Giant cell arteritis, glucocorticoids

This report highlights the risk of cardiovascular adverse effects with short courses of glucocorticoid therapy in elderly patients with inflammatory bowel disease, even with rather low-dosage regimens. Acute myocardial infarction occurred in an old man with coronary insufficiency and giant cell arteritis after treatment with prednisolone (SEDA-10, 343) but could well have been coincidental. 

Nordborg E, Schaufelberger C, Andersson R, Bosaeus I, Bengtsson BA. The ineffectiveness of cyclical oral clodro-nate on bone mineral density in glucocorticoid-treated patients with giant-cell arteritis. J Intern Med 1997 242(5) 367-71. 

In a double-blind, placebo-controlled study of the safety and efficacy of methotrexate therapy combined with glucocorticoids in patients with giant cell arteritis over 24 months, adverse events were defined as a new diagnosis of any condition during treatment (39). The combination of methotrexate plus prednisolone reduced the number of relapses and improved the course of the disease. Methotrexate was withdrawn in three patients who had adverse events that were clearly drug-related. One had leukopenia, anemia, and mucositis, one developed pancytopenia, and one oral ulcers. These patients were not taking folic acid or folinic acid supplements. 

Glucocorticoids are used widely in the treatment of a variety of rheumatic disorders and are a mainstay in the treatment of the more serious inflammatory rheumatic diseases, such as systemic lupus erythematosus, and a variety of vasculitic disorders, such as polyarteritis nodosa, Wegener s granulomatosis, Churg-Strauss syndrome, and giant cell arteritis. 

---