Therapy

Why?

• Patients on lower doses are more likely to require increases to control symptoms, though there is no clear difference in the rate of ocular complications. ^{c d}
• There are fewer side-effects. Patients with greater doses of steroid have more side-effects. ^b
• Alternate day regimens cause fewer steroid side-effects, but are worse at controlling symptoms. ^a
• Patients on long-term steroids who take vitamin D and calcium have less bone loss in their lumbar spine and forearm, though the effect on non-traumatic fractures is unclear. ^a

High-dose steroids help control symptoms in giant cell arteritis

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
giant cell arteritis c	prednisolone > 20mg daily	prednisolone < 20mg daily	Dose increase required to control symptoms or lower ESR up to 40 weeks	46%	89 (51 to 100)	2 (2 to 4)
giant cell arteritis a	prednisolone alternate days	prednisolone daily	symptom resolution by 4 weeks	85%	-65 (-92 to -38)	-2 (-3 to -1)
giant cell arteritis a	prednisolone alternate days	prednisolone daily	Adverse effects due to steroids  by 8 weeks	65%	100	2 (1 to 2)