[Complicated Horton's syndrome: therapeutic modalities].
FORMS THAT RAISE THERAPEUTIC PROBLEMS: The complicated forms of Horton's syndrome regroup various situations: ocular involvement at the start, large vein involvement, corticosteroid resistance (rare), corticosteroid dependence preventing the reduction in the daily dose of prednisone to less than 15 mg, high rate of morbidity with prolonged corticosteroid therapy. GENERAL PRINCIPLES: The ocular forms and those with large vein involvement, require a minimal attack treatment with 1mg/kg/d of prednisone. Cortisone assaults are often prescribed despite the fact that their efficacy remains to be demonstrated. Curative treatment with heparin (calcic or of low molecular weight) should be prescribed for 5 to 7 days with later relay to a platelet anti-aggregant, without any randomised study having validated this proposition. THE CASE OF CORTICOSTEROID-DEPENDENCE: The iatrogenic risk of corticosteroids is high and alternative treatments should be proposed: azathioprine, methotrexate, dapsone or hydroxychloroquine. Osteoporosis is the most frequent complication of corticosteroid therapy and must be avoided by the administration of a biphosphonate.
Agard
Christian
C
Service de médecine interne B, Hôpital Hôtel-Dieu, CHU de Nantes. christian.agard @chu-nantes.fr
Barrier
Jacques-Henri
JH
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D004351:Drug Resistance; D013700:Giant Cell Arteritis / Q000150:complications* / Q000188:drug therapy*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007049:Iatrogenic Disease; D009017:Morbidity; D018917:Optic Neuropathy, Ischemic / Q000209:etiology* / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011241:Prednisone / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D011241:Prednisone