Treating giant cell arteritis 

Steroid medication (corticosteroids) is the preferred treatment for giant cell arteritis (GCA). A type of steroid medicine called prednisolone is usually prescribed.

Prednisolone

If you have symptoms indicating that your vision is at risk, you may be given an initial prednisolone injection. After this, prednisolone tablets will be prescribed for you.

If your vision is not at risk, you will be prescribed prednisolone tablets or capsules straight away. You will probably start on a relatively high dose (usually between 40 to 60 milligrams). This dose will then be gradually reduced every two to four weeks, depending on how well you respond to treatment.

You may need to take prednisolone for up to two years to prevent your symptoms returning. Your symptoms should improve significantly within a few days of starting your treatment. However, there is a chance that it will return (relapse) once treatment stops.

Do not suddenly stop taking steroid medication, unless told by a doctor that it's safe to do so. Suddenly stopping treatment with steroids can make you feel very ill.

Side effects

About one in 20 people who take prednisolone will experience changes in their mental state when they take the medication.

For example, you may feel very depressed and suicidal, very anxious or very confused. Some people also experience hallucinations (feeling, seeing or hearing things that are not there). Contact your GP as soon as possible if you experience changes to your mental state. 

Other side effects of prednisolone include:

  • increased appetite that often leads to weight gain
  • increased blood pressure
  • mood changes, such as becoming aggressive or irritable with people
  • weakening of the bones (osteoporosis)
  • stomach ulcers
  • increased risk of infection - particularly to the virus that causes chickenpox and shingles (varicella-zoster virus). 

Seek immediate medical advice if you think that you have been exposed to the varicella-zoster virus or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dosage of prednisolone is decreased.

See side effects of corticosteroids for more information about how these side effects may affect you and how they are treated.

Low-dose aspirin

Low-dose aspirin is increasingly being recommended for people who have a history of giant cell arteritis, because it has been found to be effective in preventing complications of giant cell arteritis, such as heart attacks or stroke.

Immunosuppressants

Some people with giant cell arteritis may benefit from treatment with immunosuppressants, such as methotrexate or leflunomide, that are taken along with prednisolone.

Immunosuppressants are a type of medication used to reduce or suppress the immune system (the body's defence against illness and infection). Using immunosuppressants can allow steroid medication to be reduced and can help prevent the condition recurring.

Common side effects of immunosuppressant medication include nausea, vomiting, diarrhoea and skin rashes.

Follow up

The doctor in charge of your care will ask you to attend regular follow-up appointments so they can check how well you are responding to treatment. They will assess whether your dosage of prednisolone needs to be adjusted and how well you are coping with the side effects of the medication.

During these appointments you will have blood tests to check the levels of inflammation inside your body. You may also be referred for scans to assess how strong your bones are.

Follow-up appointments are usually recommended on a weekly or fortnightly basis for the first two or three months of your treatment, and then every three months after that time.

If you experience a return of your symptoms during any part of your treatment, contact your doctor because your dosage may need to be adjusted.

Steroid card

If you need to take steroids for more than three weeks, your GP or pharmacist should arrange for you to be issued with a steroid card.

It's important to carry the steroid card with you at all times because it will explain that you are regularly taking steroids and that your dose should not suddenly be stopped. This information may prove very important for healthcare professionals who need to treat you in the event of a sudden illness, accident or emergency.

Page last reviewed: 23/01/2013

Next review due: 23/01/2015