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[Pulse therapy with methylprednisolone and cyclophosphamide in systemic juvenile rheumatoid arthritis: the results of
Insights
Pulse therapy (PT) with methylprednisolone and cyclophosphamide significantly improved systemic JRA symptoms, especially in patients with shorter disease duration. This treatment allowed for reduced oral steroid use with minor, reversible side effects.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Pharmacology
Background:
- Systemic Juvenile Rheumatoid Arthritis (JRA) presents significant treatment challenges in pediatric rheumatology.
- Effective therapeutic strategies are needed to manage systemic JRA manifestations and improve patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of pulse therapy (PT) for systemic JRA.
- To compare PT outcomes based on disease duration (DD).
Main Methods:
- 30 systemic JRA patients were randomized into three groups.
- Group 1 (n=13): PT with methylprednisolone and cyclophosphamide, DD < 2 years.
- Group 2 (n=8): PT, DD ≥ 2 years.
- Group 3 (n=10): No PT, DD < 2 years.
- All groups received concomitant medications (NSAIDs, methotrexate, oral steroids).
Main Results:
- Group 1 showed rapid and significant improvement in systemic and articular manifestations and laboratory indices.
- Treatment effects in Group 1 surpassed those in Groups 2 and 3.
- PT enabled avoidance or reduction of oral steroid administration in Group 1.
- Observed side effects were minor and fully reversible.
Conclusions:
- Pulse therapy (PT) is an effective treatment for systemic JRA, particularly when initiated early (DD < 2 years).
- Early PT can lead to significant clinical improvement and reduced reliance on oral steroids.
- The treatment regimen demonstrated a favorable safety profile with reversible side effects.
Abstract:
The treatment for systemic JRA is among actual problems of pediatric rheumatology. To evaluate the effectiveness of pulse therapy (PT) with methylprednisolone 25-30 mg/kg/day for 3 consecutive days combined with cyclophosphamide 0.4-0.5 g/sq. m body surface area (BSA) on the 3rd day, repeated quarterly for 12 months, 30 patients with systemic JRA were randomized into 3 groups: 1--those with disease duration (DD) less than 2 years receiving PT (n = 13), 2--with DD 2 years and more (n = 8) receiving PT, and 3--with DD less than 2 years receiving no PT. Children in all 3 groups received concomitant medication (one of nonsteroidal anti-inflammatory drugs, methotrexate 10 mg/sq. m BSA/week and oral steroids). A rapid and significant improvement, according to systemic and articular manifestations as well as laboratory indices occurred in the 1st group, in most of the measured parameters exceeded effects in the other two groups and gave the opportunity to avoid the administration of oral steroids or to give the lesser initial dose. Side effects were minor and completely reversible.