This handout is for giant cell arteritis (gca / temporal arteritis). Your care team identified this based on: new-onset headache in patient ≥50 (acr 2021 classification criterion).
Other reasons your team may use this plan: jaw claudication (highest lr+ for gca — acr 2021); amaurosis fugax / acute visual loss (acr 2021 / eular 2023 — iv pulse indication); scalp tenderness or temporal artery abnormality (acr 2021).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| prednisone | 40-60 mg PO daily (1 mg/kg) | PO | daily | 2022 ACR / 2023 EULAR strong — induction; do not delay for biopsy |
| methylprednisolone | 500-1000 mg IV daily × 3 days then prednisone 60 mg | IV → PO | daily × 3 d then PO | IV pulse for visual / neurologic involvement (ACR 2024) |
| tocilizumab | 162 mg SC weekly (or q2 weeks initially) | SC | weekly | GiACTA NEJM 2017 — Class I steroid-sparing; CRP unreliable on TCZ (rely on symptoms) |
| methotrexate | 10-25 mg PO/SC weekly | PO/SC | weekly | EULAR 2023 alternative steroid-sparer; modest effect |
| aspirin | 81 mg PO daily | PO | daily | EULAR 2023 — possible reduction in ophthalmic / cerebrovascular events |
| pantoprazole | 40 mg PO daily | PO | daily | GI prophylaxis during high-dose steroid (BSR 2020) |
| alendronate | 70 mg PO weekly | PO | weekly | ACR 2017 GIO — bone protection during chronic steroid |
Plan: GCA — induction steroid + tocilizumab steroid-sparing (2022 ACR + 2023 EULAR)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Slow steroid taper to ≤5 mg by 12 months when feasible (BSR 2020 / EULAR 2023); aortic surveillance imaging q1-2 years if LV-GCA (EULAR 2018); relapse education + return-precaution counseling
Guideline: 2022 ACR/Vasculitis Foundation GCA + 2023 EULAR Recommendations + GiACTA (Stone NEJM 2017)