American Board of Internal Medicine (ABIM) Certification Practice Exam

How should prednisone be adjusted following the initial treatment of GCA?

1. Decreased by 5% every week

2. Increased continuously

3. Reduced by about 10% every few weeks

4. Maintained at a constant dosage

The correct answer is: Reduced by about 10% every few weeks

In the management of giant cell arteritis (GCA) following the initial treatment with high-dose prednisone, the strategy typically involves gradual tapering of the corticosteroid dosage to minimize side effects while preventing disease relapse. Reducing the dosage by about 10% every few weeks aligns with clinical guidelines and the common practice of prescribing a tapering schedule that allows for careful monitoring of symptoms and potential flares of the condition. This approach balances the need for effective disease control during the tapering process while progressively reducing the amount of medication to minimize the risk of long-term corticosteroid-related complications, such as osteoporosis, adrenal suppression, and metabolic changes. The initial high dose is necessary to quickly control inflammation, but as symptoms stabilize, this tapering strategy is effective in ensuring that the patient does not experience a return of symptoms while also allowing the body to adjust to lower steroid levels. This careful and structured reduction is tailored to the patient's clinical response and laboratory markers.