Editing Giant cell arteritis (section)

==Treatment==
GCA is considered a [[medical emergency]] due to the potential of irreversible vision loss.<ref name=ranasaeed /> [[Corticosteroid]]s, typically high-dose [[prednisone]] (1&nbsp;mg/kg/day), should be started as soon as the diagnosis is suspected (even before the diagnosis is confirmed by biopsy) to prevent irreversible blindness secondary to [[ophthalmic artery]] occlusion. Steroids do not prevent the diagnosis from later being confirmed by biopsy, although certain changes in the histology may be observed towards the end of the first week of treatment and are more difficult to identify after a couple of months.<ref name="pmid16987903">{{cite journal | vauthors = Font RL, Prabhakaran VC | title = Histological parameters helpful in recognising steroid-treated temporal arteritis: an analysis of 35 cases | journal = The British Journal of Ophthalmology | volume = 91 | issue = 2 | pages = 204–209 | date = February 2007 | pmid = 16987903 | pmc = 1857614 | doi = 10.1136/bjo.2006.101725 }}</ref> The dose of corticosteroids is generally slowly tapered over 12–18 months.<ref name="BSR2020">{{cite journal | vauthors = Mackie SL, Dejaco C, Appenzeller S, Camellino D, Duftner C, Gonzalez-Chiappe S, Mahr A, Mukhtyar C, Reynolds G, de Souza AW, Brouwer E, Bukhari M, Buttgereit F, Byrne D, Cid MC, Cimmino M, Direskeneli H, Gilbert K, Kermani TA, Khan A, Lanyon P, Luqmani R, Mallen C, Mason JC, Matteson EL, Merkel PA, Mollan S, Neill L, Sullivan EO, Sandovici M, Schmidt WA, Watts R, Whitlock M, Yacyshyn E, Ytterberg S, Dasgupta B | title = British Society for Rheumatology guideline on diagnosis and treatment of giant cell arteritis | journal = Rheumatology | volume = 59 | issue = 3 | pages = e1–e23 | date = March 2020 | pmid = 31970405 | doi = 10.1093/rheumatology/kez672 | hdl-access = free | doi-access = free | hdl = 10044/1/76450 }}</ref> Oral steroids are at least as effective as intravenous steroids,<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=708 |title=BestBets: Steroids and Temporal Arteritis |url-status=live |archive-url=https://web.archive.org/web/20090227170010/http://www.bestbets.org/bets/bet.php?id=708 |archive-date=2009-02-27 }}</ref> except in the treatment of acute visual loss where intravenous steroids appear to offer significant benefit over oral steroids.<ref>{{cite journal | vauthors = Chan CC, Paine M, O'Day J | title = Steroid management in giant cell arteritis | journal = The British Journal of Ophthalmology | volume = 85 | issue = 9 | pages = 1061–1064 | date = September 2001 | pmid = 11520757 | pmc = 1724128 | doi = 10.1136/bjo.85.9.1061 }}</ref> Short-term side effects of prednisone are uncommon but can include mood changes, [[avascular necrosis]], and an increased risk of infection.<ref>{{cite journal | vauthors = Richards RN | title = Side effects of short-term oral corticosteroids | journal = Journal of Cutaneous Medicine and Surgery | volume = 12 | issue = 2 | pages = 77–81 | date = March 2008 | pmid = 18346404 | doi = 10.2310/7750.2008.07029 | s2cid = 30995207 }}</ref> Some of the side effects associated with long-term use include weight gain, [[diabetes mellitus]], [[osteoporosis]], avascular necrosis, [[glaucoma]], [[cataract]]s, cardiovascular disease, and an increased risk of infection.<ref>{{cite journal | vauthors = Youssef J, Novosad SA, Winthrop KL | title = Infection Risk and Safety of Corticosteroid Use | journal = Rheumatic Disease Clinics of North America | volume = 42 | issue = 1 | pages = 157–176 | date = February 2016 | pmid = 26611557 | pmc = 4751577 | doi = 10.1016/j.rdc.2015.08.004 }}</ref><ref>{{cite journal | vauthors = Oray M, Abu Samra K, Ebrahimiadib N, Meese H, Foster CS | title = Long-term side effects of glucocorticoids | journal = Expert Opinion on Drug Safety | volume = 15 | issue = 4 | pages = 457–465 | date = 2016-04-02 | pmid = 26789102 | doi = 10.1517/14740338.2016.1140743 | s2cid = 39396172 }}</ref> It is unclear whether adding a small amount of [[aspirin]] is beneficial or not as it has not been studied.<ref>{{cite journal | vauthors = Mollan SP, Sharrack N, Burdon MA, Denniston AK | title = Aspirin as adjunctive treatment for giant cell arteritis | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 8 | pages = CD010453 | date = August 2014 | pmid = 25087045 | pmc = 10589060 | doi = 10.1002/14651858.CD010453.pub2 }}</ref> Injections of [[tocilizumab]] may also be used.<ref>{{cite web|title=Press Announcements - FDA approves first drug to specifically treat giant cell arteritis|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm559791.htm|website=www.fda.gov|access-date=10 February 2018}}</ref> Tocilizumab is a humanized [[antibody]] that targets the interleukin-6 receptor, which is a key [[cytokine]] involved in the progression of GCA.<ref name=":1">{{cite journal | vauthors = Mariano VJ, Frishman WH | title = Tocilizumab in Giant Cell Arteritis | journal = Cardiology in Review | volume = 26 | issue = 6 | pages = 321–330 | date = 2018 | pmid = 29570475 | doi = 10.1097/CRD.0000000000000204 | s2cid = 4227514 }}</ref> Tocilizumab has been found to be effective at minimizing both recurrence, and flares of GCA when used both on its own and with corticosteroids.<ref name=":1" /> Long term use of tocilizumab requires further investigation.<ref name=":1" /><ref name=":2" /> Tocilizumab may increase the risk of [[gastrointestinal perforation]] and [[infection]]s, however it does not appear that there are more risks than using corticosteroids.<ref name=":1" /><ref name=":2">{{cite journal | vauthors = Rinden T, Miller E, Nasr R | title = Giant cell arteritis: An updated review of an old disease | journal = Cleveland Clinic Journal of Medicine | volume = 86 | issue = 7 | pages = 465–472 | date = July 2019 | pmid = 31291180 | doi = 10.3949/ccjm.86a.18103 | doi-access = free }}</ref>