Analysis of steroid related complications and mortality in temporal arteritis: A 15-year survey of 43 patients

Objectives. To analyze steroid related complications in patients with temporal arteritis (TA) and to evaluate their possible effect on survival. Methods. Forty-three consecutive patients with TA diagnosed in one center were followed over 10 years (mean 3 years). All were treated with prednisone. Clinical response and outcome, as well as prednisone dosage and adverse effects, were recorded throughout the followup period. A standardized mortality ratio (SMR) was calculated for the whole period. Results. Twenty- five patients (58%) developed major steroid related complications. The most common were fractures and severe infections. These complications were age related, occurring twice as often in patients older than 75 years compared to younger patients. Steroid related side effects were also dose related, occurring more commonly in patients starting with doses of > 40 mg/day and in patients taking high maintenance dosage. Nineteen patients died during the study period, 11 during the first year. Deaths of 7 patients were probably related to steroid treatment: Six had fatal infections and one had a fatal bleeding ulcer. The overall SMR was 2.12 (95% confidence interval 1.27- 2.96), mainly due to excess mortality in the first year. Conclusion. Steroid treatment in TA may cause major morbidity and increased mortality. The therapeutic regimen in TA should be individualized, and the patient's age, severity of TA, and coexistent medical conditions should be considered.