Steroid management in giant cell arteritis
Steroid management in giant cell arteritis
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DOI：
10.1136/bjo.85.9.1061
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发表时间：
2001-09-01
影响因子：
4.1
通讯作者：
O'Day, J
中科院分区：
文献类型：
--
作者：
Chan, CCK;Paine, M;O'Day, J
目的：巨细胞性动脉炎(GCA)的眼部受累是一种眼科急症，如果不治疗，可进展为永久性失明。在文献中几乎没有证据支持目前用类固醇急性治疗GCA的方案。作者试图回顾静脉和口服类固醇在GCA中的作用。方法：这项回顾性研究回顾了连续100例经活检证实为巨细胞动脉炎的患者的记录。73名在皇家维多利亚眼耳医院(RVEEH)和圣文森特医院接受治疗的视力丧失患者被纳入最后一系列研究。作者研究了患者在发病后第一周的处理，分析了治疗的类型、剂量、对视力的影响以及并发症。结果：除1例患者外，其余患者均为前部缺血性视神经病变(AION)所致视力丧失。双眼受累17例(23%)。在73名患者中，有21名(29%)的视力在开始使用类固醇后平均提高了两条斯奈伦图。与口服类固醇组(13%)相比，静脉注射类固醇组(40%)视力改善的可能性更大。除4名患者(95%)外，所有患者在1个月的复查时视力保持稳定。结论：及时使用类固醇治疗GCA可提高相当数量的患者的视力。与口服类固醇相比，静脉类固醇可能提供更大的改善前景。需要一项比较静脉注射和口服类固醇的前瞻性试验来验证这些发现，并且不会使老年患者面临不可接受的风险。
Aim-Ocular involvement in giant cell arteritis (GCA) is an ophthalmic emergency which, if untreated, can progress to permanent blindness. There is little evidence in the literature to support current protocols for the acute treatment of GCA with steroids. The authors sought to review the effects of intravenous and oral steroids in GCA.Methods-This retrospective study reviewed the records of 100 consecutive patients with biopsy proved giant cell arteritis. 73 patients with visual loss who were treated at the Royal Victorian Eye and Ear Hospital (RVEEH) and St Vincent's Hospital were included in the final series. The authors studied the management of the patients in the first week after presentation, analysing types of treatment, dose, effect on visual acuity, and complications.Results-All the patients except one had visual loss due to anterior ischaemic optic neuropathy (AION). 17 patients (23%) had bilateral eye involvement. Visual acuity improved in 21 of 73 patients (29%) by a mean of two Snellen chart lines after commencement of steroids. There was an increased likelihood of improved vision in the group who had intravenous steroids (40%) compared with those who received oral steroids (13%). In all except four patients (95%) vision remained stable at I month review.Conclusions-Prompt treatment of GCA with steroids leads to improvement of visual acuity in a significant number of cases. Intravenous steroids may offer a greater prospect of improvement compared with oral steroids. A prospective trial comparing intravenous with oral steroids is needed to validate these findings and would not expose elderly patients to unacceptable risks.