Chevalet P, Barrier J H, Glémarec J, el Kouri D, Hamidou M, de Wazières B, Duhamel E, Jégo P, Maugars Y, Planchon B, Rodat O
Service de gériatrie, Hôpital Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France.
Rev Med Interne. 2001 Jul;22(7):624-30. doi: 10.1016/s0248-8663(01)00399-x.
Our study compares clinical and therapeutic courses (corticosteroid response, corticosteroid amount, complications) in people with giant cell arteritis before and over 75 years, during the first year of treatment.
A series of 164 patients was retrospectively analysed (mean age: 73.3 years) among the two subgroups: before 75 and over 75 years. Patient received (monitoring of reduction in the corticosteroid dosage) a 240 mg intravenous bolus of methylprednisolone followed by 0.5 or 0.7 mg/kg/d of prednisone, or 0.7 mg/kg/d of prednisone without the bolus.
Corticosteroid response was identical for the two groups, before and over 75 (patients with corticoresistance: 15% vs 11.4%; NS) and giant cell arteritis-related complications were equivalent (n = 2 vs n = 2; NS). Corticosteroid load was slightly lower in the elderly group (cumulative dose of corticosteroids during the first year of treatment 5.2 g vs 5.8 g; P = 0.03). Patients with rheumatic side effects (collapses of vertebral bodies, mainly) were more frequent in the elderly group (15.5% vs 4.3%; P = 0.01), in spite of a limited mean follow-up period (10.7 months).
Even if steroid response was identical in the therapeutic course of giant cell arteritis, rheumatic side effects appeared more frequent in the elderly group (over 75 years). In order to obtain a corticosteroid-sparing effect, new studies are necessary to evaluate a reduced initial dosage of corticosteroids.
我们的研究比较了巨细胞动脉炎患者在治疗的第一年中，年龄在75岁及75岁以上和75岁以下人群的临床及治疗过程（皮质类固醇反应、皮质类固醇用量、并发症）。
对两个亚组（75岁以下和75岁及75岁以上）的164例患者（平均年龄：73.3岁）进行回顾性分析。患者接受（监测皮质类固醇剂量的减少情况）静脉推注240毫克甲泼尼龙，随后给予0.5或0.7毫克/千克/天的泼尼松，或不进行推注直接给予0.7毫克/千克/天的泼尼松。
两组（75岁以下和75岁及75岁以上）的皮质类固醇反应相同（皮质类固醇抵抗患者：15%对11.4%；无统计学差异），且与巨细胞动脉炎相关的并发症相当（分别为2例对2例；无统计学差异）。老年组的皮质类固醇负荷略低（治疗第一年皮质类固醇的累积剂量为5.2克对5.8克；P = 0.03）。尽管平均随访期有限（10.7个月），但老年组出现风湿性副作用（主要是椎体塌陷）的患者更为常见（15.5%对4.3%；P = 0.01）。
即使在巨细胞动脉炎的治疗过程中类固醇反应相同，但老年组（75岁以上）出现风湿性副作用的情况更为频繁。为了获得皮质类固醇节省效应，有必要开展新的研究来评估降低皮质类固醇的初始用量。
