Giant Cell Arteritis

The balancing act of disease control

Patients go through this whole rollercoaster ride of disease control, disease relapse and then back on steroids again.
Dr Neil Collinson Senior Clinical Development Scientist at Roche

The discovery of steroids in the mid-1940s heralded a major breakthrough in the treatment of GCA – transforming the lives of patients almost overnight. Initially hailed as a miracle cure, they won three scientists the Nobel Prize in 1950 and from then on were widely prescribed.14

They are usually a synthetic form of cortisol, a natural hormone produced by the adrenal glands, and have been the mainstay of GCA treatment for decades.2,15

If GCA is diagnosed early and treated immediately, patients have a good prognosis. A high dose of steroids has a rapid effect on symptoms and can even prevent sight loss – one of untreated GCA’s most devastating consequences.1,10

However, the greatest challenge most GCA patients face is coping with the side effects of the medication.1

Steroids are the best drug in the world for a week. But after that, the side effects begin to mount.
Dr John Stone Director of Clinical Rheumatology at Massachusetts General Hospital, USA

The aim of GCA treatment is to control symptoms, but doctors also want to maintain a patient’s quality of life and minimise these steroid-related side effects.1,2

This important balance is the reason why, after treating patients with a high dose of steroids for a number of months, doctors then wean the dose down to the lowest it can be to control their symptoms while minimising side effects. Unfortunately, at least half of patients will suffer a relapse – as their steroids are reduced, their devastating GCA symptoms kick-start again and the dose must be increased to get it under control.16,17


Potential side effects of steroids

Treatment to date has been limited to high-dose long duration steroids that commonly cause severe side effects such as:2

Osteoporosis and fractures


High blood pressure

Infection and diabetes

The constant balancing act of ups and downs in steroid treatment means there is a genuine need for new long-term treatments, so that doctors have options when treating those people for whom steroid treatment is not the solution. Research is beginning to lead to new ways to tackle GCA and strides are being made to create alternatives.

Recent studies have shown that blocking IL-6-signaling could reduce the inflammation of blood vessels in GCA.

Like anyone, people with GCA can maintain their quality of life by making healthy lifestyle changes including eating plenty of fresh fruits, vegetables, wholegrains, lean meats and fish while limiting their intake of salt, sugar and alcohol. Adequate amounts of calcium and vitamin D are important, as is regular aerobic exercise, such as walking.

GCA is a chronic inflammatory disease and despite little progress for patients in almost seven decades, their outlook is improving. Understanding of the disease, improved recognition, faster diagnosis including innovative use of imaging, and optimal disease management including multidisciplinary fast-track approaches are all driving better outcomes.


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