Samson Maxime, Greigert Hélène, Bonnotte Bernard
Service de médecine interne et immunologie clinique, CHU Dijon Bourgogne, université Bourgogne Franche-Comté, Inserm, EFS BFC, UMR1098, RIGHT Interactions hôte-greffon-tumeur/ ingénierie cellulaire et génique, Dijon, France.
Service de médecine interne et immunologie clinique, CHU Dijon Bourgogne, université Bourgogne Franche-Comté, Inserm, EFS BFC, UMR1098, RIGHT Interactions hôte-greffon-tumeur/ ingénierie cellulaire et génique, Dijon, France. Service de médecine vasculaire, CHU Dijon Bourgogne, Dijon, France.
Rev Prat. 2023 Apr;73(4):395-399.
TREATMENT OF GIANT CELL ARTERITIS. The treatment of giant cell arteritis (GCA) is based on glucocorticoids. This treatment significantly reduces the risk of ischemic complications, especially those of a visual nature, rapidly relieves the symptoms of the disease, and eliminates the inflammatory syndrome. The diagnosis of GCA must be able to question if corticosteroid therapy is ineffective. Once the symptoms have resolved and the inflammatory syndrome has normalized, glucocorticosteroids are tapered very gradually. The goal is to discontinue glucocorticosteroids in 12 to 18 months. Nearly half of patients experience flares during the glucocorticoid taper. These are usually benign, not visually life-threatening, and easily controlled by increasing glucocorticoids. However, these relapses contribute to prolonging the treatment duration and thus the cumulative dose of glucocorticoids received by patients, which leads to the occurrence of adverse effects of glucocorticoids in almost all patients. For this reason, it is sometimes necessary to prescribe glucocorticoid-sparing treatments, particularly methotrexate and tocilizumab. The efficacy of these treatments and others in development is essential and to be discussed. In addition, the management of patients with GCA should include preventive measures to reduce cardiovascular, infectious and osteoporosis risks.
巨细胞动脉炎的治疗。巨细胞动脉炎（GCA）的治疗以糖皮质激素为基础。这种治疗可显著降低缺血性并发症的风险，尤其是视力方面的并发症，能迅速缓解疾病症状并消除炎症综合征。若糖皮质激素治疗无效，必须对GCA的诊断提出质疑。一旦症状缓解且炎症综合征恢复正常，糖皮质激素需非常缓慢地减量。目标是在12至18个月内停用糖皮质激素。近一半的患者在糖皮质激素减量过程中会出现病情复发。这些复发通常是良性的，不会危及视力，通过增加糖皮质激素剂量很容易控制。然而，这些复发会导致治疗时间延长，从而使患者接受的糖皮质激素累积剂量增加，几乎所有患者都会因此出现糖皮质激素的不良反应。因此，有时有必要开具糖皮质激素节省疗法，特别是甲氨蝶呤和托珠单抗。这些治疗方法以及其他正在研发的治疗方法的疗效至关重要，有待讨论。此外，GCA患者的管理应包括降低心血管、感染和骨质疏松风险的预防措施。
