Horton's disease in elderly patients aged over 75: clinical course, complications of corticotherapy. Comparative study of 164 patients. Towards a reduced initial dose].

P Chevalet, J H Barrier, J Glémarec, D el Kouri, M Hamidou, B de Wazières, E Duhamel, P Jégo, Y Maugars, B Planchon, O Rodat

Service de gériatrie, Hôpital Saint-Jacques, 85, rue Saint-Jacques, 44093 Nantes, France.

La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne 2001 Jul

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Our study compares clinical and therapeutic courses (corticosteroid response, corticosteroid amount, complications) in people with giant cell arteritis before and over 75 years, during the first year of treatment. A series of 164 patients was retrospectively analysed (mean age: 73.3 years) among the two subgroups: before 75 and over 75 years. Patient received (monitoring of reduction in the corticosteroid dosage) a 240 mg intravenous bolus of methylprednisolone followed by 0.5 or 0.7 mg/kg/d of prednisone, or 0.7 mg/kg/d of prednisone without the bolus. Corticosteroid response was identical for the two groups, before and over 75 (patients with corticoresistance: 15% vs 11.4%; NS) and giant cell arteritis-related complications were equivalent (n = 2 vs n = 2; NS). Corticosteroid load was slightly lower in the elderly group (cumulative dose of corticosteroids during the first year of treatment 5.2 g vs 5.8 g; P = 0.03). Patients with rheumatic side effects (collapses of vertebral bodies, mainly) were more frequent in the elderly group (15.5% vs 4.3%; P = 0.01), in spite of a limited mean follow-up period (10.7 months). Even if steroid response was identical in the therapeutic course of giant cell arteritis, rheumatic side effects appeared more frequent in the elderly group (over 75 years). In order to obtain a corticosteroid-sparing effect, new studies are necessary to evaluate a reduced initial dosage of corticosteroids.

Citation

P Chevalet, J H Barrier, J Glémarec, D el Kouri, M Hamidou, B de Wazières, E Duhamel, P Jégo, Y Maugars, B Planchon, O Rodat. Horton's disease in elderly patients aged over 75: clinical course, complications of corticotherapy. Comparative study of 164 patients. Towards a reduced initial dose]. La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne. 2001 Jul;22(7):624-30