Henoch-Schonlein Purpura treatment with steroids

[bdigParticipant]

So, for Henoch-Schonlein Purpura I read the emedicine bibliography and discussion on HSP which seemed to waffle on the subject of steroids, though I think it’s clear that steroids are used when there’s GI/jt involvement: http://emedicine.medscape.com/article/780452-medication

But, there was this article in Peds: http://pediatrics.aappublications.org/content/early/2010/09/20/peds.2009-3348.abstract

It also suggests that it’s ok to use steroids.  I know in clinical practice this is what I have seen.  It sounds like it’s a bit of a debatable topic, and maybe you have experience that suggest otherwise, but I thought I would mention this.

[ashishMember]

Good discussion. You’re absolutely right about it being debatable. I’ve looked at several resources and articles now, and that seems to be the running theme. In general, it’s a disease that often resolves quickly and without any pharmacologic interventions.

I’d say use NSAIDs cautiously for joint pain, especially given the concerns for renal disease associated with HSP. For patients with severe symptoms requiring hospitalization, or GI symptoms that prevent them from eating, use steroids with or without other therapies (i.e., cyclophosphamide, azathioprine, plasmapheresis, IVIG, etc.). Given that it’s a debatable topic, I can “almost” assure you that you would only be asked to give NSAIDS in the absence of renal disease or give steroids for severe symptoms.

Updated version is below:

HENOCH SCHONLEIN PURPURA (HSP)

Henoch Schonlein purpura (HSP) is a vasculitis which can involve multiple systems, including the skin, joints, GI tract and kidneys. Classic findings include PALPABLE and TENDER purpura that blanch. These are most often found at the lower extremities and buttocks, but may be elsewhere. There may also be periarticular joint involvement (soft tissue only) at the knees or ankles, and a faint rash. Patients may initially present with colicky abdominal pain +/- blood in stool +/- intussusception +/- gallbladder hydrops. Skin findings are impressive, but the labs show a normal platelet count. Urinalysis will likely show hematuria +/- proteinuria which can range from mild to nephrotic range (order a spot protein to creatinine ratio). This may be diagnosed on clinical findings. Complement levels can be low. A biopsy may be obtained if there is doubt about the diagnosis. Biopsy would show IgA, IgG and C3 deposits. For treatment, do not give steroid monotherapy because it will not work. The disease often resolves without intervention and the use of medications is debatable, meaning it’s unlikely to be tested. For the boards, give NSAIDS for joint pain in the absence of renal disease, and for severe symptoms (can’t eat) or for a hospitalized patient, give steroids with or without other therapies (i.e., cyclophosphamide, azathioprine, plasmapheresis, IVIG, etc.).

IMAGE: http://bit.ly/nsNXZo

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