Giant cell arteritis treatment (Giant cell arteritis (temporal arteritis) management)
Urgent treatment of giant cell arteritis, an inflammation of the arteries around the head, started quickly with steroids to protect your sight.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Giant cell arteritis is an emergency: any new loss or blurring of vision, or double vision, needs same-day medical help to try to protect your sight.
- High-dose steroids are usually started immediately on suspicion, even before a biopsy or scan confirms the diagnosis.
- Treatment controls the inflammation rather than curing it instantly; the steroid dose is reduced slowly over roughly one to two years.
- Steroids have important side effects, so good treatment includes bone, blood-sugar and infection protection and a clear plan for tapering the dose.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Starting steroids quickly greatly reduces the risk of sudden, permanent sight loss.
Delaying steroids to wait for a biopsy or scan is not appropriate when giant cell arteritis is strongly suspected.
Headache, scalp tenderness and jaw pain usually improve quickly once high-dose steroids are started. A poor response should make the team reconsider the...
A named contact and clear route to same-day help for any vision change.
Headache, scalp tenderness and jaw pain usually improve quickly once high-dose steroids are started. A poor...
The starting dose is usually held while symptoms settle and tests are reviewed. You may notice steroid effects...
The steroid dose is reduced in careful steps, guided by your symptoms and inflammation blood tests. A...
The dose continues to come down slowly, often towards stopping by around 12-18 months if there are no flares...
What is giant cell arteritis and how is it treated?
Giant cell arteritis (also called temporal arteritis) is inflammation of medium and large arteries, most often the ones running over the temples and scalp. It mainly affects people over 50 and is more common in women. The swelling in the artery walls can reduce blood flow, and the most feared problem is sudden, permanent loss of vision in one or both eyes.
Giant cell arteritis is treated as a medical emergency. The main treatment is high-dose steroids (a corticosteroid such as prednisolone), usually started straight away the moment the condition is strongly suspected — often before any test confirms it. Treating early is what protects your sight, because once vision is lost from giant cell arteritis it usually cannot be brought back.
Treatment does not cure the condition in one go. It controls the inflammation while the steroid dose is slowly reduced over many months, and sometimes a steroid-sparing medicine is added. The aim is to keep the disease quiet, protect your eyes and blood vessels, and reduce the harm caused by long-term steroids.
This guide explains what the condition is, how it is confirmed, how treatment works, and the warning signs that mean you must seek help the same day.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
High-dose oral steroids (prednisolone)
The standard treatment for most people without sight loss is high-dose prednisolone tablets, usually 40-60 mg a day to start, then reduced slowly over many months as symptoms...
Intravenous steroids for sight loss
If you have visual loss or double vision, very high-dose steroids may be given into a vein in hospital for up to a few days before switching to tablets, to try to protect the...
Tocilizumab (steroid-sparing biologic)
A medicine, often given by injection, that blocks an inflammation signal (interleukin-6). It can help control the disease while allowing a faster steroid reduction, and may...
Methotrexate (steroid-sparing tablet)
A weekly tablet sometimes added to reduce the total amount of steroid needed, though the evidence for it in giant cell arteritis is more limited.
Preparing for your treatment
- Treat new vision loss, blurring or double vision as an emergency and seek help the same day, before any test.
- Make a clear note of your symptoms and when they started: headache, scalp tenderness, jaw ache when chewing, vision changes, shoulder or hip stiffness.
- Bring a full list of your medicines, as some interact with steroids or affect your infection and bone risk.
- Tell the team if you have diabetes, high blood pressure, glaucoma, stomach ulcers, osteoporosis or any recent infection, as steroids can worsen these.
- If a temporal artery biopsy or ultrasound is planned, ask how soon it can happen, as steroids should not be delayed to wait for it.
- Ask whether you are being referred onto a fast-track giant cell arteritis pathway, which aims for specialist review quickly.
