[Bolus of methylprednisolone and Horton's disease/rhizomelic pseudo-polyarthritis. Preliminary results of a pilot study of treating the bolus with low doses of corticoids].
The aim of this study was to reduce the side effects of corticosteroid therapy responsible for high morbidity in giant cell arteritis. Nine patients were admitted consecutively for temporal arteritis (7 cases) or polymyalgia rheumatica (2 cases) without ocular involvement (mean age: 69.3 years; positive temporal biopsy: 6 cases). The following protocol was used: methylprednisolone, 500 mg/d, i.v., for 3 consecutive days, then low doses (an average of 22.5 mg/d) of prednisone or an equivalent drug. The mean length of follow-up was 15.1 months (range: 6-22 months). The mean lapse of time until the erythrocyte sedimentation rate returned to normal was 10.6 days (range: 3-30 days). The mean dose of prednisone or an equivalent drug at 6 months was 13 mg/d (range: 5-22.5 mg/d). One patient was cured after 17 months of treatment. Another suffered a biological relapse after 13 months of treatment. All the other patients were asymptomatic with no biological signs of an inflammatory syndrome. The complications included: electrocardiogram modifications without necrosis during pulse therapy in 1 woman; unstable angina developed 2 months after the onset of treatment in 1 man; recurrent urinary infections in 1 predisposed male patient. No bone or metabolic side effects have been noted to date. We think that 3 days of intensive intravenous corticotherapy followed by low doses of corticoïds per os constitute an effective and well-tolerated regimen. Additional studies including comparison with conventional treatments should be carried out to confirm these results and, even better, to evaluate the long-term benefits of this protocol in terms of side effects.