The recent article by Prøven et al (Prøven A, Gabriel S, Orces C, O'Fallon WM, Hunder GG. Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes. Arthritis Rheum 2003;49:703–8) emphasizes the toxicities inherent in the use of high-dose steroids for the management of giant cell arteritis (GCA).
The authors report that 48% of 125 patients treated for GCA experienced “relapses or recurrences.” I suspect that such occurrences were grounds for raising the glucocorticoid doses used for the management of these patients, which in turn would be expected to augment the risk of steroid-related toxicities. It has been my clinical experience that a number of “flares” of GCA—prompting increases in corticosteroid doses—are diagnosed on the basis of asymptomatic rises in the acute-phase reactants, especially the erythrocyte sedimentation rate. I am thus curious about the specifics as to how Prøven et al defined “relapses or recurrences,” and I would appreciate their thoughts as to whether this definition could have played a role in prolonging the duration of steroid therapy in their patients, and, by implication, the toxicities attendant on such therapy.