- Arrange support at home, as high-dose steroids can affect sleep, mood, appetite and energy in the early weeks.
What happens
If giant cell arteritis is suspected, a doctor will usually start high-dose steroids straight away rather than wait for tests. You will be examined, have blood tests (including inflammation markers such as ESR and CRP), and be referred urgently to a specialist — a rheumatologist or ophthalmologist — ideally the same working day.
To confirm the diagnosis, you may have an ultrasound scan of the arteries at the temples and shoulders, a temporal artery biopsy (a small sample of artery taken under local anaesthetic), or sometimes a specialist MRI scan. These help confirm the condition but should not hold up treatment.
Once treatment starts, you will be reviewed regularly. The steroid dose is reduced in steps as long as symptoms stay away and inflammation markers settle. Your team will monitor for side effects and, in some people, add a steroid-sparing medicine. Treatment is usually led by a rheumatologist, with ophthalmology involved if the eyes are affected.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Delaying steroids to wait for a biopsy or scan is not appropriate when giant cell arteritis is strongly suspected.
- Steroids alone are not a substitute for urgent eye assessment when there is any visual symptom.
- A normal inflammation blood test does not fully exclude the condition, so it should not be used on its own to withhold treatment.
- Self-managing or stopping steroids without specialist guidance is unsafe.
Delay or rearrange if…
- Never delay starting steroids when sight is threatened; instead, treat as an emergency.
- A planned steroid reduction should be paused if symptoms return or inflammation markers rise.
- Starting or continuing a steroid-sparing biologic should be reconsidered during active infection.
- Routine (non-urgent) tests can wait, but treatment and urgent eye review cannot.
Alternatives to discuss
- There is no safe alternative to prompt steroids when giant cell arteritis is suspected; the choice is about which medicines, not whether to treat.
- Steroid-sparing options such as tocilizumab or methotrexate to reduce total steroid exposure.
- Shared care with ophthalmology when the eyes are affected, or with other specialists if large arteries are involved.
- Supportive measures such as bone protection, blood-pressure and blood-sugar control alongside treatment.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Starting steroids quickly greatly reduces the risk of sudden, permanent sight loss.
- Headache, scalp tenderness and jaw pain often improve within a few days of starting treatment.
- Controlling the inflammation lowers the risk of stroke and damage to large arteries.
- A steroid-sparing medicine can allow a faster steroid reduction and fewer steroid side effects in some people.
- Regular specialist review means flares and side effects can be caught and managed early.
Risks & complications
- Steroid side effects such as weight gain, increased appetite, mood and sleep changes, raised blood sugar and a rounder face
- Higher blood pressure and fluid retention
- Thinning of the bones over time, increasing fracture risk
- Increased risk of infections while the immune system is dampened
- Flares of the disease as the steroid dose is reduced, sometimes needing the dose to go back up
- Raised eye pressure (glaucoma) or cataract from long-term steroids
- Stomach irritation or ulcers
- Side effects from steroid-sparing medicines, such as effects on the liver, blood counts or infection risk with tocilizumab or methotrexate
- Sudden, permanent loss of vision in one or both eyes, which can occur before or in the first days of treatment
- Stroke or damage to large arteries such as the aorta
- Serious infection while on high-dose steroids and steroid-sparing treatment
The greatest danger of giant cell arteritis is irreversible sight loss, and most cases of blindness or stroke happen before treatment or in the first week of treatment. That is why steroids are started immediately on suspicion. The main risks of treatment itself come from steroids, so ask your clinician how your bones, blood sugar, blood pressure and infection risk will be monitored, and what the plan is for reducing the dose safely.
