Monitoring
During prednisone taper, patients should be evaluated regularly by clinical examination, and inflammatory markers periodically checked. Patients with GCA frequently experience unpredictable disease relapses, requiring an increase in the glucocorticoid dose; however, isolated elevation of inflammatory markers in the absence of clinical symptoms should not automatically result in escalation of therapy.
Patients on long-term glucocorticoids can develop glucocorticoid-induced adverse effects. Patients should be monitored for diabetes, elevated blood pressure, and glucocorticoid-induced bone loss.[69][70][71] If available, bone mineral density testing is recommended within 6 months of starting glucocorticoid therapy for adults and every 1-2 years thereafter while continuing glucocorticoid therapy.[68] Patients typically have a normochromic, normocytic anemia with a normal white blood cell (WBC) count and elevated platelet count. Complete blood count should be monitored. Significant elevation of the WBC count should prompt an evaluation for possible hematologic malignancy.
Because patients with GCA are at increased risk for developing aortic aneurysms, long-term monitoring for such complications is recommended.[110] Although expert opinion varies, a reasonable strategy has been recommended by the French Study Group for Large Vessel Vasculitis:[61]
Computed tomography (CT) or magnetic resonance imaging (MRI) screening for complications of aortitis is recommended at GCA diagnosis, then every 2 to 5 years, provided the patient has no contraindications to a potential aorta repair
Transthoracic echocardiography (most thoracic aneurysms develop in the ascending aorta) may also be an appropriate screening test, although the descending thoracic aorta would not be imaged with echocardiography.
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