What is the role of glucocorticoids in the treatment of polyarteritis nodosa (PAN)?

Updated: Nov 14, 2017
  • Author: Dana Jacobs-Kosmin, MD, FACP; Chief Editor: Herbert S Diamond, MD  more...
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Answer

No standard regimen for steroid dosing exists in PAN. It is common practice to use high-dose oral prednisone at 1 mg/kg/day. [62] Methylprednisolone could also be given, for example, at a pulse dose of 1,000 mg intravenously daily, repeated over 3 days, prior to initiating oral prednisone.

Tapering of the prednisone can begin as early as 1 month later if the patient's clinical status and ESR normalize. Prednisone taper can continue over the next 12 months until it has been stopped.

When prednisone is combined with cyclophosphamide, the steroid dose is tapered more rapidly, if possible, to reduce the increased risk of infection.

Patients receiving long-term steroid therapy are at risk for glucocorticoid-induced osteoporosis. Calcium and vitamin D supplementation should be given. Bisphosphonates are indicated in patients in whom glucocorticoids are being initiated.


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