EPU‐95'Montmorency'
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CORTICOTHERAPIE'EN'2012'
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1. INTRODUCTION'
1.1. HISTORIQUE'
ROSS( T9C( 5MC9:IA8?5;C( A;A8565GHT?;?U=9C( <9( &V56AC( !<<?C5;( A88?:9;8( T-A889;8?5;( C=:( TA( 7A8V5T5@?9( <9C(
C=::>;AT9CEEE(
ROWQX( C=:( <9C( A:@=69;8C( 9D7>:?69;8A=D( Y:5Z;G">U=A:<( A[[?:69( U=9( \T9C( H5:8?H5C=::>;AT9C( C5;8(
9CC9;8?9TT9C(](TA(I?9EEE(
R^_^X( TA( <>C5D`H5:8?H5C8>:5;9( 9C8( <>H5=I9:89( 7A:( &E( 29?HVC89?;X( H9( U=?( A( 79:6?C( <-ACC=:9:( TA( C=:I?9( <9C(
A<<?C5;;?9;CE((
*A( 6?C9( ](TA(<?C75C?8?5;( <9C( HT?;?H?9;C( <9( TA( H5:8?C5;9( 9;( R^SQ( A( H5;C8?8=>( =;( 7:5@:BC(8V>:A79=8?U=9( 9;(
T-ACC5H?A;8(](TA( <>C5D`H5:8?H5C8>:5;9E($9C( ?675:8A;89C( <>H5=I9:89C( >8A?9;8( H5=:5;;>9C( 7A:( T-A88:?M=8?5;(
<=( /:?D('5M9T(<9(7V`C?5T5@?9( 98(<9(6><9H?;9(9;(R^SQ( ](<9=D(M?5HV?6?C89CX(+E$E(a9;<ATT(98(&E(29?HVC89?;(
75=:(T9=:C(8:AIA=D(C=:(T9C(V5:65;9C(H5:8?H5C=::>;AT9C(98(](=;(:V=6A85T5@=9(/EG"E(K9;Hb(75=:(T-=8?T?CA8?5;(
8V>:A79=8?U=9(<9(TA(H5:8?C5;9E((
1.2. LES'GRANDES'INDICATIONS'DE'LA'CORTICOTHERAPIE''
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2. LA'MALADIE'DE'HORTON'
2.1. EN'BREF'
*A(6ATA<?9(<9(K5:85;(L)KN(9C8(TA(7T=C([:>U=9;89(<9C(IACH=TA:?89C(C`C8>6?U=9CX(AI9H(=;9(7:><?T9H8?5;(75=:(
T9C(A:8B:9C(<9(TA:@9(98(<9(65`9;(HAT?M:9E((
"5;(?;H?<9;H9(7A:(79:C5;;9( c@>9(<9(7T=C(<9(SQ(A;C(IA:?9( C9T5;(T9C(:>@?5;C(d(<9(RSJ_SeRQQ(QQQE( %T(9D?C89(
=;9( A=@69;8A8?5;( <9( T-?;H?<9;H9( <9( TA( )K( 98( H9( 6AT@:>( T9C( H5::9H8?5;C( T?>9C( A=( I?9?TT?CC969;8( <9( TA(
757=TA8?5;E(+TT9(A889?;8(<9C(C=f98C(c@>C(<9(7T=C(<9(SQ(A;C(98(T9(:?CU=9(C9(6Af5:9(AI9H(T-c@9(7=?CU=-?T(9C8(PQ(
[5?C(7T=C(?675:8A;8(A7:BC(^Q(A;C(U=-9;8:9(SQ(98(WQ(A;CE(
2.2. LES'COMPLICATIONS'
*A( H567T?HA8?5;( 6Af9=:9( U=-9C8( T-A6A=:5C9( 5=( TA( H>H?8>( A( ;988969;8( :>@:9CC>( <97=?C( T-=8?T?CA8?5;( <9( TA(
H5:8?H58V>:A7?9( 9;( R^S_E( *A( [:>U=9;H9( <9( H98( >I>;969;8( IA:?9( <9( PQ( ]( WQ(g( 9;( [5;H8?5;( <9C( C>:?9C( 98(
C=:85=8(<=(65<9(<9(:9H:=8969;8(<9C(7A8?9;8CE(
*A(C=:65:8AT?8>(T?>9(TA()K(9C8(8:BC(IA:?AMT9(<9(hX_(](_SXS(g(C9T5;(T9C(C>:?9C(98(:9C89(H5;8:5I9:C>9X(HA:(9TT9(
;-A( 7=( i8:9( <>65;8:>9( H567A:A8?I969;8( ]( =;9( 757=TA8?5;( 8>65?;( A77A:?>9( 7A:( T-c@9E( %T( C-A@?8(
9CC9;8?9TT969;8(<-=;9(C=:65:8AT?8>(<-5:?@?;9(HA:<?5IACH=TA?:9E(*9C(<>HBC(C=:I?9;;9;8(A=(H5=:C(<9C(U=A8:9(
7:96?9:C( 65?C( <9( 8:A?8969;8X( 98( C5;8( <=C( ]( <9C( AHH?<9;8C( IACH=TA?:9C( H>:>M:A=D( 9;( HAC( <9( 6ATA<?9(
HT?;?U=969;8( 5=( M?5T5@?U=969;8( 6AT( H5;8:jT>9(k( 5=( ]( T5;@( 89:69( <=C( ]( <9C( A889?;89C( HA:<?AU=9C(
