Samson Maxime, Greigert Hélène, Ghesquière Thibault, Bonnotte Bernard
CHU Dijon Bourgogne, hôpital François-Mitterrand, service de médecine interne et immunologie clinique, 2, boulevard Mal-de-Lattre-de-Tassigny, 21000 Dijon, France; Université Bourgogne-Franche Comté, Inserm, EFS BFC, UMR1098, 21000 Dijon, France.
CHU Dijon Bourgogne, hôpital François-Mitterrand, service de médecine interne et immunologie clinique, 2, boulevard Mal-de-Lattre-de-Tassigny, 21000 Dijon, France; Université Bourgogne-Franche Comté, Inserm, EFS BFC, UMR1098, 21000 Dijon, France.
Presse Med. 2019 Sep;48(9):968-979. doi: 10.1016/j.lpm.2019.06.002. Epub 2019 Jul 16.
Glucocorticoids (GC) remain the gold standard of the treatment of giant cell arteritis provided objectives of GC-tapering are accurately followed: 15 to 20mg/day at 3 months, 10mg/day at 6 months, 5mg/day at 9-12 months and withdrawal between 12 and 18 months. In case of corticodependance at ≥7.5 mg/day of prednisone or intolerance to GC, a GCsparing therapy has to be introduced, mainly methotrexate or tocilizumab. Individual characteristics of each patient, data about the efficacy of the treatment, its cost and how easy the follow-up under this treatment is are important factors to consider for choosing the right GC-sparing therapy. For all these reasons, except particular situations, we prefer using methotrexate before tocilizumab. Prevention of cardiovascular events is an important aspect of the treatment of GCA. We recommend using aspirin (75-100mg/day) during the first month of treatment or longer in case of occurrence of an ischemic complication. Each patient treated for GCA should receive a prevention of osteoporosis with respect of usual recommendations.
糖皮质激素（GC）仍然是治疗巨细胞动脉炎的金标准，前提是要严格遵循GC减量的目标：3个月时为每日15至20毫克，6个月时为每日10毫克，9至12个月时为每日5毫克，并在12至18个月内停药。如果泼尼松每日剂量≥7.5毫克时出现皮质激素依赖或对GC不耐受，则必须采用糖皮质激素节约疗法，主要是甲氨蝶呤或托珠单抗。每个患者的个体特征、治疗效果数据、成本以及该治疗方案下随访的难易程度都是选择合适的糖皮质激素节约疗法时需要考虑的重要因素。出于所有这些原因，除特殊情况外，我们更倾向于在使用托珠单抗之前先使用甲氨蝶呤。预防心血管事件是巨细胞动脉炎治疗的一个重要方面。我们建议在治疗的第一个月使用阿司匹林（每日75至100毫克），如果发生缺血性并发症则使用更长时间。每位接受巨细胞动脉炎治疗的患者都应按照常规建议接受骨质疏松预防治疗。
