In our cohort, a significant part of patients (23%) went into remission after treatment with leflunomide in a mean of months. The corticosteroid-sparing effect of leflunomide was achieved with a low dose of mg in GCA and 14 mg in PMR. The recommended loading dose of 100 mg in treatment of arthritides was not used due to the fact that such a high dose is often associated with side effects. In other autoimmune diseases, doses of 20 mg (RA, PsA) [ 5 , 6 ] and 30 mg (GPA) [ 8 ] were used in order to induce remission.
Different formulations have been developed in an effort to enhance the delivery of topical corticosteroids. Betamethasone valerate in a foam had superior efficacy for scalp psoriasis and was preferred by patients when compared with betamethasone valerate lotion [ 20 ]. The foam becomes a liquid on contact with skin and is also well tolerated by patients with trunk and extremity psoriasis [ 21 ]. A clobetasol propionate spray is also available; like foams, sprays are easy to apply to large areas [ 22 ]. The main advantage of these newer preparations is likely greater patient acceptance, which may translate into greater adherence; the main disadvantage is cost.