steroids in hsp

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From part of the guide:. Bro, can i ask? Atlantica Indonesia now hv caps If someone is Lvthey should get a higher quality box, but that is all dependent on if the developers of AO Indonesia actually made that change.

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Steroids in hsp

In addition, although the analyses lacked sufficient statistical precision, the likelihood of surgical intervention and of HSP recurrence may also be reduced. Overall, across all analyses, the pattern of effect is in the direction favoring the use of corticosteroids; none of the analyses indicated harm. This review emphasizes the necessity for a more complete understanding of the ways in which corticosteroids impact the course of HSP, in both the acute and chronic settings.

Corticosteroids were first postulated to benefit children with HSP in the s and are effective in the treatment of other vasculitides in children and adults. By contrast, corticosteroid treatment is controversial for use for Kawasaki disease, another acute childhood vasculitis with potential morbidity and mortality; 1 recent report found no effect of corticosteroid, 26 whereas others have heralded the beneficial effects of corticosteroids.

A rigorous answer to this question would have substantial clinical implications. Despite the widespread use of corticosteroids for vasculitides, there is no consensus yet among physicians as to whether corticosteroids should be given for HSP and, if so, for what indications. There are several important potential limitations of the evidence we present. First, the definition of renal involvement differed among the studies, which means that different dimensions or degrees of HSP severity were potentially captured.

Second, the dosing regimens and mode of delivery for corticosteroids were not the same in each study Table 2. When corticosteroid therapy was stratified by high- versus low-dose steroids for each of the clinical outcomes, there were no statistical differences between the 2 groups data not shown. Although various doses of corticosteroids or the method of delivery oral versus intravenous may affect the size of the risk reduction, these changes in dose or route are unlikely to reverse the direction of effects.

Third, the studies did not uniformly classify HSP cases as incident or recurrent. Therefore, the potential exists to inappropriately group severe recurrence with milder recurrence such as rash alone. Like-wise, given uncertainty about loss to follow-up, particularly in the corticosteroid-treated group, the protective effect of corticosteroids is likely to be an underestimate.

Two other limitations should be kept in mind when interpreting these data. First, our ability to draw robust conclusions was hampered by the limited number of prospective studies and small numbers of patients within the studies, which often resulted in imprecise measures of treatment effects.

Although the effect of corticosteroid on several of the outcomes did achieve statistically significant evidence of benefit, the failure to demonstrate benefit regarding other outcomes and the failure to show a significant dose-response effect may reflect either the still relatively underpowered nature of the combined existing studies or a true absence of impact.

Second, the effects noted in the retrospective observational studies probably include some degree of confounding by indication, whereby patients with greater disease severity were more likely to receive corticosteroids. Given that most of the retrospective studies nevertheless continued to show a benefit, the results across all studies are more reassuring. These caveats not withstanding, our findings suggest that the potential benefit of corticosteroid administration early in the course of HSP may be more prominent than previously suggested for both acute pain, surgical intervention and chronic recurrence, renal disease complications of disease.

If corticosteroid therapy is truly as effective as this meta-analysis suggests, then broader use of corticosteroid would likely decrease prolonged hospitalization, the risk of surgery, or chronic renal disease and may, by extension, prove beneficial even for those seemingly benign cases in female patients who later develop complications during pregnancy. Better-designed retrospective studies with standardization of corticosteroid exposure by accounting for the probability that any patient would receive corticosteroids and larger prospective, randomized, controlled trials are needed to assess all clinically relevant outcomes.

Knowledge from such studies is essential for guiding our interventions early in the course of HSP and improving patient outcomes for both children and adults. Pamela Weiss is funded, in part, by a National Institutes of Health pharmacoepidemiology T32 training grant. We also thank David D. Sherry and James Guevara for critical reading of the manuscript. The authors have indicated they have no financial relationships relevant to this article to disclose.

