[Treatment of complicated Horton's disease].

Treatment of giant cell (temporal) arteritis is based on steroid therapy, which is sufficient in most cases. Several steroid-sparing strategies have been evaluated to reduce steroids side effects: alternate-day steroid administration or adding a second drug (methylprednisolone, dapsone, azathioprine, methotrexate). The efficacy of these strategies has not been proved. There is no demonstration that a medication (methylprednisolone pulses, dapsone, azathioprine, methotrexate) may be more efficient than an other in resistant giant cell arteritis. Ophthalmologic manifestations have a poor prognosis and usually specific blindness cannot be improved. The localizations of the disease in large arteries necessitate a more important initial corticosteroid dosage (1 mg/kg/d). Vascular surgery is seldom necessary but should not be done in the active phase of the disease. Anticoagulant therapy may be useful to reduce excess vascular mortality but its benefit has not been demonstrated.