Published figures to discuss
Outcomes depend heavily on how quickly treatment starts. Reliable, precise figures for sight loss and relapse vary between studies and populations, so this guide describes risks in cautious, qualitative terms rather than fixed percentages. The key, well-established point is that most sight loss and stroke happen before treatment or in the first week.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Permanent visual loss if giant cell arteritis is untreated | Often quoted at up to around 15 to 20% | New visual symptoms, jaw claudication or scalp tenderness with suspected GCA are emergencies; steroids are usually started before tests are complete. | NICE CKS — Giant cell arteritiscks.nice.org.ukPublished figure |
| Relapse during treatment taper | Common; many cohorts report relapse in roughly one-third to one-half of patients | A relapse is not a failure of care, but it should trigger review of diagnosis, steroid dose and steroid-sparing options. | NICE CKS — Giant cell arteritiscks.nice.org.ukSource-linked context |
| Glucocorticoid side effects during long treatment courses | Common, especially with months of moderate-to-high dose treatment | Bone protection, blood pressure, diabetes risk, infection risk and cataract/glaucoma monitoring should be built into aftercare. | NICE CKS — Giant cell arteritiscks.nice.org.ukSource-linked context |
| False-negative temporal artery biopsy or ultrasound | Possible, especially after steroids or with skip lesions | A negative test does not always rule out GCA if the clinical picture is convincing. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no procedure to recover from. Here, recovery means how your symptoms respond to treatment and how you are monitored over the months that the steroid dose is reduced.
- Quick relief of headache and scalp tenderness within days of starting steroids
- Tiredness, disturbed sleep, increased appetite or mood changes from high-dose steroids
- A temporary return of some symptoms when the dose is reduced, which should be reported
- Needing regular blood tests to track inflammation and check for side effects
Aftercare
- Take steroids exactly as prescribed and never stop them suddenly, as this can be dangerous after weeks of treatment.
- Carry a steroid emergency card (or wear an alert) so other healthcare staff know you are on long-term steroids.
- Keep all monitoring appointments and blood tests so the dose can be adjusted and side effects caught early.
- Take bone-protection treatment (such as calcium, vitamin D and any prescribed medicine) as advised.
- Watch for and report signs of infection promptly, as steroids can mask them.
- Tell any doctor, dentist or pharmacist that you take steroids and, if relevant, a steroid-sparing medicine.
- Seek same-day help for any new vision change, severe headache or stroke-like symptoms.
- Steroid emergency card collected and carried
- Clear written tapering plan for the steroid dose
- Bone-protection treatment arranged
- Blood-test and review appointments booked
- List of warning signs that mean same-day help
- Named contact number for the rheumatology or eye team
- Up-to-date medicines list shared with your GP
⚠ Get urgent help if…
- Any new loss of vision, blurring, a dark patch or curtain over vision, or double vision — seek same-day emergency help
- A sudden, severe or rapidly worsening headache
- Pain in the jaw or tongue when chewing or talking
- Stroke-like symptoms: face drooping, arm weakness or slurred speech (call 999)
- High fever, shivering or feeling very unwell, which could signal infection while on steroids
- Severe stomach pain, black stools or vomiting blood
- Very high or very low blood sugar symptoms if you have diabetes
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
Treated early, giant cell arteritis is usually controlled well and the immediate threat to sight is reduced. Most people's headache and scalp symptoms settle quickly on steroids. Vision that has already been lost before treatment, however, usually does not return, which is why speed matters so much.
A good result means your symptoms stay away, your inflammation blood tests settle, and the steroid dose can be reduced without flares. It does not guarantee the disease will never come back, and some people need treatment, including a steroid-sparing medicine, for a long time.
Giant cell arteritis is a long-term condition. Many people are able to stop steroids after roughly one to two years, but relapses are common and some need low-dose treatment or a steroid-sparing medicine for longer. Even after treatment ends, you should know the warning signs, because the disease can return.
Related tests, treatments or support
Giant cell arteritis often overlaps with polymyalgia rheumatica, a related condition causing shoulder and hip stiffness, and the two may be treated together. If large arteries such as the aorta are involved, imaging and shared care with other specialists may be needed.
