Related Experiment Videos
[Outcome, treatment and prognosis of Horton's disease]
Insights
This study on Horton's disease (HD) found that while cerebrovascular accidents were a common cause of early death, patients generally did not die from HD itself. Survival rates were influenced by intercurrent diseases and sex, not by disease presentation or corticosteroid therapy choice.
Area of Science:
- Rheumatology
- Neurology
- Clinical Medicine
Context:
- Horton's disease (HD), also known as giant cell arteritis, is a systemic vasculitis.
- Understanding long-term outcomes and prognostic factors is crucial for managing this condition.
- Previous studies have focused on acute management and treatment efficacy.
Purpose:
- To analyze the treatment, prognosis, and clinical outcomes of patients with Horton's disease.
- To identify factors influencing survival rates in a cohort of HD patients.
- To evaluate the impact of disease presentation, HLA-DR4 status, and corticosteroid dosage on survival.
Summary:
- A computerized analysis of 108 Horton's disease patients diagnosed between 1970-1981 revealed an 80.1% 5-year survival rate.
- Cerebrovascular accidents were the most common cause of death, particularly within the first two years.
- Intercurrent disease and male sex were significant negative prognostic factors, while disease presentation, HLA-DR4, and corticosteroid choice did not significantly impact 5-year survival.
- Initial prednisone/prednisolone doses exceeding 0.5 mg/kg/day were associated with reduced relapse rates, with no additional benefit observed above 1 mg/kg/day unless complications were present.
Impact:
- This research provides valuable insights into the long-term prognosis of Horton's disease.
- Findings emphasize the importance of managing comorbidities and considering sex-specific survival differences.
- The study informs optimal corticosteroid dosing strategies to minimize relapse risk in Horton's disease patients.
Abstract:
Precise information was obtained by a computerized analysis of the treatment, prognosis and clinical outcome of 108 representative cases selected from a series of 160 patients with Horton's disease (HD) diagnosed between 1970 and 1981. At the end of the study, 18 patients had died (16,6 p. 100), the commonest cause of death being a cerebrovascular accident. Death occurred during the first two years of the illness in half these cases. Despite these early complications of the disease, from a statistical point of view, the patients did not die of HD or the complications of its treatment. The 5 years survival rate 80,1 p. 100 (actuarial analysis). Most deaths were from natural causes; an intercurrent disease was often implicated; the lower probability of survival for men (69,9 p. cent at 5 years, compared to 85,4 p. cent for women) is compatible with the lower life expectancy which is well established. The roles of intercurrent disease and sex were statistically significant. On the other hand, there was no difference in the probability of 5 year survival when the different presenting of the disease, the terrain (HLA-DR4) and choice of corticosteroid therapy were compared. The initial dose of prednisone or prednisolone should exceed 0,5 mg/kg/day, if relapse is to be avoided. No additional benefits were observed with doses in excess of 1 mg/kg/day except in cases with complications from the onset (ocular, coronary insufficiency, stenosis of the main large arteries, without being able to prejudge their mechanism).(ABSTRACT TRUNCATED AT 250 WORDS)