Exercices pour artérite à cellules géantes (GCA) — symptômes visuels = URGENCE, induction douce, risque d'anévrisme aortique

ACR 1990 + 2022 ACR/EULAR criteria + 2018 EULAR management framework. Giant cell arteritis (GCA, Horton's disease) is a large-vessel vasculitis essentially exclusive to people over 50. The classic presentation: new-onset temporal headache + jaw claudication (pain on chewing) + scalp tenderness + visual disturbance + dramatically elevated ESR/CRP + age ≥50. Temporal artery biopsy remains the diagnostic gold standard, supplemented by PET-CT or MRA for large-vessel involvement (the aorta and its branches are commonly affected). The single most important clinical fact about GCA: anterior ischemic optic neuropathy (AION) causes irreversible blindness, and any new visual symptom (transient monocular vision loss, blurred vision, diplopia) is a same-day emergency requiring IV methylprednisolone before any other workup. Stone 2017 GiACTA trial established tocilizumab as steroid-sparing — critical because the steroid taper takes 12-24 months and the cumulative steroid burden is substantial. Long-term aortic aneurysm risk requires annual aortic imaging surveillance. Exercise programming is phase-aware: gentle during induction (high-dose steroid + headache + jaw pain prevent much movement); graded aerobic + light strength after stabilisation; cardiac/aortic monitoring critical given large-vessel involvement.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity work, wall-push-up for scaled upper-body strength, scapular-retraction for posture (chronic steroid + elderly population), cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + chest-wall mobility, standing-march for managed cardio after aortic clearance, sit-to-stand for functional + critical bone-loading (steroid osteoporosis from 12-24 month taper), ankle-pump for circulation + DVT prevention during induction immobility. The AI coach also knows the nutrition side — Mediterranean anti-inflammatory backbone (Bichara 2024 + Hocaoglu 2024), steroid-induced osteoporosis HIGH risk calcium 1000-1200 + vitamin D 1000-2000 IU + weight-bearing + bisphosphonate per rheum (ACR guidelines fracture risk ≥7.5 mg pred ≥3 months), blood glucose monitoring (steroid-induced diabetes), aortic nutrition adjunct low-sodium <2 g/day + omega-3, protein 1.2-1.4 g/kg/day during catabolic steroid phase, AVOID grapefruit + Seville orange (methylpred metabolism + tocilizumab interaction caution), Mediterranean fish 2-3×/week + nuts + olive oil. CRITICAL: Vasculitis Foundation + ACR + rheumatology + ophthalmology if any visual symptom (urgent same-day) + cardiology if LV involvement + endocrinology if steroid diabetes + dietitian familiar with vasculitis. This is NEVER a replacement for rheumatology + ophthalmology emergency care.