Follow-up & long-term care
Follow-up is regular and ongoing. Early reviews check that symptoms have settled and tests are improving; later reviews guide the steroid reduction and watch for relapse and side effects. Blood tests for inflammation and for steroid or drug side effects are done at intervals, and any new vision change is reviewed urgently.
- Bone-protection treatment and periodic bone-density checks while on long-term steroids
- Regular inflammation blood tests to guide the dose
- Blood-pressure and blood-sugar monitoring
- Monitoring blood counts and liver tests if taking a steroid-sparing medicine
- Staying up to date with recommended vaccinations as advised by your team
- Knowing relapse warning signs even after treatment stops
Repeat, follow-on and what comes next
- Relapses are common as the steroid dose is reduced, and the dose often has to go back up temporarily.
- Some people need a steroid-sparing medicine added to control the disease or limit steroid side effects.
- Treatment length varies; some people stop within one to two years while others need low-dose treatment for longer.
- Ongoing monitoring for large-artery complications, such as aortic involvement, may be needed.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact and clear route to same-day help for any vision change.
- A written steroid tapering plan and a steroid emergency card.
- Scheduled inflammation blood tests and structured follow-up with rheumatology, and ophthalmology if needed.
- Bone protection, plus monitoring of blood pressure, blood sugar and, where relevant, drug blood tests.
- Shared care with the GP so prescriptions and monitoring continue safely.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Speed and type of specialist review (rheumatology, ophthalmology) arranged
- Diagnostic tests used, such as artery ultrasound, temporal artery biopsy or MRI
- Whether a steroid-sparing biologic such as tocilizumab is used, which is costly and usually needs funding criteria
- Frequency of monitoring blood tests and follow-up appointments
- Bone-protection assessment and any bone-density scanning
- Length of time treatment and monitoring are needed
- Which specialist will lead care and how quickly you will be seen
- Which diagnostic tests are included and how soon they happen
- Whether steroid-sparing medicines and their monitoring are included
- What monitoring blood tests and follow-up reviews are covered
- Whether bone protection and bone-density scanning are included
- What happens, and who to contact, if your vision changes or you have a flare
- How care will be shared with your NHS GP for prescriptions and monitoring
On the NHS? Giant cell arteritis is a medical emergency that is routinely diagnosed and treated on the NHS; private care may be used for a rapid specialist opinion, but suspected sight loss must never wait for a private appointment.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being given clear, written instructions on what to do if vision changes.
- Not understanding that lost sight is usually permanent and that speed is critical.
- Steroids started without a plan for bone, blood-sugar, blood-pressure and infection protection.
- No clear tapering plan, or an expectation that the disease is cured after the first course.
- Not being told the risks of a steroid-sparing biologic, including infection.
Marketing red flags
- Any suggestion that suspected giant cell arteritis or sight loss can wait for a private appointment.
- Offering tests as a reason to delay starting steroids.
- Claims of a quick cure rather than long-term, monitored treatment.
- Downplaying steroid side effects or omitting bone and infection protection.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- How confident are you that this is giant cell arteritis, and what would change the diagnosis?
- What exactly should I do, and who do I call, if my vision changes?
- What is my steroid tapering plan, and how will it be guided?
- What are you doing to protect my bones, blood sugar and stomach while I am on steroids?
- Would a steroid-sparing medicine such as tocilizumab be suitable for me?
- How will we know if the disease is flaring or coming back?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Why are steroids started before the diagnosis is confirmed?
Can lost vision be restored?
Is this treated on the NHS or privately?
How long will I be on steroids?
What is a temporal artery biopsy?
Will I have lots of side effects from steroids?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE CKS — Giant cell arteritis BSR guideline on diagnosis and treatment of giant cell arteritis (executive summary) BSR full guideline on giant cell arteritis Versus Arthritis — Polymyalgia rheumatica and giant cell arteritis PMRGCAuk — patient support and information Giant cell arteritis: advancing diagnostics and management (Eye, 2023)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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