Giant cell arteritis in elderly people aged 75 and over. Clinical and therapeutic courses, steroid-induced side effects. Comparative study about 164 patients. Toward a reduced initial steroid dosage

Purpose. - Our study compares clinical and therapeutic courses (corticoster oid response, corticosteroid amount, complications) in people with giant ce ll arteritis before and over 75 years, during the first year of treatment. Methods. - A series of 164 patients was retrospectively analysed (mean age: 73.3 years) among the two subgroups: before 75 and over 75 years. Patient received (monitoring of reduction in the corticosteroid dosage) a 240 mg in travenous bolus of methylprednisolone followed by 0.5 or 0.7 mg/kg/d of pre dnisone, or 0.7 mg/kg/d of prednisone without the bolus. Results. - Corticosteroid response was identical for the two groups, before and over 75 (patients with corticoresistance: 15% vs 11.4%; NS) and giant cell arteritis-related complications were equivalent (n = 2 vs n = 2, NS). Corticosteroid load was slightly lower in the elderly group (cumulative dos e of corticosteroids during the first year of treatment 5.2 g vs 5.8 g, P = 0.03). Patients with rheumatic side effects (collapses of vertebral bodies , mainly) were more frequent in the elderly group (15.5% vs 4.3%; P = 0.01) , in spite of a limited mean follow-up period (10.7 months). Conclusion. - Even if steroid response was identical in the therapeutic cou rse of giant cell arteritis, rheumatic side effects appeared more frequent in the elderly group (over 75 years). In order to obtain a corticosteroid-s paring effect, new studies are necessary to evaluate a reduced initial dosa ge of corticosteroids. (C) 2001 Editions scientifiques et medicales Elsevie r SAS.