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 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.
Les formes simples de la maladie de Horton se dxe9;finissent par l’absence d’atteinte oculaire, l’absence d’atteinte clinique des artxe8;res de gros calibre, l’absence de corticorxe9;sistance, et l’absence de corticodxe9;pendance xe0; un haut niveau (formes simples devenant secondairement compliquxe9;es).
Ces formes simples justifient un traitement d’attaque xe0; la dose de 0,7 mg/kg/j de prednisone alors que les assauts cortisoniques n’ont pas de justification prxe9;cise. Des doses initiales quotidiennes plus faibles de prednisone, 0,5 mg/kg/j voire moins, semblent exposer xe0; un risque plus xe9;levxe9; de reprise xe9;volutive de la maladie mais sont nxe9;anmoins xe0; xe9;valuer.
La iatrogxe9;nicitxe9; des corticoxef;des pose des problxe8;mes chez les patients corticodxe9;pendants et ceux recevant un traitement d’attaque trop long. Le risque d’ostxe9;oporose cortico-induite est particulixe8;rement important au cours de la maladie de Horton. Enfin, il n’existe toujours pas d’xe9;tude prospective permettant de prxe9;ciser les indications des anticoagulants ou des anti-agrxe9;gants plaquettaires en phase aiguxeb; de la maladie.
Corticosteroids remain the basis of treatment of giant cell arteritis, with prednisone the molecule of choice, since they improve the symptoms and considerably reduce the risk of blindness. Several clinical forms of the disease must be distinguished in order to specify the modalities of corticosteroid treatment and any eventual associated treatments.
The simple forms of the disease are defined by the absence of ocular involvement, the absence of clinical involvement of the large arteries, the absence of corticosteroid resistance and the absence of corticosteroid dependence (simple forms subsequently complicated).
These simple forms justify an attack treatment with 0.7 mg/kg/d of prednisone although cortisone assaults do not have a specific justification. Initiation with lower daily doses of prednisone at 0.5/mg/kg or even less appear to expose the patient to a higher risk of progression of the disease, but merit assessment.
The iatrogeneity of corticosteroids raises problems in corticosteroid dependent patients and those receiving prolonged attack treatment. The risk of cortisone-induced osteoporosis is particularly high during giant cell arteritis. There is still no prospective study specifying the indications for treatment of the disease with anticoagulants or platelet anti-aggregants.
Epidxe9;miologie, imagerie et traitement de la maladie de Horton<a name="bafn1">a><a href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W78-4RTCMVF-2&_user=10&_coverDate=05%2F31%2F2008&_rdoc=6&_fmt=full&_orig=browse&_srch=doc-info(%23toc%236620%232008%23999249994%23688292%23FLA%23display%23Volume)&_cdi=6620&_sort=d&_docanchor=&_ct=35&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=75e8884d6ae8927de3629bb9226be101#afn1">alt="star, open" title="star, open" border="0">a>