Diagnosis and Treatment of Giant Cell Arteritis

Diagnostic Criteria

• The American College of Rheumatology (ACR)/Vasculitis Foundation guidelines require confirmation of GCA diagnosis through either temporal artery biopsy, cross-sectional imaging, or elevated acute-phase reactants (ESR/CRP) 1, 2, 3
• The Aetna Clinical Policy Bulletin (CPB) specifically requires GCA diagnosis confirmation through either temporal artery biopsy or cross-sectional imaging, or acute-phase reactant elevation (high ESR and/or high CRP) 6

Treatment Recommendations

• For patients with newly diagnosed GCA, guidelines conditionally recommend the use of oral glucocorticoids with tocilizumab over oral glucocorticoids alone, but this applies to confirmed cases of GCA 6, 7
• The 2018 EULAR recommendations emphasize that a suspected diagnosis of GCA should be confirmed by imaging or histology before initiating treatment 9

Alternative Approaches

• For patients with suspected GCA but negative workup, guidelines recommend continued clinical monitoring 4, 6
• Consideration of alternative diagnoses should be taken into account for patients with suspected GCA but negative workup 3
• Cautious glucocorticoid tapering is recommended if symptoms are well-controlled 7, 9
• If clinical suspicion remains high despite negative testing, repeating vascular imaging during active symptoms may be considered 2, 3