Table 1 Suggested algorithm for the GCA patients’ stratification
Disease state | Risk | Impact on management recommendation |
|---|---|---|
Disease activity: -Elevated acute phase reactant / biomarkers -Presence of constitutional symptoms -Presence of PMR symptoms | -Risk of relapse -presence of extracranial large vessel affection | Likely to require longer treatment with glucocorticoids |
Disease severity: -predominant cranial manifestations | -Risk of ischemic vascular complications | -IV methylprednisolone Induction therapy -Less likely to require long-term GG therapy |
Possibility of accrual damage: -Large vessel involvement on imaging -Aortic inflammation at baseline - Ischaemic complications -Halo score grade | -Risk of relapse -Risk of aortic dilation or aneurysm | Adjuvant therapy Long-term GC therapy |
Presence of Comorbidities: -DM, CVS, glaucoma | -Poor GC benefit: Risk ratio - developing disease- and therapy-related complications | Adjuvant therapy at baseline -Preventive measures to minimize disease associated complications |
Relapsing disease | Long-term vascular damage | Higher steroid dose + adjuvant therapy |