharmacologic medical therapies for temporal arteritis is high-dose corticosteroid therapy. | ||
*Damage may be irreversible if treatment is delayed beyond 48 hours. | *Damage may be irreversible if treatment is delayed beyond 48 hours. | ||
* | *Oral prednisone 40-60 mg/day should be started, with a temporal artery biopsy performed within 1 week. [104] | ||
*Prednisone doses of 80-100 mg/day have been suggested for patients with visual or neurologic symptoms of | *Prednisone doses of 80-100 mg/day have been suggested for patients with visual or neurologic symptoms of temporal arteritis and follow-up care within 72 hours after starting therapy should be arranged.[138] | ||
* | *Patients with acute visual changes from temporal arteritis can be started on intravenous (IV) methylprednisolone at a dose of 1,000 mg daily for 3 days. | ||
*Initial high-dose IV corticosteroid | *Initial high-dose IV corticosteroid, methylprednisolone, treatment 15 mg/kg of ideal body weight/day may reduce remission rates. [139, 140] | ||
* | *Use of low-dose aspirin (81 mg) for prevention of visual loss and stroke is recommended in temporal arteritis. [141] | ||
British guidelines recommend the following schedule for tapering of standard-regimen corticosteroids [53] : | British guidelines recommend the following schedule for tapering of standard-regimen corticosteroids [53] : | ||
Continue prednisolone, 40-60 mg (not <0.75 mg/kg) for 4 weeks (or until symptoms and laboratory abnormalities resolve), then | *Continue prednisolone, 40-60 mg (not <0.75 mg/kg) for 4 weeks (or until symptoms and laboratory abnormalities resolve), then | ||
Reduce dose by 10 mg every 2 weeks to 20 mg, then | *Reduce dose by 10 mg every 2 weeks to 20 mg, then | ||
Reduce dose by 2.5 mg every 2-4 weeks to 10 mg, then | *Reduce dose by 2.5 mg every 2-4 weeks to 10 mg, then | ||
Reduce dose by 1 mg every 1-2 months, provided no relapse occurs | *Reduce dose by 1 mg every 1-2 months, provided no relapse occurs | ||
The guidelines recommend that patients on steroid therapy receive prophylactic treatment with the following medications [53] : | The guidelines recommend that patients on steroid therapy receive prophylactic treatment with the following medications [53] : | ||
Low-dose aspirin, 81 mg per day – To decrease cranial ischemic complications | *Low-dose aspirin, 81 mg per day – To decrease cranial ischemic complications | ||
Proton pump inhibitor – For gastrointestinal protection | *Proton pump inhibitor – For gastrointestinal protection | ||
Bisphosphonate, calcium, and vitamin D – For bone protection | *Bisphosphonate, calcium, and vitamin D – For bone protection | ||
It may be reasonable to maintain the patient on treatment for 2 years to lessen the chances for relapses. Even then, relapses have been reported. [142] | It may be reasonable to maintain the patient on treatment for 2 years to lessen the chances for relapses. Even then, relapses have been reported. [142] | ||
Revision as of 12:48, 9 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
The medical therapy for temporal arteritis is as follows:[53, 22, 8, 136, 137]
- Pharmacologic medical therapies for temporal arteritis is high-dose corticosteroid therapy.
- Damage may be irreversible if treatment is delayed beyond 48 hours.
- Oral prednisone 40-60 mg/day should be started, with a temporal artery biopsy performed within 1 week. [104]
- Prednisone doses of 80-100 mg/day have been suggested for patients with visual or neurologic symptoms of temporal arteritis and follow-up care within 72 hours after starting therapy should be arranged.[138]
- Patients with acute visual changes from temporal arteritis can be started on intravenous (IV) methylprednisolone at a dose of 1,000 mg daily for 3 days.
- Initial high-dose IV corticosteroid, methylprednisolone, treatment 15 mg/kg of ideal body weight/day may reduce remission rates. [139, 140]
- Use of low-dose aspirin (81 mg) for prevention of visual loss and stroke is recommended in temporal arteritis. [141]
British guidelines recommend the following schedule for tapering of standard-regimen corticosteroids [53] :
- Continue prednisolone, 40-60 mg (not <0.75 mg/kg) for 4 weeks (or until symptoms and laboratory abnormalities resolve), then
- Reduce dose by 10 mg every 2 weeks to 20 mg, then
- Reduce dose by 2.5 mg every 2-4 weeks to 10 mg, then
- Reduce dose by 1 mg every 1-2 months, provided no relapse occurs
The guidelines recommend that patients on steroid therapy receive prophylactic treatment with the following medications [53] :
- Low-dose aspirin, 81 mg per day – To decrease cranial ischemic complications
- Proton pump inhibitor – For gastrointestinal protection
- Bisphosphonate, calcium, and vitamin D – For bone protection
It may be reasonable to maintain the patient on treatment for 2 years to lessen the chances for relapses. Even then, relapses have been reported. [142]
Long-term corticosteroid therapy has frequent and potentially serious consequences, including diabetes mellitus, vertebral compression fractures, steroid myopathy, steroid psychosis, and immunosuppression-related infections. [143]
US Food and Drug Administration (FDA) expanded the indications for use of tocilizumab for use in GCA. Tocilizumab had previously been approved for use in rheumatoid arthritis. [146]
Improvement of systemic symptoms (eg, headache, lethargy) typically occurs within 72 hours of initiation of therapy. The elevation in erythrocyte sedimentation rate (ESR) and ischemic manifestations (eg, temporal headache, jaw claudication) diminish in several days.
High-dose steroid therapy should be maintained only long enough for symptoms to resolve. Steroids should then be tapered slowly to the lowest dose required to suppress symptoms.