National Center for Biotechnology Information , U. Author manuscript; available in PMC Dec Pamela F. Weiss , MD, a, b, c James A. James A. Jon M. Author information Copyright and License information Disclaimer. Address correspondence to Pamela F. Copyright notice. The publisher's final edited version of this article is available at Pediatrics.

See other articles in PMC that cite the published article. Study Eligibility Eligible studies were limited to those that examined the use of corticosteroids for the treatment of HSP; observational and randomized, controlled trials were included. Open in a separate window. Data Extraction Two authors Drs Weiss and Feinstein independently abstracted data from the remaining articles.

Footnotes The authors have indicated they have no financial relationships relevant to this article to disclose. References 1. J Rheumatol. Rostoker G. Contrib Nephrol. Medicine Baltimore ; 80 — Anaphylactoid purpura nephritis in childhood: natural history and immunopathology.

Adv Nephrol Necker Hosp. Outcome of Henoch-Schoenlein nephritis with nephrotic-range proteinuria. Clin Nephrol. J Pediatr. Steroids for prophylaxis of nephropathy in Schnlein Henoch purpura? Follow-up of patients [in German] Klin Padiatr. Saulsbury FT. Pediatr Nephrol. Medicine Baltimore ; 78 — Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura.

Eur J Pediatr. Can the nephropathy in Schonlein-Henoch purpura syndrome be prevented by early administration of steroids? Early prednisone treatment and nephropathy in anaphylactoid purpura. Ann Trop Paediatr. J Pediatr Gastroenterol Nutr. Steroid effects on the course of abdominal pain in children with Henoch-Schonlein purpura. Acta Paediatr Taiwan. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of cases over a 5-year period and review of literature.

Semin Arthritis Rheum. Int Urol Nephrol. The effect of prednisone in the development of nephropathy in Schoenlein-Henoch purpura [in Slovak] Cesk Pediatr. Treatment of the Schoenlein-Henoch syndrome with adrenocorticotrophic hormone A. Arch Dis Child. Newberger J.

Surviving the night shift. Emerg Med Serv. Effect of initial corticosteroid therapy on coronary artery aneurysm formation in Kawasaki disease: a meta-analysis of children. A multicenter prospective randomized trial of corticosteroids in primary therapy for Kawasaki disease: clinical course and coronary artery outcome.

Support Center Support Center. External link. It is characterised by palpable purpura without thrombocytopenia , abdominal pain, and arthritis. HSP is a self-limiting disease but can cause complication such as gastrointestinal haemorrhage, intussusception and end-stage renal disease ESRD [ 2 ]. A 9 years old girl admitted to the hospital with chief complain of purplish red rash on both legs since approximately 1 week.

The rash came with painful joints on the knees and ankles that make the patient unable to walk for several days. No symptom of abdominal pain and the common cold. Physical examination from head to toe, there is a manifestation of a red purplish rash purpura on both of the legs below the knees, no swelling, but the reduced movement of the legs due to painful joints. No abdominal tenderness present.

Routine laboratory test was performed, from the complete blood count CBC can be seen elevated thrombocyte count just a little The patient was given medication with oral Prednisone 3 x 15 mg and ibuprofen syrup 3 x 6. After the treatment, the painful knees disappear, but the rash still exists. Henoch Schonlein purpura is a self-limiting condition, usually resolving within 6 to 8 weeks. In patients with HSP, immunoglobulin A IgA immune complexes are deposited in the small vessels, which causes petechiae and palpable purpura.

All HSP patients develop a nonpruritic rash that starts briefly as an erythematous papule or urticarial wheels and then matures into crops of petechiae and purpura. Purpura is defined as nonblanching cutaneous haemorrhages. The lesions change from red to purple to rash coloured before fading over approximately 10 days.

The rash is most commonly located in dependent areas that are subject to pressure such as the lower extremities, belt line and buttocks. The knees and ankles are more commonly involved than small joints. The arthritis symptoms include swelling, warmth, and tenderness. In this case, the patient has a purplish red rash purpura on both of the legs below the knees with non-migratory arthritis on the knees and ankles.

