[Benefits of corticosteroids in the treatment of Horton's disease and rhizomelic pseudopolyarthritis: advantages and inconveniences. A meta-analysis].
Although corticosteroid treatment is clearly beneficial to patients with temporal arteritis, its exact risk/benefit ratio in these old and side effects-prone patients is unknown. We have thus surveyed that available French and English literature, in order to pool the published series and to evaluate the iatrogenic potential of corticosteroids in this situation. We selected 11 series, yielding a total of 1008 patients. A treatment failure resulted in the death of the patient in five cases. Twenty-seven patients became blind, but only 2 under treatment. The side-effects involved 29% of the patients and are responsible of 29 deaths (2.9%): osteoporosis was the main problem, followed by femoral head necrosis and muscle wasting. Gastroduodenal ulcers were uncommon and generally benign; sigmoid colon diverticulitis was infrequent but dangerous; some infectious complications were noted (herpes zoster, tuberculosis, etc...); high blood pressure and diabetes were common problems. Psychiatric side-effects were rare. Thus, the unwanted effects of corticosteroids in the treatment of temporal arteritis are relatively infrequent and generally not severe, except osteoporosis. They should be systematically prevented by appropriate diet and treatments (e.g., calcium, potassium, and vitamin D supplements).
Service de Médecine Interne, Hôpital Saint-Antoine, Paris.
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Généreau
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Cabane
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000368:Aged; D002423:Cause of Death; D002986:Clinical Trials as Topic; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000453:epidemiology; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000453:epidemiology; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007239:Infections / Q000139:chemically induced / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology; D011111:Polymyalgia Rheumatica / Q000188:drug therapy*; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones
Bénéfice des corticoïdes lors du traitement de la maladie de Horton et de la pseudopolyarthrite rhizomélique: avantages et inconvénients. Une méta-analyse.