Steroid tablets (usually prednisolone) are the most commonly used treatment for GCA. They're very effective and usually start to work within a few days. They work by reducing the activity of your immune system to reduce inflammation in the blood vessels. Your doctor will want to start treatment as soon as possible because of the possible risk of sight loss if you're not treated promptly.
You’ll usually be given a high dose of between 40 mg and 60 mg of prednisolone tablets every day for 3–4 weeks to begin with. If you’re well after that, and your blood tests have improved, your doctor will start reducing the dose. The specialist will want to see you regularly to monitor your progress.
It can be dangerous to suddenly stop taking your steroid tablets or to alter the dose unless your doctor tells you to. Normally your body produces its own steroids but this stops when you're on steroid treatment. When you come off steroid treatment it can take a little while for your body to start producing its own supply again.
It isn’t always possible to stop steroids completely, but you'll usually need to take them for 1–3 years because inflammation can come back (relapse) if your dose is reduced or stopped too quickly. Relapse is most common within the first 18 months of treatment. If you have a relapse, your steroid dose may have to be increased. Regular blood tests will show if there are signs of relapse.
If an increased dose of steroids doesn't stop relapses, your doctor may suggest you take an additional medication, such as methotrexate.
If you do develop visual symptoms, you may need to go to hospital urgently to be given steroids (methylprednisolone) through a drip into a vein.
There are some possible side-effects from steroids. Although these can be worrying, steroids are necessary to treat GCA. It’s important to start steroid treatment straight away to reduce the risk of sight loss.
You should be given a steroid card showing the dose of steroids you're on. If you need to see another doctor or healthcare professional (e.g. a dentist) you should tell them your steroid dose or show them the card. Depending on what the problem is you may need to increase your steroid dose temporarily or take them by a different method.
Steroids are the best first-line treatment available to get GCA under control quickly. However, if you have a relapse your doctor may suggest an additional medication to help reduce the dose of steroids – for example a disease-modifying anti-rheumatic drug (DMARD) such as methotrexate, leflunomide or azathioprine.
Your doctor may suggest low-strength aspirin (75 mg) as it helps to protect against loss of vision.
As steroids have possible side-effects, your doctor may also suggest additional medications to protect you from these. You will be started on calcium and vitamin D supplements to protect your bones. Your doctor may also advise you to start another medication called a bisphosphonate to reduce the risk of developing osteoporosis.
Because steroids can affect the stomach lining, you may also be given a stomach-protecting tablet (for example, a proton pump inhibitor, or PPI) such as omeprazole. Bisphosphonates and PPIs will usually be started at the same time as the steroids.