title: Treatment of giant-cell arteritis, a literature review.
abstract: Giant-cell arteritis (GCA) is the most common vasculitis in people aged more than 50 years. Despite the frequency of this disease, there is currently no international consensus on its therapeutic modalities. The aim of this study was to conduct a review on an international literature about the treatment of GCA, whatever the clinical pattern might be. Oral corticosteroids remain the cornerstone treatment, possibly preceded by intravenous bolus in complicated forms. In cases of glucocorticoid (GC) dependence or GC-related side effects, a GC-sparing agent may be necessary. Methotrexate is one of the most used treatments despite its low level of evidence and mild efficacy. Cyclophosphamide and tocilizumab look promising but require validation in further studies. The results for TNF-α blockers and azathioprine are disappointing. Preventing complications of prolonged corticosteroid therapy is a world challenge and the management of GC-induced osteoporosis is not the same from one country to another. There is a significant risk of arterial thrombosis, mainly at treatment onset, which may encourage to associate an antiplatelet therapy, especially in patients with other cardiovascular risk factors. Place of statins in the treatment of the disease is uncertain.
authors.affiliation: a Department of Vascular Medicine , Centre Hospitalier Universitaire de Caen , Caen , Basse Normandie , France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Watelet
authors.affiliation: b Department of Internal Medicine and Clinical Immunology , Hôpital François Mitterrand, CHU de Dijon; INSERM UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE , Dijon , France , and.
authors.forename: Maxime
authors.initials: M
authors.lastname: Samson
authors.affiliation: c Department of Internal Medicine , Centre Hospitalier Universitaire de Caen , Caen , Basse Normandie , France.
authors.forename: Hubert
authors.initials: H
authors.lastname: de Boysson
authors.affiliation: c Department of Internal Medicine , Centre Hospitalier Universitaire de Caen , Caen , Basse Normandie , France.
authors.forename: Boris
authors.initials: B
authors.lastname: Bienvenu
mesh_terms: D018501:Antirheumatic Agents / Q000494:pharmacology; D001379:Azathioprine / Q000494:pharmacology*; D004359:Drug Therapy, Combination / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D013700:Giant Cell Arteritis / Q000188:drug therapy* / Q000503:physiopathology; D005938:Glucocorticoids / Q000494:pharmacology*; D006801:Humans; D054539:Medication Therapy Management; D008727:Methotrexate / Q000494:pharmacology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D001379:Azathioprine; D008727:Methotrexate
keywords: Giant cells arteritis; Glucocorticoid; Glucocorticoid-sparing agent