?CHV>6?U=9C(HV9l(T9C(7A8?9;8C(A`A;8(9=(<9([5:89C(<5C9C(<9(H5:8?H5m<9C(5=(=;9(6ATA<?9(6AT(H5;8:jT>9E(
*A( 65:M?<?8>( 9C8( >@AT969;8(T?>9( A=D( :?CU=9C(?;V>:9;8C(](TA( H5:8?H58V>:A7?9(A=(T5;@( H5=:C( L<?AMB89X( K&!X(
5C8>575:5C9([:AH8=:A?:9X(<>H5679;CA8?5;(HA:<?AU=9nN(U=?(A77A:A?CC9;8(<BC(TA(7:96?B:9(A;;>9X(HV9l(_S(](
WS(g(<9C(7A8?9;8CE(,A;C(7T=C?9=:C(>8=<9CX(TA(H5:8?H58V>:A7?9(](<5C9(>T9I>9(L7T=C(<9(RQ(6@ef(79;<A;8(7T=C(
<9(C?D(65?CN(9C8(ACC5H?>9(](=;(:?CU=9(AHH:=(<9(<>HBC(98(](=;9(65:M?<?8>(7T=C(?675:8A;89E((
2.3. LE'DIAGNOSTIC'
o(T-V9=:9(AH8=9TT9X(TA(M?57C?9( <-A:8B:9( 89675:AT9(:9C89(T9(69?TT9=:(65`9;(<9(75C9:(T9(<?A@;5C8?H(<9()KE(
)A?C( A=( H5=:C( <9C( <?D( <9:;?B:9C( A;;>9CX( T-=8?T?8>( <9( ;5=I9TT9C( 89HV;?U=9C( <-?6A@9:?9( 75=:( 75C9:( T9(
<?A@;5C8?H(<9(IACH=TA:?89(<9C(@:5C(IA?CC9A=D(A(>8>(>8=<?>9E(
2.4. LE'TRAITEMENT'DE'LA'MALADIE'DE'HORTON'
2.4.1. UNE'URGENCE,'MAIS'LA'MALADIE'DE'HORTON'EST'CURABLE''
*9( 8:A?8969;8( 9C8( MAC>( C=:( TA( H5:8?H58V>:A7?9( U=?( 79:698( =;9( A6>T?5:A8?5;( :A7?<9( <9C( C`678j69C( 6A?C(
<?6?;=9(A=CC?(T9(:?CU=9(<9(H567T?HA8?5;C(IACH=TA?:9C(](T5;@(89:69E((
*A(:A7?<?8>(<-?;C8A=:A8?5;(<=(8:A?8969;8(9;(HAC(<9(8:5=MT9C(I?C=9TC(9C8(T9(69?TT9=:([AH89=:(7:><?H8?[(<9(TA(
:>H=7>:A8?5;(HT?;?U=9E("?(TA(H5:8?H58V>:A7?9(9C8(?;C8A=:>9(9;(65?;C(<9(Ph(V9=:9CX(7T=C(<9(SQ(g(<9C(7A8?9;8C(
A=:5;8(=;9(A6>T?5:A8?5;(H5;8:9(W(g(A7:BC(Ph(V9=:9CE((
%T( ;-9D?C89( A=H=;( H5;C9;C=C( H5;H9:;A;8( T9( CHV>6A( 8V>:A79=8?U=9X( TA( <5C9( 98( TA( <=:>9( <9( 8:A?8969;8E(
.T5MAT969;8X(T-?;C8A=:A8?5;(:A7?<9(<9(TA(H5:8?H58V>:A7?9(9C8(:9H566A;<>9(7A:(85=CX(A[?;(<9(<?6?;=9:(T9C(
C?@;9C(HT?;?U=9C(98(<9(7:>I9;?:(T9C(H567T?HA8?5;C(?CHV>6?U=9CE((
2.4.2. LA'CORTICOTHERAPIE'RESTE'LE'TRAITEMENT'DE'REFERENCE'MAIS'
%T(;-9D?C89(85=f5=:C(A=H=;(H5;C9;C=C(C=:(TA(<5C9(?;?8?AT9X(TA(<=:>9(<9(TA(H5:8?H58V>:A7?9(98(T9C(65<AT?8>C(<9(
<>H:5?CCA;H9( U=?( C5;8( 7T=8j8( MAC>9C(C=:( <9C(:9H566A;<A8?5;C( <-9D79:8CE( *A( 89;<A;H9( @>;>:AT9( 9C8( ](TA(
MA?CC9(<9C(<5C9C(98(](TA(:><=H8?5;(<9C(<=:>9C(<=([A?8(<9(TA(H565:M?<?8>(ACC5H?>(](H9(8:A?8969;8E(
*9C(7A8?9;8C(:>75;<9;8(@>;>:AT969;8(](<9C(<5C9C(IA:?A;8(9;8:9(QXS(98(QXp(6@eb@(7A:(f5=:E((
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o(7A:8?:(<9(p(5=(S(6@( <->U=?IAT9;8(7:><;?C5;9X( ?T(9C8(:9H566A;<>(<-Af5=89:(=;9(C=77T>69;8ACC?5;C(9;(
V`<:5H5:8?C5;9X(A?;C?(U=9(TA(:>AT?CA8?5;(<-=;(89C8(A=("`;AH8V>;9q(T-A::i8(<>[?;?8?[E((
+;( 65`9;;9X( p_(g( <9C( 7A8?9;8C( :9r5?I9;8( OXP(6@( ]( =;( A;( 98( _Q(g( C5;8( C9I:>C( 9;( RO( ]( Ph(65?CE( *A(
