Giant cell arteritis treatment

Liozon F, Vidal E, Barrier JH. Dapsone in giant cell arteritis treatment. Eur J Intern Med 1993 4 207. 

Giant cell arteritis (cranial or temporal arteritis) is an inflammatory condition that may affect any of the large arteries, especially the temporal and occipital arteries. The thickened temporal arteries may be tender and non-pulsatile, with erythema and oedema of the overlying skin. Early treatment with high-dose corticosteroids such as prednisolone is essential and should be continued for a minimum of 2-3 years at a reduced dose. 

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. 

Although the most common methotrexate dosing regimens for the treatment of rheumatoid arthritis are 15 or 17.5 mg weekly, there is an increased effect up to 30 or 35 mg weekly. The drug decreases the rate of appearance of new erosions. Evidence supports its use in juvenile chronic arthritis, and it has been used in psoriasis, psoriatic arthritis, polymyositis, dermatomyositis, Wegener s granulomatosis, giant cell arteritis, subacute lupus erythematosus, and vasculitis. 

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 Methotrexate was withdrawn in three patients who had adverse events that were clearly drug-related.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. 

Jover JA, Hernandez-Garcia C, Morado IC, Vargas E, Banares A, Fernandez-Gutierrez B. Combined treatment of giant-cell arteritis with methotrexate and prednisone, a randomized, double-blind, placebo-controUed trial. Ann Intern Med 2001 134(2) 106-14. 

TREATMENT Polymyalgia Rheumatica and Giant Cell Arteritis... 

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. 

Carrie F, Roblot P, Bouquet S, Delon A, Roblot F, Becq-Giraudon B Rifampin-induced non-responsiveness of giant cell arteritis to prednisone treatment. Arch Intern Med ( 994) 154, 1521-4. 

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