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Giant cell arteritis (GCA) is a systemic medium to large cell vasculitis that predominantly affects the elderly population.1 Initial high dose corticosteroids are the cornerstone of treatment, which is subsequently tapered.2 However, disease flares are not uncommon and corticosteroid related side effects are frequent.3
The limitations of corticosteroids in the treatment of some cases of GCA have led to the evaluation of other strategies using steroid sparing agents.4–7 In two previous studies patients with resistant GCA were treated with infliximab, a monoclonal chimeric antibody directed against tumour necrosis factor α (TNFα) that binds circulating and membrane bound TNF, with promising results.6,7 The rationale for this approach was that the vasculitic lesions in GCA had prominent macrophage infiltration where excess TNFα production had been demonstrated by immunohistochemistry.8
We report the case of a patient who was treated with the anti-TNFα agent etanercept, which is the fusion protein of the extracellular ligand binding portion of the p75 TNF receptor and the Fc portion of IgG1, on the basis that the GCA could not be controlled and that complications of high dose corticosteroid treatment …