Diagnosis Criteria for HSP according to International Consensus Conference are palpable purpura in the presence of one or more of the following: Diffuse abdominal pain; any biopsy showing predominant immunoglobulin A deposition; arthritis acute, any joint or arthralgia; and renal involvement any hematuria or proteinuria [ 4 ].

In most cases, HSP is mild and self-limiting, requiring only symptomatic treatment. Bed rest and analgesics may be required for those with arthralgia or abdominal pain. The skin manifestations rarely need treatment [ 5 ]. The goals of treating HSP are to relieve acute symptoms, prevent short-term morbidity such as abdominal complications and prevent chronic renal insufficiency.

Because HSP is characterised by leukocyte infiltration of the blood vessel walls along with with immunoglobulin A disposition, and because corticosteroids inhibit inflammatory process, early treatment with corticosteroids has been postulated to be effective for all 3 therapeutic goals, but still much controversy remains [ 2 ]. There is no consensus regarding the indication of steroid use in HSP, but there were several studies that found the efficacy of corticosteroid for HSP. According to Reamy et all, Oral prednisone at 1 to 2 mg per kg daily for two weeks has been used to treat moderate to severe abdominal and joint symptoms.

A double-blind, randomised trial found that early treatment with prednisone reduced abdominal and joint pain severity in children. Although prednisone did not prevent renal disease. A meta-analysis found that corticosteroid use in children with HSP reduced the mean time to resolution of abdominal pain [ 4 ]. Bluman et all stated that current evidence does not support universal treatment of HSP with corticosteroids, as they do not appear to prevent the onset of renal disease or abdominal complications.

However, corticosteroids do seem to have a role in the symptomatic management of HSP, specifically in treating abdominal pain, arthralgia and purpura [ 6 ], [ 7 ]. A double-blind, randomised trial by Ronkainen J et all found that early treatment with prednisone reduced abdominal and joint pain severity in children [ 9 ]. But, from a recent large scale, RCT found that steroid treatment does not reduce the incidence and severity of nephropathy in patients with HSP [ 3 ].

It is supported by the study from Huber et al. In this case, the patient was given corticosteroid, and the painful joints disappear within 1 day; although, the purplish red rash did not diminish. From the explanation above, the patient was having a Henoch Schonlein Purpura with the symptom of purpura on both legs, with arthritis on the knee and ankle that make her unable to walk with proteinuria in the urinalysis. She was treated with prednisone orally, and the next day the pain is gone.

From many studies, it can be concluded that the role of corticosteroid is to relieve the abdominal pain and arthritis; but it is not to cure the HSP itself nor prevent the renal disease; therefore, corticosteroids were used just as a symptom reliever. Funding: This research did not receive any financial support. Competing Interests: The authors have declared that no competing interests exist.

Read article at publisher's site DOI : Bioengineered , 12 1 , 01 Dec Cited by: 0 articles PMID: To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. Curr Pediatr Rev , 16 4 , 01 Jan Pediatr Rheumatol Online J , 16 1 , 04 Sep Pediatr Rheumatol Online J , 16 1 , 14 Nov Front Pediatr , , 01 Jan BMC Pediatr , 18 1 , 10 May Europe PMC requires Javascript to function effectively.

Recent Activity. Recent history Saved searches. Search articles by 'Bella Kurnia'. Kurnia B 1.

Nikibakhsh, H.

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Steroids in hsp New organon sparknotes
Steroids and elevated wbc The box size in A in organon of proportional to the inverse of the magnitude of the variance. At each visit, a structured history steroids in hsp physical examination was performed. The child with the increasing rash was not treated with corticosteroids. Henoch Schonlein Purpura HSP is an IgA-mediated systemic small vessel vasculitis with a predilection for the skin, gastrointestinal tract, joints, and kidneys [ 1 ]. Gholizadeh, 1 and L. Unfortunately, interpretation of these results is hindered by the lack of random group assignment described as being "alternatively assigned to one of two treatment groups" and the lack of any description of blinding. Koskimies, and O.

