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Treatment of giant cell arteritis
- Source :
- Biochem Pharmacol. 2019 Jul;165:230-239, UCrea Repositorio Abierto de la Universidad de Cantabria, Universidad de Cantabria (UC)
- Publication Year :
- 2019
-
Abstract
- Giant cell arteritis (GCA) is the most common form of vasculitis in adults. Cranial manifestations are typical clinical features of this vasculitis. Sometimes the presenting symptoms are nonspecific and, in some cases, large-vessel involvement may prevail. Polymyalgia rheumatica is a frequent manifestation that in some cases may be the presenting symptom of GCA. Visual complications, in particular the risk of blindness, constitute the most feared manifestations of GCA. Prompt recognition of this vasculitis is required to avoid irreversible complications. Prednisone/prednisolone at a dose of 40–60 mg/day is the cornerstone therapy in GCA. Glucocorticoids lead to rapid improvement of symptoms and may reduce the risk of irreversible visual loss. However, relapses are common when the prednisone dose is tapered. Therefore, additional therapies are required in relapsing GCA or when a rapid reduction of glucocorticoids is needed. The most widely used conventional immunosuppressive drug is methotrexate Adjunctive treatment with methotrexate may decrease the risk of relapses and reduce glucocorticoid exposure. However, comprehensive reviews indicate that the efficacy of methotrexate in GCA is modest. The experience with other conventional immunosuppressive drugs in GCA patients is scarce. In some cases, the new biologic agents are required. Among them, the most frequently used is the recombinant humanized anti-IL-6 receptor antibody tocilizumab. It improves clinical symptoms, reduce the cumulative prednisone dose and the frequency of relapses in GCA patients. However, anti-tumor necrosis factor-α therapy is not useful in GCA. Promising results on other biologic agents, such as abatacept, ustekinumab or anakinra, require further confirmatory studies.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Giant Cell Arteritis
Biologic Agents
Antibodies, Monoclonal, Humanized
Biochemistry
Anti-IL6-Receptor Tocilizumab
Polymyalgia rheumatica
03 medical and health sciences
chemistry.chemical_compound
Biological Factors
0302 clinical medicine
Tocilizumab
immune system diseases
Prednisone
Medicine
Animals
Humans
skin and connective tissue diseases
Giant Cell (Temporal) Arteritis
Glucocorticoids
Pharmacology
business.industry
Abatacept
medicine.disease
Dermatology
Giant cell arteritis
030104 developmental biology
Methotrexate
Treatment Outcome
chemistry
Polymyalgia Rheumatica
030220 oncology & carcinogenesis
Adjunctive treatment
cardiovascular system
Prednisolone
business
Vasculitis
Immunosuppressive Agents
Relapses
medicine.drug
Subjects
Details
- ISSN :
- 18732968
- Volume :
- 165
- Database :
- OpenAIRE
- Journal :
- Biochemical pharmacology
- Accession number :
- edsair.doi.dedup.....0f9a6800084a3f1e79f64beeb41f3fae