#5-10E. Beyond Glucocorticoids: Targeted Therapies in GCA and PMR (Nat Rev Rheumatol, 2026)

How can we effectively manage giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) while minimizing the severe toxicities of long-term glucocorticoid exposure? This comprehensive review explores the evolving therapeutic landscape for GCA and PMR, shifting beyond traditional glucocorticoid dependence. By detailing the immunopathology of these overlapping conditions, the authors highlight how targeted therapies, particularly interleukin-6 (IL-6) receptor inhibitors and Janus kinase (JAK) inhibitors, are reshaping standard treatment algorithms. The most pivotal clinical takeaway is that integrating these targeted biological and synthetic therapies significantly reduces both the risk of disease relapse and the cumulative glucocorticoid burden. However, when critically appraising this strategy, clinicians must remain cautious; because IL-6 inhibitors directly suppress C-reactive protein (CRP) production, relying solely on traditional inflammatory markers can lead to a dangerous underestimation of underlying vascular disease activity. For practicing physicians, this paper is highly relevant as it provides practical algorithms for drug selection in vulnerable elderly populations and emphasizes the necessity of incorporating advanced imaging modalities, such as PET-CT or ultrasonography, to accurately monitor disease activity and prevent long-term ischemic complications in routine clinical care.

Citation: Muratore, F. et al. Treatment strategies in giant cell arteritis and polymyalgia rheumatica: beyond glucocorticoids. Nature Reviews Rheumatology. 2026. DOI: 10.1038/s41584-026-01379-1

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