title: Prevention of relapses in systemic lupus erythematosus.
abstract: Many relapses of systemic lupus erythematosus (SLE) are preceded by a rise in antibodies against double-stranded DNA (anti-dsDNA). We investigated whether these relapses can be prevented by giving prednisone when a rise in anti-dsDNA occurs. 156 patients with SLE were studied. Anti-dsDNA was measured by Farr assay monthly. When a rise in anti-dsDNA was found, patients were randomly assigned either conventional treatment or 30 mg prednisone added to the current daily dose and tapering off to baseline over 18 weeks. A rise in anti-dsDNA was detected in 46 patients (24 assigned conventional treatment and 22 prednisolone). The relapse rate was higher in the conventional group than in the prednisolone group (20 vs 2, p < 0.001). Although rises in anti-dsDNA in the prednisone group were treated with additional prednisone, the cumulative oral doses of prednisone in the two groups did not differ significantly (p = 0.025). 7 major relapses requiring additional cytotoxic immunosuppressive treatment occurred in the conventional group versus 2 in the prednisone group. Treatment with prednisone as soon as a significant rise in anti-dsDNA occurs prevents relapse in most cases, without increasing the cumulative dose of prednisdone given.
authors.affiliation: Department of Internal Medicine, University Hospital Groningen, Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Bootsma
authors.forename: P
authors.initials: P
authors.lastname: Spronk
authors.forename: R
authors.initials: R
authors.lastname: Derksen
authors.forename: G
authors.initials: G
authors.lastname: de Boer
authors.forename: H
authors.initials: H
authors.lastname: Wolters-Dicke
authors.forename: J
authors.initials: J
authors.lastname: Hermans
authors.forename: P
authors.initials: P
authors.lastname: Limburg
authors.forename: F
authors.initials: F
authors.lastname: Gmelig-Meyling
authors.forename: L
authors.initials: L
authors.lastname: Kater
authors.forename: C
authors.initials: C
authors.lastname: Kallenberg
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D004247:DNA / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D003520:Cyclophosphamide; D004247:DNA; D001379:Azathioprine; D011241:Prednisone