Advances in management of giant cell arteritis

Giant cell arteritis (GCA) is the most common systemic vasculitis in older adults and is a medical emergency due to the potential for irreversible visual loss and stroke in the acute phase and aortic complications in the longer term. Prompt recognition of the condition and immediate initiation of glucocorticoids remain central to management and advances in therapy, particularly with tocilizumab in the first 12 months, have reduced glucocorticoid-related morbidity. Upadacitinib has recently been shown in phase 3 trials to be effective, and its place in the Australasian therapeutic landscape will evolve in the coming years. Management also focusses on assessing for and reducing disease and treatment-related complications, including relapse, aortic aneurysm, infection, diabetes and osteoporosis. The optimal treatment strategy beyond the initial 12 months of therapy remains undefined and is typically individualised and informed by comorbidities, patient preference, clinician familiarity, cost and regulatory access. This review outlines current best practice for the management of GCA in Australia with a focus on recent therapeutic advances and strategies for longer-term patient care.