[:>U=9;H9(<9(TA(:9HV=89(IA:?9(<9(h(](pQ(g(9;([5;H8?5;(<9(TA(:A7?<?8>(<9(TA(<>H:5?CCA;H9E(
2.4.3. QUELLE'MOLECULE'?'
*9(HV5?D(<5?8(C9([A?:9(9;([5;H8?5;(<9C(HA:AH8>:?C8?U=9C(<9C(<?[[>:9;89C(65T>H=T9C(:>C=6>9C(<A;C(T9(8AMT9A=(
C=?IA;8E(%T(:975C9(C=:(=;(M5;(H567:56?C(9;8:9([:9?;A8?5;(98(9[[98(6?;>:AT5GH5:8?H5m<9E(
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Molécules'
Équivalent'
Posologique'
mg'
Anti'
Inflamm.'
Rétention'
sodée'
Pouvoir'
Freinat.'
Naturels'
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Substitués'
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2.4.4. UNE'PRESCRIPTION'TYPE'
%T([A=8(?;C?C89:(C=:(T-?;8>:i8(<-=;9(7:?C9(=;?U=9(T9(6A8?;(U=?(:><=?8(9[[98([:9?;A89=:(C=:(TA(C>H:>8?5;(<-!$&K(
U=?(IA(C9(C=79:75C9:(A=(7?H(7V`C?5T5@?U=9(<9(C>H:>8?5;(<9(H5:8?C5TE(%T(9C8(65;8:>(U=9(TA(7:?C9(9;(P([5?C(ef(
6Af5:9(T9C(9[[98C([:9?;A89=:CE(
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Ordonnance'type'(traitement'pour'2'mois)'
(
G $5:8A;H`Ts(d(SQ(6@(9;(=;9(7:?C9(T9(6A8?;(LQEp(6@eb@efN(
G aA:<>@?Hs(d(RWQ(6@(R(CAHV98ef(
G ,?[[=(asd(P(@>T=T9C(efX([5;H8?5;(bAT?>6?9(98(H:A679C(LWQQ(6@(<9($VT5:=:9(<9(atN(
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2.4.5. LA'SURVEILLANCE'
*-9[[?HAH?8>(<=(8:A?8969;8(9C8(C=?I?9(7A:(
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0;( M?TA;( 9C8( ]( :>AT?C9:X( ?;?8?AT969;8( 85=C( T9C( RS( f5=:C( 7=?C( <9( 7T=C( 9;( 7T=C( 9C7AH>X( 9;( [5;H8?5;( <9( TA(
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2.4.6. DECROISSANCE'DU'TRAITEMENT'
*A(<>H:5?CCA;H9(9C8(IA:?AMT9(C9T5;(T9C(>H5T9C(98(?T(;-`A(7AC(<9(7:585H5T9(IAT?<>E((
+;(@>;>:ATX(=;9(H5:8?H58V>:A7?9(](QXS(](QXp(6@eb@(7A:(f5=:(9C8(6A?;89;=9(f=CU=-](;5:6AT?CA8?5;(<9C(C?@;9C(
M?5T5@?U=9C(98(HT?;?U=9C(L9;I?:5;(=;(65?CN(AI9H(=;9(<?6?;=8?5;(<BC(TA(<?C7A:?8?5;(<=(C`;<:569X(9;(<9=D(
8967C(d((
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2.4.7. LES'QUESTIONS'DE'LA'VIE'DE'TOUS'LES'JOURS'
2.4.7.1. Un'antécédent'de'tuberculose,'Comment'le'prendre'en'compte'?''
/:>H?C9:(A;;>9(<9(TA(8=M9:H=T5C9(d(
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2.4.7.2. Une'cataracte'débutante'?'
*9C( H5:8?H5m<9C( 79=I9;8( A@@:AI9:( TA( HA8A:AH89( I5?:9( TA( H:>9:E( "?( 9C8( 9TT9( T?>9( A=D( H5:8?H5m<9CX( T9( <>TA?(
<-A77A:?8?5;( 9C8( <9( 7T=C( <9( R( A;E( +TT9( :>@:9CC9( 7A:8?9TT969;8( ]( T-A::i8( <=( 8:A?8969;8E( $979;<A;8X( C?(
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