The Effect of Prednisone Dose on the Clinical and Laboratory Course of Henoch–Schönlein Purpura in Children

Objective: Henoch–Schönlein purpura (HSP) is the most common form of systemic vasculitis in children. Most cases are self-limited. Corticosteroids may be considered for HSP patients with severe renal or extrarenal involvement. However, they have some adverse effects related to the dose and the period of treatment. The study aimed to assess the efficacy and safety of dose 1mg/kg/day of prednisone in the treatment of HSP clinical and laboratory manifestations compared with dose 2 mg/kg/day. Methods: A total of 28 patients (14 treated with prednisone 1 mg/kg and 14 treated with prednisone 2 mg/kg, followed up for 6 months) were included in a prospective randomized trial study, at University Children Hospital in Damascus, Syria, between 2020 and 2021. Results: As prednisone was only used in severe manifestations, severe abdominal pain was the most common indication (53.5%), followed by gastrointestinal hemorrhage (32.1%). However, prednisone effect on all symptoms and laboratory findings for all patients was studied. Both doses of prednisone (1 and 2 mg/kg/day for 2 weeks, with weaning over the subsequent 2 weeks) were effective in reducing the intensity of extrarenal symptoms, and no statistical difference was found (rash: P = 0.47, abdominal pain: P = 0.32, gastrointestinal hemorrhage: P = 0.32, arthritis: P = 0.84, and soft-tissues edema: P = 1). In both groups, new renal symptoms and gastrointestinal complications were developed. Elevated inflammatory markers (CRP: 59.3%, ESR: 77.3%) turned up normal at the end of treatment in both groups. Children treated with prednisone 2mg/kg showed increased appetite; three cases developed Cushing’s moon face; one case showed a transient hypertension at the end of treatment. Conclusions: The routine, early use of prednisone in uncomplicated HSP is not recommended. However, when it is indicated, a 2-week course of prednisone 1 mg/kg/day could be an effective alternative to the higher dose (2 mg/kg/day), with less side effects.