Managing of giant cell arteritis and polymyalgia rheumatica

Introduction: Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are relatively common and often overlapping conditions in individuals older than 50years from Western countries. Treatment yields improvement of symptoms in both conditions and reduction of the risk of permanent visual loss in GCA. Relapses constitute an important point of concern in these patients.Areas covered: This review focuses on the main therapeutic strategies for the management of both conditions. The use of conventional immunosuppressive drugs and the new biologic agents for the management of the disease are discussed.Expert opinion: An initial dose of prednisone of 40-60mg/day is useful to improve symptoms and to reduce the risk of blindness in GCA. In turn, 10-20mg/prednisone a day is generally sufficient to yield clinical improvement in most patients with PMR. A condition different from isolated PMR must be considered when resolution of PMR features is not achieved within 7days after the onset of corticosteroids. Relapses are common - generally when the dose of prednisone is below than 7.5-10mg/day. Methotrexate is the most commonly used corticosteroid sparing agent. Biologic agents, such as the recombinant humanized anti-IL-6 receptor antibody tocilizumab, have been incorporated into the management of these conditions, in particular of GCA. Osteoporosis prophylaxis is also recommended.