Letters to the editor-Giant cell arteritis-can wwe decrease its relapsing course with less toxic therapy?

摘要

We read with great interest the excellent review article "Giant cell arteritis-a changing entity" by Kesten et al. [1], As the authors note, glucocorticoids are still the mainstay of therapy in patients with giant cell arteritis (CGA). However, relapses often occur during cortico-steroid tapering and adverse effects are frequent, especially in the elderly population. At present, methotrexate is used as a corticosteroid-sparing drug, which is not devoid of toxicity. Thus, an effective and safe corticosteroid-sparing drug would be desirable. As Kesten and colleagues [1] mention, at least two distinct CD4+ T-cell subsets, namely Thl 7 and Thl cells, promote vascular inflammation in GCA. Thl 7 cells are explicitly corticosteroid-sensitive. However, Thl cells are corticosteroid-resistant and abnormal Thl responses continue, unaffected by corticosteroids, identifying GCA as a long-term, chronic immune-mediated disease. Interferon-gamma is the signature cytokine produced by the Thl cell lineage.