Treatment of Temporal Arteritis With Adrenal Corticosteroids

Birkhead, Newton C.; Wagener, Henry P.; Shick, Richard M.

doi:10.1001/jama.1957.02970450023007

Cited by 182 publications

(32 citation statements)

References 5 publications

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“…Their benefit in reducing vision loss from GCA was immediately apparent and has been confirmed over the years since then [29][30][31]. Corticosteroids have been the mainstay of treatment of GCA for 50 years; however, their poor side-effect profile has prompted much investigation into alternate or adjunctive steroid-sparing therapies.…”

Section: Treatmentmentioning

confidence: 99%

Giant-cell arteritis

Hall

2008

Current Opinion in Ophthalmology

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Section: Treatmentmentioning

confidence: 99%

Giant-cell arteritis

Hall

2008

Current Opinion in Ophthalmology

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“…They were first introduced in 1957, approximately 20 years after visual loss caused by GCA was first reported in the literature [10,11]. Their benefit was immediately apparent.…”

Section: Opinion Statementmentioning

confidence: 99%

“…Their benefit was immediately apparent. For example, in the original Mayo Clinic study, none of six patients with unilateral blindness who received cortisone developed fellow-eye involvement, whereas five of 10 patients who did not receive cortisone (before the initiation of the study) developed bilateral blindness [11]. Research over the years has confirmed that corticosteroids dramatically reduce rates of blindness caused by GCA, and corticosteroids occasionally improve already compromised vision [12,13•,Class III].…”

Section: Opinion Statementmentioning

confidence: 99%

Giant cell arteritis

Hall¹,

Balcer

2004

Curr Treat Options Neurol

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Patients with a suspected diagnosis of giant cell arteritis (GCA) should be started on high-dose corticosteroid therapy without delay. A temporal artery biopsy should be performed after initiation of therapy to confirm the diagnosis. Patients with acute visual or neurologic symptoms present a neuro-ophthalmic emergency. Therapy should be initiated immediately with high-dose intravenous methylprednisolone sodium succinate and followed by high-dose oral prednisone. Treatment may begin with high-dose oral prednisone in patients without visual or neurologic symptoms. Calcium, vitamin D, and peptic ulcer prophylaxis should accompany steroid therapy, as indicated. The following treatments should be considered for patients with suspected GCA and acute visual or neurologic signs or symptoms: intravenous methylprednisolone sodium succinate (250 mg intravenously every 6 hours) should be given for 3 days, followed by oral prednisone (80 mg per day or 1 mg/kg) for 4 to 6 weeks. Prednisone should then be tapered by 10 mg per day every month. Most patients require 1 year of therapy to avoid relapse. Taper and duration should be modified according to erythrocyte sedimentation rate, C-reactive protein, and signs and symptoms of GCA. Rheumatologic consultation and follow-up is often helpful for these patients. For patients with suspected GCA and no acute visual or neurologic signs or symptoms, therapy may begin directly with oral prednisone (80 mg per day or 1 mg/kg) with same taper and duration based on laboratory values and clinical signs and symptoms.

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“…(Arch Ophthalmol 1983;101:388-391) rpemporal (giant cell, cranial) arteri--* tis is a condition of the elderly that frequently results in devastating ocular complications.12 Bilateral blind¬ ness has been noted to develop in approximately 50% of untreated patients who originally presented with blindness in one eye.3 The thera¬ py is massive doses of systemic corticosteroids to prevent further loss of vision especially in the fellow eye of patients with unilateral visual loss; however, bilateral blindness may occur even after the onset of this treatment.1·2'4 The visual loss is gener¬ ally permanent, although occasionally there is partial or even total reversal of the visual deficit, especially after the onset of therapy.135 Although most patients with suspected tempo¬ ral arteritis are treated with large doses of systemic corticosteroids the dosage is usually tapered and discon¬ tinued if the temporal artery biopsy specimen is normal. 3 The rationale for discontinuing the corticosteroid ther¬ apy in this situation is that its longterm use is associated with numerous serious complications; furthermore, the therapy may be masking another underlying condition that is the cause of the visual loss and that should be investigated for and appropriately treated.4-6'8…”

mentioning

confidence: 99%