Généreau T
Service de médecine interne, Hôpital de La Salpêtrière, Paris.
Rev Prat. 1999 Mar 15;49(6):618-22.
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.
巨细胞（颞）动脉炎的治疗基于类固醇疗法，大多数情况下这种疗法是足够的。已经评估了几种减少类固醇副作用的节用类固醇策略：隔日给予类固醇或添加第二种药物（甲泼尼龙、氨苯砜、硫唑嘌呤、甲氨蝶呤）。这些策略的疗效尚未得到证实。没有证据表明在难治性巨细胞动脉炎中，一种药物（甲泼尼龙冲击治疗、氨苯砜、硫唑嘌呤、甲氨蝶呤）比另一种药物更有效。眼部表现预后较差，通常特异性失明无法改善。疾病在大动脉中的定位需要更重要的初始皮质类固醇剂量（1mg/kg/天）。血管手术很少必要，但不应在疾病的活动期进行。抗凝治疗可能有助于降低过高的血管死亡率，但其益处尚未得到证实。
