Combining Methotrexate with Prednisone To Treat Temporal Arteritis. Ann Intern Med. 2001;134:S71. doi: 10.7326/0003-4819-134-2-200101160-00005
Download citation file:
Published: Ann Intern Med. 2001;134(2):S71.
Giant-cell arteritis (also called temporal arteritis) involves inflammation of large and medium-sized arteries (vasculitis). This condition occurs in elderly people and can lead to sudden blindness when the inflammation involves the temporal artery, an artery located on the side of the head that supplies blood to the eye. Prompt treatment can prevent blindness. Standard therapy for giant-cell arteritis consists of large doses of the drug prednisone, followed by a gradual decrease in the dose. Patients need to take a low dose of prednisone for an average of 2 years. Unfortunately, in many patients, symptoms (including headache, changes in vision, and tenderness over the temporal artery) return as the dose of prednisone is lowered, or side effects from the prednisone develop. Thus, better ways to treat giant-cell arteritis are needed. Methotrexate is a drug that interacts with the immune system and is useful in treating other forms of vasculitis. Some reports suggest that it may help decrease the amount of prednisone needed to treat giant-cell arteritis.
To get more information on whether methotrexate plus prednisone is a better way to treat giant-cell arteritis than prednisone alone.
The study included 42 patients with newly diagnosed giant-cell arteritis in a hospital in Spain.
All patients received standard prednisone treatment. The researchers randomly assigned patients to receive either methotrexate or placebo in addition to prednisone. The placebo looked like the methotrexate but contained no active ingredients. Neither the patients nor the researchers knew which treatment a patient received until the study was completed. The researchers collected information on patients' symptoms, the total dose of prednisone they needed over the course of the treatment, and the number of side effects that patients experienced.
Of patients who received methotrexate and prednisone, 45% had at least one relapse of arteritis compared with 84% of the patients who received placebo and prednisone. Patients who took methotrexate also needed less prednisone over the course of treatment than those who took placebo. The number and severity of side effects were similar in the two groups.
Some of the patients did not complete the study; this limited the power of the study to reveal differences in side effects between the two groups.
Methotrexate combined with prednisone is more effective at preventing relapses of giant-cell arteritis than prednisone alone. Patients who receive methotrexate also appear to need less prednisone over the course of treatment but still experience some side effects from prednisone therapy.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Neurology, Rheumatology, Vasculitides, Giant Cell Arteritis/Polymyalgia Rheumatica.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only