[Non-complicated Horton's disease: initial treatment with methylprednisolone 500 mg/day bolus for three days followed by 20 mg/day prednisone-equivalent. Evaluation of 15 patients].
OBJECTIVE
To assess the efficacy and tolerance of three methylprednisolone boluses (500 mg/d) followed by a standard dose of prednisolone, 20 mg/d, as the initial treatment of non-complicated giant-cell arteritis.


METHODS
A retrospective study of 15 cases.


RESULTS
Six men and nine women with a mean age of 70.9 years were treated and followed for 41.5 months. Initial mean ESR was 83 mm; mean C-reactive protein level was 94.6 mg/L. The boluses were well tolerated, excepted in one patient who developed acute psychosis. After initiating the oral treatment, two patients presented signs of clinical relapse during the first month, and were given higher doses of corticosteroids. At 1 month, 12 patients were asymptomatic, nine of whom had normalized ESR and CRP. Mean ESR was 23; mean CRP was 13 mg/L. At 3 months, the mean prednisone dose delivered was 18.2 mg/d. Mean ESR was 12 mm. The cumulative prednisone dose given during the first year was 5,349 (+/- 2,512) mg. In the 13 patients who necessitated no more than 20 mg/d prednisone, no sequelae of giant-cell arteritis, no fractures nor major treatment intolerance occurred-during the first 2 years of treatment. Treatment was stopped in eight patients after a mean duration of 48.6 months.


CONCLUSIONS
Treatment with pulse methylprednisolone 500 mg/d for 3 days followed by 20 mg/d oral prednisone could be a valuable corticosteroid-sparing strategy in many patients with uncomplicated temporal arteritis.
Sailler
L
L
Service de médecine interne, hôpital de Rangueil-Larrey, CHU, 31998 Toulouse, France. sailler.l@chu-toulouse.fr
Carreiro
M
M
Ollier
S
S
Juchet
H
H
Delobel
P
P
Ferrand
D
D
Klinger
M
M
Arlet
P
P
D000368:Aged; D000369:Aged, 80 and over; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D012189:Retrospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids; D002097:C-Reactive Protein; D011241:Prednisone; D008775:Methylprednisolone