Complications
Clinically significant stenoses of branches of the aortic arch, especially the subclavian and axillary arteries, occur in about 10% to 15% of patients.[7]
GCA patients are 17 times more likely to develop thoracic aortic aneurysms and 2.4 times more likely to develop isolated abdominal aortic aneurysms, compared with unaffected people of the same age and sex.[98] Management of aneurysms depends on size. Smaller aneurysms can be managed medically with tight blood pressure control, whereas larger ones require surgical intervention. The incidence of aortic aneurysm after diagnosis of GCA may be as high as 30%.[7]
The treatment of GCA is associated with significant toxicity; therefore, measures to prevent or treat glucocorticoid-related adverse effects are very important. These may include managing glucocorticoid-induced diabetes, monitoring for and treating elevated blood pressure, and preventing glucocorticoid-induced bone loss with calcium, vitamin D, and bisphosphonates.
Appropriate immunisations, including influenza and pneumococcal vaccines, should be administered.
Once blindness has occurred, it is usually irreversible. Hence, treatment with glucocorticoids should be started immediately in patients with visual symptoms or a high clinical suspicion of GCA (while awaiting confirmation of diagnosis, including results of temporal artery biopsy and acute-phase reactants).[102]
The risk of vision loss after starting glucocorticoid therapy is about 1% for patients with no preceding loss of vision. In patients with impaired vision before treatment, the risk of progressive vision loss is about 13%. Data are based on a 5-year period of follow-up.[103]
The presence of constitutional symptoms or polymyalgia rheumatica may be associated with a reduced risk of blindness.[104]
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