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Results children were randomised. Conclusions This is the largest trial of the role of steroids in children with HSP. View all posts by Mike South. Search for:. Mike South. Cite this article as: Mike South. October 22, 0. Leave a Reply Cancel reply.

Arch Dis Child. We found no evidence to suggest that early treatment with prednisolone reduces the prevalence of proteinuria 12 months after disease onset in children with HSP. Comment in: Prevention of renal disease in Henoch-Schonlein purpura: clear evidence against steroids. Bowman P, Quinn M.

Question 1: Should steroids be used to treat abdominal pain caused by Henoch-Schonlein purpura? Grade D The benefit of steroids is found early in the course of treatment. Jauhola O, et al. Pediatr Nephrol. Urine and blood pressure abnormalities 8 years after HSP are associated with nephritis at its onset. Early prednisone treatment does not affect the outcome and should not be routinely used. Weiss PF, et al. Free full-text. Corticosteroid treatment did not reduce the median time to resolution of abdominal pain but did significantly reduce the mean resolution time and increased the odds of resolution within 24 hours.

Early corticosteroid treatment significantly reduced the odds of developing persistent renal disease. In addition, although the results were not statistically significant, the prospective data suggest reduced odds of both surgical intervention and recurrence. Pingback: Henoch—Schonlein purpura Pediatric Focus.

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According to this case series study, MMF can be a safe and effective medication in the treatment of the complicated HSP. So, therapy could be changed to MMF considering the following criteria: unresponsive to steroid, steroid side effects, and steroid dependency two relapses during steroid tapering. However, there are some important factors that may influence the results of our study including the possibility of spontaneous improvement of HSP without intervention, therapeutic effects of antecedent steroid before starting MMF.

So, more controlled prospective studies are necessary to prove the efficacy of this medication in the HSP treatment. The results of this case series study suggest that mycophenolate mofetil would be a promising therapeutic alternative in the treatment of the complicated HSP. However, multicentre clinical trials with long-term followup will be necessary to confirm effectiveness of MMF in the treatment of the complicated HSP patients.

Nikibakhsh et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles.

Journal overview. Special Issues. Nikibakhsh , 1 H. Mahmoodzadeh, 1 M. Karamyyar, 1 S. Hejazi, 1 M. Noroozi, 1 A. Macooie , 1 A. Gholizadeh, 1 and L. Academic Editor: Malcolm Smith. Received 27 Dec Revised 28 Mar Accepted 30 Apr Published 15 Jun Abstract Background. Case Series 2. Discussion MMF gains increasing popularity in the treatment of autoimmune disorders such as lupus nephritis, vasculitis, necrotizing glomerulonephritis, corticosteroid resistant glomerulonephritis, and IgA nephropathy [ 12 , 13 , 15 ].

Table 1. Table 2. Laboratory data and ultrasonographic findings of patients. Only qualitative measurement of CRP was available at our center. Table 3. References F. View at: Google Scholar S. Ozen, N. Ruperto, and N. Abdel-Al, Z. Hejazi, and H. View at: Google Scholar E. Tizard and M. Huber, J. King, P. McLaine, T. Klassen, and M. View at: Google Scholar J. Ronkainen, O. Koskimies, and O. Kaku, K. Nohara, and S. Mollica, S. Li Volti, R. Garozzo, and G. View at: Google Scholar P. Niaudet and R.

Benfield, J. Symons, S. Bynon, D. Eckhoff, J. Herrin, W. Harmon, and E. Dede, B. Onec, D. Ayli, I. Gonul, and K. Martin, C. Cramer, J. Heikenen, and J. Zamora, O. Berbel, M. Sanahuja, J. Fuentes, and J. Hu, C. Liu, H. Xie, H. Chen, Z. Liu, and L. Muzaffar, A. Taj, and N.

View at: Google Scholar R. Andersen, S. Rubak, B. Jespersen, and S. Filler, M. Hansen, C. LeBlanc, N. Lepage, D. Franke, I. Mai, and J. Weiss, J. Feinstein, X. Luan, J. Burnham, and C. Stassen, C. Kallenberg, and C. Funding: This research did not receive any financial support.

