Wilke W S, Hoffman G S
Cleveland Clinic Foundation, Ohio, USA.
Rheum Dis Clin North Am. 1995 Feb;21(1):59-71.
The literature about the treatment of giant cell arteritis (GCA) is diverse and often includes patients with polymyalgia rheumatica (PMR) who do not have concurrent features of GCA. Consequent heterogeneity has contributed to controversy in the analysis of clinical data. Nevertheless, we have critically reviewed this literature to derive a rational approach to initial and maintenance corticosteroid (CS) therapy and thus define "CS-resistant GCA." In this article, the authors review what has been written about the treatment of presumed CS-resistant disease. Although firm recommendations are lacking, the authors provide algorithms for the treatment of GCA patients who fail to respond to initial CS therapy or who require potentially toxic maintenance-dose CS therapy. A study design that may help to resolve the dilemmas that were found during our analysis is also outlined.
关于巨细胞动脉炎（GCA）治疗的文献多种多样，且常常纳入了不具有GCA并发特征的风湿性多肌痛（PMR）患者。由此产生的异质性导致了临床数据分析中的争议。尽管如此，我们还是审慎地回顾了这些文献，以得出一种合理的初始和维持性皮质类固醇（CS）治疗方法，并据此定义“CS抵抗性GCA”。在本文中，作者回顾了关于假定的CS抵抗性疾病治疗的相关著述。虽然缺乏确凿的推荐意见，但作者提供了针对初始CS治疗无反应或需要使用可能有毒性的维持剂量CS治疗的GCA患者的治疗方案。还概述了一种可能有助于解决我们分析过程中发现的困境的研究设计。
