Prognosis

The majority of patients respond rapidly to initial treatment with glucocorticoids, and vision loss in treated patients is rare. Lack of response to glucocorticoid therapy should alert the physician to question the diagnosis; however, up to 50% of adequately treated patients experience unpredictable disease relapses and recurrence of symptoms.[2][97]

Glucocorticoid-related adverse effects are common, occurring in over 60% of patients.[21] Major consequences of glucocorticoid therapy include diabetes mellitus and osteoporotic fractures. Use of tocilizumab may allow for more accelerated glucocorticoid tapering, but the optimal duration of tocilizumab therapy remains unclear.

The overall survival for patients with GCA is similar to that of the general population;[12] however, the risk of developing aortic aneurysms is markedly increased in patients with GCA. In a population-based study, GCA patients were 17 times more likely to develop thoracic aortic aneurysms and 2.4 times more likely to develop isolated abdominal aortic aneurysms, compared with people of the same age and sex.[98] Thoracic aortic aneurysms may result in dissection and markedly increased mortality.[99] Risk factors for the development of aortic aneurysm in GCA are incompletely understood. However, the presence of aortic inflammation at baseline appears to predispose some patients to progressive aortic dilatation.[7][38]

Epidemiological evidence suggests that patients with GCA may have an increased risk of cardiovascular disease. Therefore, monitoring for, and management of, cardiovascular risk factors is particularly warranted in this patient population.[100][101]

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