Prolonged Use of Large Intravenous Steroid Pulses in the Rheumatic Diseases of Children

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Abstract
Children (19) with rheumatic diseases refractory to standard treatment were given repeated large pulses of corticosteroid therapy. The pulses consisted of 4 repeated doses of 500 mg of hydrocortisone given i.v. over 20-30 min at 6 h intervals or of single i.v. injections of 30 mg/kg of methylprednisolone. All patients had temporary relief of signs or symptoms of inflammation. Complications were mild and only 1 child was removed from therapy because of a complication. Two children were judged to be treatment failures. Patients (5) were weaned from all steroid treatment and 8 have required continued pulses at 1 or 2 wk intervals as outpatients to maintain control. All of these were able to reduce oral prednisone doses. Effects of the 2 forms of pulse appear similar. Two children responded to the series of injections of hydrocortisone but not to single doses of methylprednisolone. Pulses were given for periods up to 3 yr without evident toxicity. Further work to define doses, schedules and optimal drug is needed since this approach to steroid use appears effective and relatively nontoxic.