Scientific case study

GCA: Case by Case

GCA:
Case by Case

Sponsored by Novartis US Medical Affairs

Michael Putman, MD, MSCI

Assistant Professor of Medicine, Medical College of Wisconsin

See clinical perspectives from Dr Putman throughout on managing patients with giant cell arteritis (GCA)

Meet the expert

Rheumatologist Dr Michael Putman offers his expert insights on optimizing the management of GCA through the examination of 4 intricate patient cases. He delves into challenges in diagnosing and treating GCA, while underscoring the significance of patient education and shared decision-making.​

Illustrative case study

How would you manage a patient with GCA who is requesting to increase their prednisone dose for new symptoms?

Current Presentation

3 months since last visit
Chief complaints: Hip pain (worsens with corticosteroid tapering) and headaches (respond to acetaminophen)

Clinical History

GCA duration: 8 months
Medications: IL-6 inhibitor and
prednisone (6 mg QD)

Key comorbidities: Osteoarthritis, insulin-dependent diabetes, hypertension, hyperlipidemia, cataracts

Clinical Findings

Examination: Decreased rotation to internal rotation of bilateral hips​
Laboratory tests: ESR 7 mm/hr, CRP normal
X-rays: Moderate degenerative arthritis in hips ​

What would be your management strategy?(Required)
Illustrative case study

How would you manage a newly diagnosed patient with GCA with diverticulosis and other comorbidities?

Current Presentation

First visit to a rheumatologist after GCA diagnosis
Chief complaints: Daily headaches, jaw claudication, recent left-sided “blurry” vision

Clinical History

GCA duration: 8 weeks
Medications: Prednisone (40 mg QD), losartan, and hydrochlorothiazide
Recently stopped statins after LDL-C levels reached <100 mg/dL​
Key comorbidities:
  • Diverticulosis identified on colonoscopy at 60 years of age
  • No history of malignancy or diverticulitis
  • History of hyperlipidemia, hypertension, and myocardial infarction at 67 years of age

Clinical Findings

Examination: Left temporal artery is both palpable and tender​
Laboratory tests: ESR 65 mm/hr, CRP 30 mg/L

What would be your management strategy?(Required)

*Used as off-label treatment option as per ACR guidelines.

Illustrative case study

What would be your next step when a patient relapses on therapy?

Current Presentation

Patient with established GCA: Last seen 6 months ago
Chief complaints: Sudden vision loss

Clinical History

GCA duration: 17 months
Medications: IL-6 inhibitor, corticosteroids discontinued 8 months ago
Key comorbidities: Degenerative joint disease, hyperlipidemia, benign prostate hyperplasia

Clinical Findings

Laboratory tests: ESR 9 mm/hr, CRP normal
Physical exam: Ophthalmology reports “optic disc pallor concerning for recurrent GCA”

In addition to reinitiating high-dose corticosteroids, what would be your management strategy for this patient?(Required)
*Used as off-label treatment option as per ACR guidelines.
Illustrative case study

When would you consider differential diagnosis in a patient diagnosed with refractory PMR?

Current Presentation

4 months since onset of symptoms
Chief complaints: Persistent fatigue, neck pain, fever

Clinical History

Diagnostic history:

  • Initially diagnosed with PMR, started on prednisone (down to 14 mg QD)
  • No headaches or jaw claudication
Imaging: Left temporal artery biopsy normal (performed after 6 weeks of corticosteroids)

Medications: None currently

Key comorbidities: Hypertension

Clinical Findings

Examination: Vascular bruit, blood pressure discrepancy between arms
Laboratory tests: ESR 91 mm/hr, CRP 8.3 mg/L

What would be your next step for this patient?(Required)
Summary

What is needed to improve standards of care in GCA?

Corticosteroid-sparing therapies with an acceptable balance of efficacy and toxicity1

Agents targeting varied disease pathways2 offer flexible options for evolving patient needs18

Approved treatments with a reduced risk of relapse,1 particularly for patients not controlled on current therapies18

Continued innovation is critical to expand therapeutic options, optimize patient outcomes, and improve standards of care in GCA

Abbreviations

ACR, American College of Rheumatology; AE, adverse event; CRP, C-reactive protein; CTA, computed tomography angiography; ESR, erythrocyte sedimentation rate; FDA, Food and Drug Administration; GCA, giant cell arteritis; IL, interleukin; LDL-C, low-density lipoprotein cholesterol; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; PET-CT, positron emission tomography and computed tomography; PMR, polymyalgia rheumatica; QD, once daily.

References

1. Low C, Conway R. Ther Adv Musculoskel Dis. 2019;11:1759720X19827222. 2. Mollan SP et al. Eye (Lond). 2021;35(3):699-701. 3. Hellmich B et al. Ann Rheum Dis. 2020;79(1):19-30. 4. Buttgereit F
et al. Rheumatology. 2018;57(suppl. 2):ii11-ii21. 5. Dejaco C et al. Ann Rheum Dis 2024;83(1):48-57. 6. Maz M et al. Arthritis Rheumatol. 2021;73(8):1349-1365. 7. Kolasinski S et al. Arthritis Care Res (Hoboken). 2020;72(2):149-162. 8. Babigumira JB et al. Rheumatol Ther. 2017;4(1):111-119.
9. Charlson ME et al. J Chron Dis. 1987;40(5):373-383. 10. Deyo RA et al. J Clin Epidemiol. 1992;45(6):613-619. 11. Aussedat M et al. Autoimmun Rev. 2022;21(1):102930.
12. Alba MA et al. Autoimmun Rev. 2024;23(6):103580. 13. Koster MJ, Matteson EL, Warrington KJ. Rheumatology. 2018;57(suppl_2):ii32-ii42. 14. Blockmans D et al. Arthritis Rheum.
2006;55(1):131-137. 15. Prieto-González S et al. Ann Rheum Dis. 2012;71(7):1170-1176
16. Evans JM et al. Ann Intern Med. 1995;122(7):502-507. 17. Kermani TA et al. Ann Rheum Dis. 2013;72(12):1989-1994. 18. Galli E et al. Curr Opin Rheumatol. 2024;36(5):344-350.

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