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Efficacy of methylprednisolone pulse therapy in children with rheumatoid arthritis
Yahya Aghighi1, Lida Attarod, Maryam Javanmard
1Pediatric Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Methylprednisolone pulse therapy effectively treated juvenile rheumatoid arthritis (JRA), significantly improving clinical signs and lab markers. While some transient complications occurred, the treatment led to a mean remission of 3.3 months.
Area of Science:
- Pediatric Rheumatology
- Clinical Pharmacology
Background:
- Juvenile rheumatoid arthritis (JRA) is a significant autoimmune condition in children.
- Pulse therapy, particularly with corticosteroids, is a recognized treatment modality for JRA.
Purpose of the Study:
- To evaluate the efficacy and safety of methylprednisolone pulse therapy in pediatric patients with JRA.
- To assess the clinical outcomes and complications associated with this treatment regimen.
Main Methods:
- A cross-sectional study involving 120 children diagnosed with JRA.
- Analysis of clinical signs, laboratory markers (ESR, CRP, hemoglobin), and patient-reported symptoms before and after approximately 500 cycles of methylprednisolone pulse therapy.
- Statistical comparison using SPSS and paired t-tests.
Main Results:
- Significant improvement observed in joint swelling, tenderness, morning stiffness, ESR, CRP, and hemoglobin levels post-therapy.
- Pre-treatment symptoms like weakness, malaise, loss of appetite, and fever resolved completely.
- Reported complications included tachycardia (13.3%), hypertension (8.3%), headache (1.7%), and flushing (1.7%).
Conclusions:
- Methylprednisolone pulse therapy demonstrates high efficacy in managing active juvenile rheumatoid arthritis.
- The treatment leads to substantial clinical improvement and normalization of inflammatory markers.
- While transient complications can occur, they are generally manageable, and the therapy provides a significant period of remission (mean 3.3 months).
Abstract:
Pulse therapy is one of the most well-known methods used in the treatment of juvenile rheumatoid arthritis. This study assessed the outcome of methylprednisolone pulse therapy, its rate of efficacy, and its associated complications in patients with juvenile rheumatoid arthritis (JRA). This cross-sectional study was performed on 120 children with JRA who attended the Pediatric Ward of Imam Khomeini Hospital from 1994 to 2004 and who had undergone around 500 cycles of methylprednisolone pulse therapies. Clinical signs, including signs of improvement, complications, or recurrence of disease, were noted. SPSS version 11.5 and paired t test were used to compare the variables prior to and after treatment. Clinical signs observed included: feeling of weakness (100%), malaise (98.3%), loss of appetite (93.3%), fever (88.3%), skin rash (28%), lymphadenopathy (18.3%), serositis (4.2%), splenomegaly (3.3%), and hepatomegaly (1.7%); however, none of these findings were present after pulse therapy. The number of swollen and tender joints, duration of morning stiffness, erythrocyte sedimentation rate, C-reactive protein, and hemoglobin levels showed significant improvement after pulse therapy. Complications of pulse therapy included tachycardia (n = 16, 13.3%), hypertension (n = 10, 8.3%), headache (n = 2, 1.7%), and flashing (n = 2, 1.7%). The mean duration of remission was 3.3 +/- 0.7 months.
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