Liozon F, Vidal E, Boutros-Toni F, Gaches F, Loustaud-Ratti V, Liozon E, Berdah J F
Service de Médecine Interne A, CHU Dupuytren, Limoges.
Ann Med Interne (Paris). 1994;145(4):223-9.
We report a prospective study of 42 patients with biopsy-proven giant cell arteritis (CGA) who recovered for more than one year (mean follow up of 71 months since withdrawal of steroid treatment). It was used the same regimen of prednisone and well closely monitored along the whole treatment. In 22 patients, dapsone was given concomitantly with prednisone. Mean duration of steroid therapy was 23.1 months (range: 6-57 months); it was significantly decreased with treatment by dapsone (12 months and 12 days). Age, sex, initial clinical and biological (acute phase reactants) findings did not provide useful information for predicting steroid treatment needed for recovery. Thirty-six relapses were observed in 22 patients (60%) during treatment or after its withdrawal. Incidence of relapses declined during steroid treatment and relapses were (only) observed over first 6 months after steroid withdrawal. Three amaurosis fugax occurred at the beginning of treatment and an axillar bilateral stenosis was also observed. Forty-eight side effects of corticosteroids were recorded in 26 patients (63%): myopathy (n = 12), bone complications (n = 11), metabolic complications (n = 9). Twelve patients (63%) had experienced side effects of dapsone. This study emphasized the difficulty in treating CGA. Close monitoring is required. A steroid regimen is recommended.
我们报告了一项针对42例经活检证实为巨细胞动脉炎（CGA）且康复超过一年（自停用类固醇治疗起平均随访71个月）患者的前瞻性研究。采用相同的泼尼松治疗方案，并在整个治疗过程中进行密切监测。22例患者在服用泼尼松的同时加用了氨苯砜。类固醇治疗的平均持续时间为23.1个月（范围：6 - 57个月）；加用氨苯砜治疗后显著缩短（12个月零12天）。年龄、性别、初始临床和生物学（急性期反应物）检查结果对于预测康复所需的类固醇治疗并无有用信息。22例患者（60%）在治疗期间或停药后出现了36次复发。复发率在类固醇治疗期间下降，且仅在停用类固醇后的前6个月观察到复发情况。治疗开始时出现了3次一过性黑矇，还观察到一例双侧腋窝狭窄。26例患者（63%）记录到48例皮质类固醇的副作用：肌病（n = 12）、骨骼并发症（n = 11）、代谢并发症（n = 9）。12例患者（63%）出现了氨苯砜的副作用。本研究强调了治疗CGA的困难。需要密切监测。推荐采用类固醇治疗方案。
