Principles of acute treatment of temporal arteritis. Place of high-dose corticosteroid therapy.

Corticosteroid therapy, the elective treatment for temporal arteritis, can produce adverse effects on hone in this elderly population which usually oc cur late after acute high-dose administration. Such adverse effects are exc eptional and generally have little impact as long as certain cortisone-spar ing principles are followed: duration of acute treatments should be as short as possible; dosage ran be tapered off rapidly, cutting the acute dose in half in 4 week s; to titrate dosage, inflammatory proteins should be monitored (especially CR P because of its rapid kinetics and sometimes another protein with slow er kinetics); this appears to be more useful for cortisone-sparing than the cl assical method based on clinical analysis and sedimentation rate; acute regimens should be accompanied by anticoagulation until figrinogen ha s returned to normal levels; clinical relapses during treatment are usually benign and can generally be controlled by raising the dose slightly; in case of failure due to an acute flare-up far from corticosteroid administration, it would he interesting t o study the cortisone sparing effect of giving a 240 mg iv. bolus of methyl prednisolone followed by low-dose corticosteroids; if the relapse is only e xpressed in laboratory tests, holding the dose at same plateau for two week s generally leads to spontaneous normalization, Intravenous bolus methlyprednisolone is Hell tolerated in this population o f elderly patients, There is no recognized indication in the uncomplicated forms of temporal arteritis. The cortisone-sparing effect of this technique may result from the fact that the acute oral dose can be reduced. Complica ted forms, particularly with ocular involvement, are recognized indications for bolus administration although the administration modalities have not y et been validated. In patients with overt ocular involvement, repenting eme rgency high-dose iv boluses every 6 to 8 hours warrants evaluation with the objective of recovering visual function.