Vertebral collapse in juvenile chronic arthritis: its relationship with glucocorticoid therapy

Forty-six patients with juvenile chronic arthritis maintained on glucocorticoid therapy have been reviewed retrospectively for evidence of vertebral collapse. The 23 patients who had sustained vertebral fractures had received a daily dose 2.3 times higher than those without. No patients sustained a vertebral collapse until they had received a prednisolone cumulative dose of at least 5 g. It would appear that the ideal dose, if collapse of vertebrae is to be avoided, should be not more than 5 mgs daily, probably best given as 10 mg on alternate days; unfortunately, some children with serious systemic disease cannot be controlled on these low doses. In such cases it seems justified to investigate the possible use of the oxazoline derivative of prednisolone (deflazacort) in view of its reported bone-sparing properties in adults.