Treatment	Polymyalgia rheumatica	Giant cell arteritis
Initial therapy	Oral glucocorticoid, 12.5 to 25 mg per day of prednisone (minimum effective dose) or the equivalent, until clinical improvement is achieved, typically two to four weeks	Oral glucocorticoid, 40 to 60 mg per day of prednisone or the equivalent, plus subcutaneous tocilizumab (Actemra) weekly for one to two months until stable
Taper	Taper to 10 mg per day over four to eight weeks, then decrease by 1 mg every four weeks until discontinuation	Taper prednisone or equivalent dose by 10% to 20% per month while monitoring C-reactive protein level and erythrocyte sedimentation rate When dose is < 10 mg daily, taper by 1 mg per month until discontinuation, individualizing duration to the patient, typically over one to five years
Remission	Patient is considered in remission once clinically stable at 10 mg per day	Patient is considered in remission once clinically stable at 20 mg per day
Treatment of relapse	Reassess diagnosis Increase prednisone dose or equivalent by 10% to 20% or to dose before relapse Reattempt taper gradually over four to eight weeks	Mild flare-up: increase prednisone dose or equivalent by 10% to 20% Severe flare-up: repeat initial therapy and consider adding glucocorticoid-sparing drugs (e.g., tocilizumab, methotrexate, abatacept [Orencia])
Additional considerations	Consider oral methotrexate, 7.5 to 10 mg per week, in patients at high risk of relapse, with glucocorticoid-related adverse effects, or with comorbidities likely to be exacerbated by glucocorticoids Consider intramuscular methylprednisolone, 120 mg administered every three weeks, in patients at high risk of glucocorticoid-related adverse effects	Consider methotrexate with a glucocorticoid or glucocorticoid alone