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Dr. John Wade, MD, FRCPC, Rheumatologist, discusses how Giant Cell Arteritis is treated.
Dr. John Wade is a leading rheumatologist in Canada. He believes that outstanding clinical and diagnostic assessment combined with generational change in therapeutics over the last decade have altered the lives of patients with arthritis for the better.
Dr. John Wade completed his medical studies at the University of British Columbia and Harvard Medical School. Since returning to Vancouver General Hospital and the University of British Columbia, he has focused on optimizing care for patients with arthritis and other inflammatory disorders.
He has been a leader in training future generations of doctors. Dr Wade https://rheumatology-now.com/dr-john-wade-rheumatology-now/has served as Head, Division of Rheumatology, Vancouver General Hospital; Post Graduate Medical Director, Department of Medicine , University of British Columbia; Board Member, The Arthritis Society BC and Yukon Division and President Medical Staff, Vancouver General Hospital.
Dr. Wade has spent over 20 years being a leader in continuing medical education. He believes that learning is a lifelong experience. He has chaired over 50 local, national and international medical meetings to improve doctors’ knowledge in both internal medicine and rheumatology.
Treating Giant Cell Arteritis
The treatment of giant cell arteritis is important. If your doctor or specialist suspects you have giant cell arteritis and confirms the diagnosis, it will be recommended to you that you go on high dose prednisone.
Prednisone is an extremely effective treatment for this condition. The dose of prednisone will generally be a high dose. Typically, your specialist will recommend a dose of one milligram per kilogram of prednisone.
Sometimes they may choose a lower dose. Occasionally if there is concern about visual loss, they may recommend that you receive steroid or prednisone through an intravenous injection, or a pulse steroid injection.
Once you’ve started the high-dose prednisone, then you will probably be on that medication for a number of months before the dose is slowly tapered, and you may be on prednisone for several months, and even potentially for several years.
When patients go on high-dose prednisone for giant cell arteritis, one of the biggest management problems is handling the side effects from the prednisone. It’s important that you see your specialist to discuss about lifestyle and other medications that can minimize the side effects of long-term, high-dose prednisone.
In recent years we’ve recognized that there are some prednisone-sparing medications to treat giant cell arteritis. Historically we’ve used medications including methotrexate, azathioprine and cyclophosphamide, which are pills that will treat inflammatory-type conditions. And we will still use those medications today.
Recently there has been a large, international, randomized trial showing the effectiveness of one of the biologics to treat giant cell arteritis. The biologic interleukin-6 inhibitor, or tocilizumab, has been studied in clinical trials and shown that using this medication early on reduces the need for high doses of prednisone, and reduces the need for how long you’re going to be on prednisone.
Trials comparing the interleukin-6 inhibitor tocilizumab with prednisone, vs. prednisone in high doses alone, shows that the disease is much better treated with using this medication, and much less side effects in terms of prednisone side effects and lower risks of infections.
At this time, the treatment for giant cell arteritis should include tocilizumab, but unfortunately the cost of this medication is such that presently, third-party payers may at this time not be paying for it in certain parts of your country. But I suspect that as time goes on, this will become standard treatment for patients that are on high doses of prednisone, and having side effects from the prednisone, and not getting better.
Giant cell arteritis we recognize can be a chronic disease, and you may be living with this for months or years. So it’s important that you follow up with your healthcare provider and specialist to ensure that the symptoms of giant cell arteritis are controlled and not requiring further medical treatment as you reduce the prednisone.
If you have any concerns or questions about the treatment of giant cell arteritis, speak to your healthcare provider or specialist.
Presenter: Dr. John Wade, Rheumatologist, Vancouver, BC
Local Practitioners: Rheumatologist