Glucocorticoid therapy in giant cell arteritis: Comment on the article by Prøven et al

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Glucocorticoid Therapy in Giant Cell Arteritis: Comment on the Article by Prøven et al

To the Editor:

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.

William P. Docken MD*, * Brigham and Women's Hospital Chestnut Hill, MA.

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