Background Temporal arteritis (TA) is a serious disease and require a prolonged period of steroid therapy.
Objectives With the aim of clarifying if steroid cumulative dose is a significative risk factor for adverse effects, we performed a study of 20 TA patients, attending the rheumatology out-patients clinic of Santa Maria Hospital, Lisbon, with a minimum follow-up time of 2 years.
Results The mean follow-up period was 84.3 ± 28.9 months. 12 patients were female (60%, mean age at the time of diagnosis of 69.4 ± 8.6 years) and 8 were male (40%, mean age at the time of diagnosis of 64.6 ± 7.7 years). All the patients were treated with prednisone (PDN), 2 with 3 × 1000 mg methylprednisolone pulses and 4 with concomitant immunosupressors (3 azathioprine and 1 cyclophosphamide). The mean initial PDN dose was 53,2 mg. The PDN dose was tapered and the mean doses were: 1st month – 49,9 ± 18,7 mg; 3rd month ? 34,0 ± 19,1 mg; 6th month ? 24,9 ± 17,7 mg; 12th month ? 10,5 ± 7,8 mg; 24th month ? 5,9 ± 3,2 mg; 36th month ? 5,6 ± 3,2 mg; 60th month ? 7,8 ± 8,6 mg; 84th month ? 5,3 ± 2,8 mg.
By the end of the first 6 months 50% of the baseline dose was reached and after 2 years all patients were on a maintenance low dose (5.9 mg). 2 patients (10%) were able to stop the PDN (at 48 and 55 months). The mean cumulative PDN dose was 17641,8 ± 8937,3 mg. 17 (85%) patients had corticosteroid related adverse effects. Although these patients had a mean cumulative PDN dose (19064,2 ± 8880,7 mg) superior to the dose of the patients without adverse effects (9575 ± 3401,5 mg), the difference was not statistically significative. The mean cumulative PDN dose for each of the observed adverse effects is characterised in the next Table 1.
Conclusion Our results suggest that PDN cumulative dose is a major factor in the induction of hyperglycemia and cataracts. All the others adverse effects had a trend to be correlated with higher PDN doses but this observation did not reach a statistically significative difference.
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