A randomized, placebo-controlled trial of prednisone in early Henoch Schönlein Purpura [ISRCTN85109383].
BACKGROUND
Henoch Schönlein Purpura (HSP) is the most common systemic vasculitis of childhood. There is considerable controversy over whether children with HSP should be treated with corticosteroids. The goal of this study was to investigate whether early corticosteroid administration could reduce the rate of renal or gastrointestinal complications in children with HSP.


METHODS
Forty children with HSP, seen in the emergency room of a tertiary-care, paediatric centre, entered a randomized, double-blind, placebo controlled study. The treatment group (n = 21) received oral prednisone, 2 mg/kg/day for one week, with weaning over a second week, while the placebo group (n = 19) received an identical appearing placebo. Co-primary outcomes were the rate of renal involvement at one year and the rate of acute gastrointestinal complications. Co-primary outcomes were analysed using Fisher's Exact test.


RESULTS
At one year, there was no difference in the rate of renal involvement (3/21 prednisone group vs. 2/19 placebo group, P = 1.0). There was also no statistically significant difference in the rate of acute gastrointestinal complications (2/21 prednisone group vs. 3/19 placebo group, P = 0.7). Two children in the placebo group did experience intussusceptions compared with none in the prednisone group (P = 0.2).


CONCLUSIONS
Early prednisone therapy in HSP does not appear to reduce the risk of renal involvement at one year, or the risk of acute gastrointestinal complications. There may be a reduced risk of intussusception. The routine, early use of prednisone in uncomplicated HSP cannot be recommended at this time.
Huber
Adam M
AM
IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada. adamtheresa@hfx.eastlink.ca
King
Jim
J
McLaine
Peter
P
Klassen
Terry
T
Pothos
Mary
M
D015746:Abdominal Pain / Q000209:etiology; D000284:Administration, Oral; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005767:Gastrointestinal Diseases / Q000517:prevention & control*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006417:Hematuria / Q000517:prevention & control; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D007443:Intussusception / Q000209:etiology; D007674:Kidney Diseases / Q000517:prevention & control*; D008297:Male; D011241:Prednisone / Q000008:administration & dosage*; D011507:Proteinuria / Q000517:prevention & control
D005938:Glucocorticoids; D011241:Prednisone