title: Azathioprine therapy for steroid-resistant Henoch-Schönlein purpura: a report of 6 cases.
abstract: BACKGROUND
  A small percentage of children with Henoch-Schönlein purpura (HSP) develop a chronic form of the disease that often requires prolonged corticosteroid therapy. Disease modifying anti-rheumatic agents (DMARDs) or biologics have been successfully used to treat those refractory cases. Azathioprine is a DMARD that has been reported to be effective in HSP nephritis and in adult cutaneous leukocytoclastic vasculitis, a condition with cutaneous histology similar to HSP.
  
  
  METHODS
  A description of 6 cases with relapsing HSP without significant renal involvement, treated with azathioprine are reported. All 6 cases met the classification criteria for the diagnosis of HSP, had relapsing symptoms despite corticosteroid use, were successfully treated with azathioprine and were tapered off of corticosteroids. The duration of azathioprine therapy ranged from 7-21 months and no adverse events were reported.
  
  
  CONCLUSIONS
  Azathioprine is effective in controlling prolonged relapsing symptoms of HSP, allowing earlier discontinuation of corticosteroids. This report shows that azathioprine can be included in the therapeutic options for relapsing HSP and is the first case series in the literature of azathioprine use in HSP without significant renal involvement.
authors.affiliation: Department of Pediatrics, Division of Rheumatology, Washington University School of Medicine, One Children's Place, Campus Box 8116, St. Louis, MO, 63110, USA. fotis_l@kids.wustl.edu.
authors.forename: Lampros
authors.initials: L
authors.lastname: Fotis
authors.affiliation: Department of Internal Medicine, Division of Rheumatology and Pediatric Rheumatology, Saint Louis University School of Medicine, 1402 S Grand Blvd., Doisy Hall, Room R213A, St. Louis, MO, 63104, USA.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Tuttle
authors.affiliation: Department of Pediatrics, Division of Rheumatology, Washington University School of Medicine, One Children's Place, Campus Box 8116, St. Louis, MO, 63110, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Baszis
authors.affiliation: Department of Internal Medicine, Division of Rheumatology and Pediatric Rheumatology, Saint Louis University School of Medicine, 1402 S Grand Blvd., Doisy Hall, Room R213A, St. Louis, MO, 63104, USA.
authors.forename: Peri H
authors.initials: PH
authors.lastname: Pepmueller
authors.affiliation: Department of Internal Medicine, Division of Rheumatology and Pediatric Rheumatology, Saint Louis University School of Medicine, 1402 S Grand Blvd., Doisy Hall, Room R213A, St. Louis, MO, 63104, USA.
authors.forename: Terry L
authors.initials: TL
authors.lastname: Moore
authors.affiliation: Department of Pediatrics, Division of Rheumatology, Washington University School of Medicine, One Children's Place, Campus Box 8116, St. Louis, MO, 63110, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: White
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D011695:IgA Vasculitis / Q000188:drug therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone; D008775:Methylprednisolone
keywords: Azathioprine; Child; Purpura, Schoenlein-Henoch; Steroids