What is your approach to patients with biopsy proven giant cell arteritis that continue to have symptoms after initiation of high dose glucocorticoid therapy?

First, let's define and discuss “high-dose” steroids. Oral therapy is typically 60-100 mg of prednisone daily, and IV is 500-1000 mg of methylprednisolone daily for three days, followed by oral prednisone. There has been no difference in long-term outcomes for vision loss or diplopia. The complication rate for IV in the affected age group is not insignificant and may be best delivered in a hospital setting or a hospital outpatient unit, so a patient can be monitored. Studies have shown in MS/opt...