Treatment of Vision Loss in Giant Cell Arteritis

Opinion statement If giant cell arteritis is suspected as a cause of visual loss, emergent management is necessary. Clinical suspicion should prompt the practitioner to obtain laboratory studies and initiate treatment prior to establishing the diagnosis. The evaluation includes immediate erythrocyte...

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Bibliographic Details
Published in:Current treatment options in neurology 2012-02, Vol.14 (1), p.84-92
Main Authors: Scheurer, Ryan A., Harrison, Andrew R., Lee, Michael S.
Format: Article
Language:English
Subjects:
Critical Care Medicine
Diabetes
Family Medicine
General Practice
Intensive
Internal Medicine
Medicine
Medicine & Public Health
Neurologic Ophthalmology and Otology (RK Shin
Neurology
Ophthalmology
Section Editor
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Summary:Opinion statement If giant cell arteritis is suspected as a cause of visual loss, emergent management is necessary. Clinical suspicion should prompt the practitioner to obtain laboratory studies and initiate treatment prior to establishing the diagnosis. The evaluation includes immediate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC). Treatment begins with high-dose intravenous corticosteroids. We recommend intravenous methylprednisolone (250 mg every 6 h) for 3 to 5 days. During that time, a temporal artery biopsy should be performed for pathologic diagnosis. We also begin daily adjunctive aspirin orally. After the initial bolus of intravenous corticosteroids, therapy transitions to oral prednisone administered at 1 mg/kg per day until the activity of the disease process attenuates, as demonstrated by improvement in systemic symptoms and normalization of both ESR and CRP. This change usually occurs in the first 3 to 4 weeks. The patient should be followed closely, with therapy tapered as guided by systemic symptoms, ESR, and CRP. To maximize the use of remaining vision, appropriate patients should be referred to specialists for help with low-vision therapies, assistive devices, and precautions to protect the better-seeing eye.
ISSN:1092-8480
1534-3138
DOI:10.1007/s11940-011-0152-7