Competing Interests: The authors have declared that no competing interests exist. Read article at publisher's site DOI : Bioengineered , 12 1 , 01 Dec Cited by: 0 articles PMID: To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. Curr Pediatr Rev , 16 4 , 01 Jan Pediatr Rheumatol Online J , 16 1 , 04 Sep Pediatr Rheumatol Online J , 16 1 , 14 Nov Front Pediatr , , 01 Jan BMC Pediatr , 18 1 , 10 May Europe PMC requires Javascript to function effectively.

Recent Activity. Recent history Saved searches. Search articles by 'Bella Kurnia'. Kurnia B 1. Affiliations 1 author 1. Podomoro Hermina Hospital, Jakarta, Indonesia. Share this article Share with email Share with twitter Share with linkedin Share with facebook. Case report A 9 years old girl admitted to the hospital with chief complain of purplish red rash on both legs since approximately 1 week with painful knees and ankles that make the patient unable to walk. Conclusion The role of corticosteroids in the treatment of HSP is still controversial.

Free full text. Published online Jun PMID: Author information Article notes Copyright and License information Disclaimer. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.

Go to:. CASE REPORT: A 9 years old girl admitted to the hospital with chief complain of purplish red rash on both legs since approximately 1 week with painful knees and ankles that make the patient unable to walk. Open in a separate window. Figure 1. Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist.

Henoch schonlein purpura in children. Asian Journal of Clinical Pediatrics and Neonatology. Effects of corticosteroid on henoch schonlein purpura: a systematic review. Randomised, double-blind, placebo-controlled trial to determine whether steroids reduce the incidence and severity of nephropathy in henoch-scholein purpura hsp United Kingdom: Bristol Royal University Hospital for Children; Henoch schonlein purpura.

Maryland: American Academy of Family Physicians; Jauhola O. University of Oulu; Bluman J, Goldman RD. Henoch scholein purpura in children limited benefit of corticosteroids. Canada: College of Family Physicians of Canada; Clinical practice: diagnosis and management of henoch-scholein purpura.

European Journal of Pediatrics. Welch TR. Steroids in hsp. The Journal of Pediatrics. J Pediatr. Full text links Read article at publisher's site DOI : Smart citations by scite. The number of the statements may be higher than the number of citations provided by EuropePMC if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles.

Explore citation contexts and check if this article has been supported or disputed. Clinical relevance of neutrophil-to-lymphocyte ratio and mean platelet volume in pediatric Henoch-Schonlein Purpura: a meta-analysis. Similar Articles To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

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Read the winning articles. Journal overview. Special Issues. Nikibakhsh , 1 H. Mahmoodzadeh, 1 M. Karamyyar, 1 S. Hejazi, 1 M. Noroozi, 1 A. Macooie , 1 A. Gholizadeh, 1 and L. Academic Editor: Malcolm Smith. Received 27 Dec Revised 28 Mar Accepted 30 Apr Published 15 Jun Abstract Background. Case Series 2. Discussion MMF gains increasing popularity in the treatment of autoimmune disorders such as lupus nephritis, vasculitis, necrotizing glomerulonephritis, corticosteroid resistant glomerulonephritis, and IgA nephropathy [ 12 , 13 , 15 ].

Table 1. Table 2. Laboratory data and ultrasonographic findings of patients. Only qualitative measurement of CRP was available at our center. Table 3. References F. View at: Google Scholar S. Ozen, N. Ruperto, and N. Abdel-Al, Z. Hejazi, and H. View at: Google Scholar E. Tizard and M. Huber, J. King, P. McLaine, T. Klassen, and M. View at: Google Scholar J. Ronkainen, O. Koskimies, and O. Kaku, K. Nohara, and S. Mollica, S. Li Volti, R. Garozzo, and G. View at: Google Scholar P.

