MANAGEMENT OF GIANT-CELL ARTERITIS VALUE OF SYNTHETIC ANTIMALARIAL AGENTS - A RETROSPECTIVE STUDY OF 36 PATIENTS

Thirty-six patients with giant cell arteritis were studied retrospecti vely. Histological examination of the temporal artery or another arter y was positive in 95% of cases. Mean follow-up was five years. A synth etic antimalarial was used in every case. Two groups were differentiat ed. One (Group I) was composed of 21 patients who were given the antim alarial drug as part of the first-line therapy, either with a corticos teroid in a mean dose of 36 mg/d (18 patients) or with a nonsteroidal antiinflammatory agent. The other group (Group II) included 15 patient s in whom the antimalarial was used after a period of corticosteriod t herapy, because of steroid-dependency (n=5) or adverse effects (n=9), or systematically (n=1). Withdrawal of the corticosteroid was achieved in 81% of cases, after a mean interval of 15 months. Many patients di scontinued the corticosteriod after less than one year (8 out of 18 pa tients of group I). The 18 Group I patients who were given a corticost eriod were all able to discontinue this drug. The overall recovery rat e was 58%; mean time to recovery was 33 months with a mean follow-up o f 52 months. There were no recurrences at discontinuation of the treat ment. Adverse effects of antimalarial therapy were recorded in 30.5% o f patients and required discontinuation of the drug in 19%. The most o ften used regimen was hydroxychloroquine (400 mg/d) for at least two y ears and prednisone 20 to 30 mg/d for two months, in the absence of va scular complications. First-line treatment with a synthetic antimalari al agent and a corticosteriod seems beneficial in patients with giant cell arteritis. A prospective controlled study aimed at evaluating the efficacy of this approach may be warranted.