TREATMENT OF CORTICOSTEROID-RESISTANT GIANT-CELL ARTERITIS

The literature about the treatment of giant cell arteritis (GCA) is di verse and often includes patients with polymyalgia rheumatica (PMR) wh o do not have concurrent features of GCA. Consequent heterogeneity has contributed to controversy in the analysis of clinical data. Neverthe less, we have critically reviewed this literature to derive a rational approach to initial and maintenance corticosteroid (CS) therapy and t hus define ''CS-resistant GCA.'' In this article, the authors review w hat has been written about the treatment of presumed CS-resistant dise ase. Although firm recommendations are lacking, the authors provide al gorithms for the treatment of GCA patients who fail to respond to init ial CS therapy or who require potentially toxic maintenance-dose CS th erapy. A study design that may help to resolve the dilemmas that were found during our analysis is also outlined.