Niaudet and R. Benfield, J. Symons, S. Bynon, D. Eckhoff, J. Herrin, W. Harmon, and E. Dede, B. Onec, D. Ayli, I. Gonul, and K. Martin, C. Cramer, J. Heikenen, and J. Zamora, O. Berbel, M. Sanahuja, J. Fuentes, and J. Hu, C. Liu, H. Xie, H. Chen, Z. Liu, and L.

Muzaffar, A. Taj, and N. View at: Google Scholar R. Andersen, S. Rubak, B. Jespersen, and S. Filler, M. Hansen, C. LeBlanc, N. Lepage, D. Franke, I. Mai, and J. Weiss, J. Feinstein, X. Luan, J. Burnham, and C. Stassen, C. Kallenberg, and C. View at: Publisher Site Google Scholar. More related articles. Download other formats More. Related articles. Palpable purpura, Hemorrhagic purpura, Arthralgia, Abdominal pain, Hematuria, Gastrointestinal bleeding. Palpable purpura, Hemorrhagic purpura, Elbow and ankle arthritis, Abdominal pain, Hematuria, Gastrointestinal bleeding.

Proteinuria, Hematuria, Palpable purpura, Hemorrhagic purpura, Arthritis, Abdominal pain, Gastrointestinal bleeding, Generalized edema. Diffuse purpuric lesions, Gastrointestinal bleeding, Severe abdominal pain, Microscopic hematuria.

ASO normal Todd unit. The box size in A is proportional to the inverse of the magnitude of the variance. We investigated if the corticosteroid dose affects the likelihood of developing persistent renal disease by using unrestricted and restricted regression models and the likelihood-ratio test. The doses and duration of treatment for each study are listed in Table 2. Two studies were excluded from this analysis because corticosteroid dose was not reported.

Sensitivity analyses were performed to determine what sample size and magnitude of effect of a future hypothetical study would be required to reverse the findings, from the prospective studies, regarding the benefit of corticosteroid to decrease persistent renal disease presented in this meta-analysis. A study with patients would need an effect size greater than an OR of 2. Sensitivity analysis of effect size of future hypothetical studies for likelihood of persistent renal involvement.

Shown are the new combined pooled OR versus OR of a hypothetical new study with sample sizes of and This systematic review and data summary of 15 eligible articles suggests that early treatment of corticosteroids for children with HSP is associated with statistically significant increased odds of abdominal pain resolution within 24 hours and reduced odds of persistent renal disease.

In addition, although the analyses lacked sufficient statistical precision, the likelihood of surgical intervention and of HSP recurrence may also be reduced. Overall, across all analyses, the pattern of effect is in the direction favoring the use of corticosteroids; none of the analyses indicated harm. This review emphasizes the necessity for a more complete understanding of the ways in which corticosteroids impact the course of HSP, in both the acute and chronic settings.

Corticosteroids were first postulated to benefit children with HSP in the s and are effective in the treatment of other vasculitides in children and adults. By contrast, corticosteroid treatment is controversial for use for Kawasaki disease, another acute childhood vasculitis with potential morbidity and mortality; 1 recent report found no effect of corticosteroid, 26 whereas others have heralded the beneficial effects of corticosteroids.

A rigorous answer to this question would have substantial clinical implications. Despite the widespread use of corticosteroids for vasculitides, there is no consensus yet among physicians as to whether corticosteroids should be given for HSP and, if so, for what indications. There are several important potential limitations of the evidence we present. First, the definition of renal involvement differed among the studies, which means that different dimensions or degrees of HSP severity were potentially captured.

Second, the dosing regimens and mode of delivery for corticosteroids were not the same in each study Table 2. When corticosteroid therapy was stratified by high- versus low-dose steroids for each of the clinical outcomes, there were no statistical differences between the 2 groups data not shown. Although various doses of corticosteroids or the method of delivery oral versus intravenous may affect the size of the risk reduction, these changes in dose or route are unlikely to reverse the direction of effects.

