What are the possible treatments for Horton’s disease?
The basic treatment is medication and consists of corticosteroid therapy, a cortisone-based treatment. This treatment is very effective, considerably reducing the risk of vascular complications which make the disease so serious. This treatment works because cortisone is the strongest anti-inflammatory drug known, and Horton’s disease is an inflammatory disease. Within a week, the improvement is already considerable and within a month of treatment the inflammation is normally under control.
An antiplatelet treatment is added. This is to prevent platelets in the blood from aggregating and causing a blockage blocking circulation in an artery.
Treatment with cortisone is initially at a loading dose, then, when the inflammation is under control (sedimentation rate or ESR has returned to normal), the doctor decreases the dose of corticosteroids in stages. He seeks to find the minimum effective dose in order to limit the undesirable effects of the treatment. On average, treatment lasts 2 to 3 years, but it is sometimes possible to stop cortisone sooner.
Because of the side effects these treatments can cause, people on treatment should be closely monitored during treatment. Special attention should be paid to the elderly in order to prevent an increase in blood pressure (hypertension), a osteoporosis (bone disease) or eye disease (glaucoma, cataract).
Due to the complications associated with corticosteroid therapy, alternatives are being studied such as methotrexate, azathioprine, synthetic antimalarials, ciclosporin, and anti-TNF α, but have not shown superior efficacy.