Temporal arteritis: treatment controversies

Introduction: Although giant cell or temporal arteritis represents 5-10% of ischaemic optic neuropathies and is the most common arteritis in people over 60 years old. Currently there is no established treatment with oral glucocorticoids available. Background: Glucocorticoid (GC) is still the treatment of choice but has to be started without delay in order to prevent neurological or systemic complications. However, we can resort to intravenous treatment in cases where there is loss of sight or other neurological symptoms. In cases refractory to GC or in those in whom we wish to decrease the dose due to adverse effects, individualised treatment with methotrexate or TNF blockers could be indicated. There is insufficient evidence to recommend other treatments, such as azathioprine, dapsone, cyclosporine, cyclophosphamide or imitinib. In patients with vascular risk factors, anti-platelet therapy with ASA should be assessed. Surgical treatment should be considered in selected cases with symptoms due to arterial stenosis. Conclusions: The corticoids continue to be the treatment of choice in temporal arteritis, however, given the clinical variability of the disease and the special characteristics of this group of patients, usually elderly and with systemic diseases, we believe that individualised treatment with coherent therapeutic guidelines are essential. Currently there is not only treatment with oral glucocorticoids available, although in our patients we can choose to use intravenous megadoses, anti-platelet treatment, resort to methotrexate or TNF inhibitors in refractory cases, or even consider surgical approaches. (C) 2010 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.