Laboratory testing such as elevated sedimentation rate or C-reactive protein and a compatible semiology may be the only available elements to make a decision to initiate treat- If available, ultrasound finding of a halo sign surrounding a temporal artery may be helpful in diagnosis giant cell arteries.680,681 Biopsy con- firmation should not be imperative to initiate treat- ment in cases in which giant cell arteritis seems to be the most likely diagnosis. 2. In addition to steroids, it is reasonable to consider adjunctive, steroid-sparing therapy in the treatment of patients with stroke thought to be caused by giant cell arteritis. In a patient-level meta-analysis of 3 randomized clinical trials, methotrexate use was associated with lower risk of diseases relapses.682 Similarly, 1 phase I clinical trial and 1 phase II clini- cal trial support the use of tocilizumab to increase the rate of sustained glucocorticoid-free remis- Takayasu arteritis is more common in Asian countries compared with Europe or the United States, and it tends to occur in younger people compared with those with giant cell arte- Takayasu arteritis may cause stroke directly by causing cerebral vasculitis or extracra- nial stenosis, most often of the common carotid Observational studies support the use CLINICAL STATEMENTS AND GUIDELINES Kleindorfer of steroids plus adjunctive therapy that may include There are no data to support 1 agent over the other in terms of efficacy in stroke risk reduction among patients with Takayasu arteritis. In adults with ischemic stroke or TIA and diagnosis of giant cell arteritis or Takayasu arteritis, a slow taper of oral steroids to a target of 5 mg/d after 1 year is reasonable in light of reports of exacerbation after rapid steroid withdrawal.690,709 3. 