Larroque P, Clément R, Bauduceau B, Chanudet X, Thomas A, Celton H, Cloarec M
Service de médecine interne et pathologie cardiovasculaire, Hôpital d'instruction des armées Begin, Saint-Mandé.
J Mal Vasc. 1989;14 Suppl C:137-47.
716 cases collected from 9 recent studies published between 1981 and 1985 served as a basis for a general review of the current treatment of temporal arteritis. Steroid therapy was instituted as first intention in 652 cases, high dose treatment was continued for between 8 days and 3 months but the majority of authors started a reduction in the dosage from the 4th or 5th week. There was no overall agreement regarding the duration of maintenance therapy nor the criteria allowing its discontinuation, and withdrawal was not possible before the 25th month on average. The ideal initial dosage, in the absence of randomized studies, remains to be defined: generally around 0.5 mg/kg/d in milder forms, the dosage may be increased to 1 mg/kg/d in the presence of complicated temporal arteritis. Besides cortico steroid therapy, other treatments are successively envisaged: synthetic anti-malarials (SAM), non steroidal anti-inflammatories (NSAI), dapsone... while these are generally used as back-up treatment, David-Chausse used SAM as first intention, combined in 17 cases with NSAI in 61 of his 66 patients, with very promising results which require confirmation in other studies. In this review the cure rate was around 25% and the relapse rate 38%; complications related to the disease occurred in 19%, while almost one patient in two--47%--developed iatrogenic complications. Blindness dominates the prognosis, and occurred in 15% of cases, most often as an inaugural event, it very rarely regressed on steroid treatment. Although death occurred in 18% of cases, the prognosis of temporal arteritis generally remains favorable, with a 5 year survival curve identical to a control population.
从1981年至1985年间发表的9项近期研究中收集的716例病例，为颞动脉炎当前治疗的总体回顾提供了依据。652例患者首先采用了类固醇疗法，高剂量治疗持续8天至3个月，但大多数作者从第4周或第5周开始减少剂量。关于维持治疗的持续时间以及允许停药的标准，尚无总体共识，平均在第25个月之前无法停药。在缺乏随机研究的情况下，理想的初始剂量仍有待确定：一般来说，病情较轻的患者约为0.5mg/kg/d，合并颞动脉炎并发症时，剂量可增至1mg/kg/d。除皮质类固醇疗法外，还依次考虑了其他治疗方法：合成抗疟药（SAM）、非甾体抗炎药（NSAI）、氨苯砜……虽然这些通常用作辅助治疗，但David-Chausse首先采用了SAM，他的66例患者中有61例将其与NSAI联合使用，17例患者取得了非常有前景的结果，需要其他研究加以证实。在本次综述中，治愈率约为25%，复发率为38%；与疾病相关的并发症发生率为19%，而几乎一半的患者（47%）出现了医源性并发症。失明在预后中占主导地位，发生率为15%，大多作为首发事件出现，很少能通过类固醇治疗恢复。虽然18%的病例发生了死亡，但颞动脉炎的总体预后通常较好，5年生存率曲线与对照人群相同。