Third, the studies did not uniformly classify HSP cases as incident or recurrent. Therefore, the potential exists to inappropriately group severe recurrence with milder recurrence such as rash alone. Like-wise, given uncertainty about loss to follow-up, particularly in the corticosteroid-treated group, the protective effect of corticosteroids is likely to be an underestimate.

Two other limitations should be kept in mind when interpreting these data. First, our ability to draw robust conclusions was hampered by the limited number of prospective studies and small numbers of patients within the studies, which often resulted in imprecise measures of treatment effects.

Although the effect of corticosteroid on several of the outcomes did achieve statistically significant evidence of benefit, the failure to demonstrate benefit regarding other outcomes and the failure to show a significant dose-response effect may reflect either the still relatively underpowered nature of the combined existing studies or a true absence of impact.

Second, the effects noted in the retrospective observational studies probably include some degree of confounding by indication, whereby patients with greater disease severity were more likely to receive corticosteroids. Given that most of the retrospective studies nevertheless continued to show a benefit, the results across all studies are more reassuring.

These caveats not withstanding, our findings suggest that the potential benefit of corticosteroid administration early in the course of HSP may be more prominent than previously suggested for both acute pain, surgical intervention and chronic recurrence, renal disease complications of disease. If corticosteroid therapy is truly as effective as this meta-analysis suggests, then broader use of corticosteroid would likely decrease prolonged hospitalization, the risk of surgery, or chronic renal disease and may, by extension, prove beneficial even for those seemingly benign cases in female patients who later develop complications during pregnancy.

Better-designed retrospective studies with standardization of corticosteroid exposure by accounting for the probability that any patient would receive corticosteroids and larger prospective, randomized, controlled trials are needed to assess all clinically relevant outcomes.

Knowledge from such studies is essential for guiding our interventions early in the course of HSP and improving patient outcomes for both children and adults. Pamela Weiss is funded, in part, by a National Institutes of Health pharmacoepidemiology T32 training grant. We also thank David D. Sherry and James Guevara for critical reading of the manuscript. The authors have indicated they have no financial relationships relevant to this article to disclose.

National Center for Biotechnology Information , U. Author manuscript; available in PMC Dec Pamela F. Weiss , MD, a, b, c James A. James A. Jon M. Author information Copyright and License information Disclaimer. Address correspondence to Pamela F. Copyright notice. The publisher's final edited version of this article is available at Pediatrics. See other articles in PMC that cite the published article. Study Eligibility Eligible studies were limited to those that examined the use of corticosteroids for the treatment of HSP; observational and randomized, controlled trials were included.

Open in a separate window. Data Extraction Two authors Drs Weiss and Feinstein independently abstracted data from the remaining articles. Footnotes The authors have indicated they have no financial relationships relevant to this article to disclose. References 1. J Rheumatol. Rostoker G. Contrib Nephrol. Medicine Baltimore ; 80 — Anaphylactoid purpura nephritis in childhood: natural history and immunopathology.

Adv Nephrol Necker Hosp. Outcome of Henoch-Schoenlein nephritis with nephrotic-range proteinuria. Clin Nephrol. J Pediatr. Steroids for prophylaxis of nephropathy in Schnlein Henoch purpura? Follow-up of patients [in German] Klin Padiatr. Saulsbury FT. Pediatr Nephrol. Medicine Baltimore ; 78 — Effectiveness of early prednisone treatment in preventing the development of nephropathy in anaphylactoid purpura. Eur J Pediatr. Can the nephropathy in Schonlein-Henoch purpura syndrome be prevented by early administration of steroids?

Early prednisone treatment and nephropathy in anaphylactoid purpura. Ann Trop Paediatr. J Pediatr Gastroenterol Nutr. Steroid effects on the course of abdominal pain in children with Henoch-Schonlein purpura. Acta Paediatr Taiwan. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of cases over a 5-year period and review of literature. Semin Arthritis Rheum. Int Urol Nephrol. The effect of prednisone in the development of nephropathy in Schoenlein-Henoch purpura [in Slovak] Cesk Pediatr.