Early prednisone therapy in Henoch-Schönlein purpura: a randomized, double-blind, placebo-controlled trial.
OBJECTIVE
To evaluate the efficacy of early prednisone therapy in preventing renal and treating extrarenal and renal symptoms in Henoch-Schönlein purpura (HSP) in a placebo-controlled trial.


METHODS
A total of 171 patients (84 treated with prednisone and 87 receiving placebo) were included and followed up for 6 months. The endpoints were renal involvement at 1, 3, and 6 months and healing of extrarenal symptoms. The analyses were performed on an intent-to-treat basis.


RESULTS
Prednisone (1 mg/kg/day for 2 weeks, with weaning over the subsequent 2 weeks) was effective in reducing the intensity of abdominal pain (pain score, 2.5 vs 4.8; P = .029) and joint pain (4.6 vs 7.3; P = .030). Prednisone did not prevent the development of renal symptoms but was effective in treating them; renal symptoms resolved in 61% of the prednisone patients after treatment, compared with 34% of the placebo patients (difference = 27%; 95% confidence interval = 3% to 47%; P = .024).


CONCLUSIONS
The general use of prednisone in HSP is not supported, but patients with disturbing symptoms may benefit from early treatment, because prednisone reduces extrarenal symptoms and is effective in altering (but not preventing) the course of renal involvement.
Ronkainen
Jaana
J
Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland.
Koskimies
Olli
O
Ala-Houhala
Marja
M
Antikainen
Marjatta
M
Merenmies
Jussi
J
Rajantie
Jukka
J
Ormälä
Timo
T
Turtinen
Juha
J
Nuutinen
Matti
M
D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018771:Arthralgia / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000188:drug therapy* / Q000453:epidemiology; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D011241:Prednisone