Evidence-based On-call

Giant cell arteritis

Therapy

Warn patients they may be on steroids for a long time, and that side-effects are common with long-term use. ^a

Common problems include weight gain and vertebral fractures. ^d
Watch out for iatrogenic Cushing's syndrome, bacterial sepsis and hypertension. ^a

Note:

Around a third of patients with giant cell arteritis on steroids have side-effects, commonest being weight-gain (~ 50%) and vertebral fractures (~15%). ^c
Dyspepsia symptoms are more common with steroids, but there is no clear increase in the occurrence of peptic ulcers. ^a

Cushing's syndrome is common in patients on long-term steriods.

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
giant cell arteritis ^a	steroid use (mean of 35 mg prednisolone for 2 months)	placebo	Cushing's syndrome/ acne/ hirsutism at 2 months	2.6%	4.5 (3.5 to 5.7)	12 (9 to 17)
	steroid use	placebo	bacterial sepsis at 2 months	4.8%	1.2 (1.0 to 1.6)	110 (38 to infinity)
	steroid use	placebo	hypertension at 2 months	0.24%	2.2 (1.4 to 3.8)	350 (150 to 1100)
	steroid use	placebo	ulcer symptoms at 2 months	0.25%	1.9 (1.1 to 3.0)	440 (200 to 4000)
	steroid use	placebo	diabetes mellitus at 2 months	0.32%	1.7 (1.1 to 2.6)	450 (200 to 3100)