[Intravenous high dose glucocorticoids in patients with ankylosing spondylitis]

To study efficacy and tolerance of 1-3-day intravenous therapy with high dose glucocorticoids in patients with active ankylosing spondylitis (AS).

Methylprednisolone (MP, n = 33) and dexamethason (DM, n = 13) were given to 46 patients with active AS (median BASDAI 47; coxitis was in 37 patients, arthritis of other peripheral joints--in 30 patients). MP and DM were given as 1-3 intravenous infusions, in single doses equivalent to 500-1000 mg of MP. Total doses were 500-3000 mgfor MP and 120-360 mg for DM. Intervals between the infusions were from I to 8 days.

An immediate positive effect was seen in all the patients. Significant reduction of AS activity (lowering of BASDAI by 50% and more) was registered in 22 (48%) patients. In accordance with ASAS criteria, 20% improvement occurred in 35 (76%) patients, 50%--in 25 (54%). A significant decrease was seen in the number of joints with inflammation, volume of exudate in hip joints, ESR, C-reactive protein level, functional condition of the patients (BASFI), spinal mobility. Side effects were observed in 26 of 46 (56%) patients. Severe side effects manifested in 17% cases. Efficacy and tolerance of MP and DM were comparable. The immediate response to therapy and side effect rate were unrelated to single and total doses of glucocorticoids. The response persisted for 3 months in 41% patients, a significant effect was observed for 3 months in 9% patients.

Short-term intravenous therapy with high-dose glucocorticoids is highly effective in the majority of patients with active AS and well tolerated. A short-term effect was seen both for spondylitis and arthritis of peripheral joints, including coxitis, but the effect is not long-lasting.