New therapeutic targets in giant-cell arteritis. Considerations based on the current pathogenic model and the availability of new therapeutic agents

摘要

Giant-cell arteritis (GCA), a granulo-matous arteritis of the elderly has been considered the paradigm of a glucocor-ticosteroid sensitive disease (,2). Response to treatment is often spectacular within hours or days and, based on this observation, quick and complete disappearance of symptoms has been considered a requirement to admit the diagnosis of GCA when histological confirmation is not available (, 4). Why, then, is there a need for alternative or adjuvant therapies in GCA? In spite of the initial response to gluco-corticoids experienced by the majority of patients, the management of GCA still faces a number of unresolved challenges (2): 1) Visual impairment, commonly due to anterior ischemic optic neuritis, still occurs in 15-20% of patients in recent series (5-7). When visual loss is established, prompt gluco-corticosteroid treatment is only followed by objective improvement in the visual field in 4% of involved eyes (8, 9). In 10-17% of patients who present with visual symptoms, vision continues to deteriorate during the first 1-2 weeks after the initiation of glucocorticosteroid treatment (10-11)