What Is the Right Dosage of Steroids for Henoch-Schonlein Vasculitis?

Arthur Kavanaugh, MD

Disclosures

January 18, 2006

Question

What is the right dosage of steroids for Henoch-Schonlein vasculitis? Are there other treatment alternatives?

Response From the Expert

Arthur Kavanaugh, MD 
University of California at San Diego, Division of Rheumatology, Allergy, and Immunology, La Jolla, California.

 

 

Henoch-Schonlein purpura is a systemic small-vessel vasculitis that typically affects the skin of the lower extremities and can also affect the gastrointestinal tract and kidneys. [1] It is idiopathic, although a number of cases have appeared following upper respiratory infections or the use of certain medications. The treatment of this condition is variable, and is driven largely by the persistence and severity of end-organ involvement. Most patients, particularly children, require only supportive care (rest, hydration, treatment of intercurrent infections, etc). In patients with more severe internal organ involvement (renal, gastrointestinal, articular), corticosteroids may be instituted. As is the case with other vasculitides, dosing is largely empiric. Many will begin treatment with a large dose (eg, 1 mg/kg/day of prednisone equivalent) with a goal of rapid tapering. The vast majority of patients become symptom-free after 1-4 months, although relapse has been described in approximately 5% to 10% of cases. Because of the typical outcome and course, there is minimal and only anecdotal experience with other treatment modalities.

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