Henoch-Schonlein Purpura in Emergency Medicine Medication
- Author: Philip Bossart, MD; Chief Editor: Steven C Dronen, MD, FAAEM more...
Medication Summary
Very limited data are available on the treatment of Henoch-Schönlein purpura. Fortunately, most patients recover quickly in several weeks without treatment.[5]
Nonsteroidal anti-inflammatory drugs (NSAIDs) may help joint pain and do not seem to worsen the purpura. However, NSAIDs should be used cautiously in patients with renal insufficiency.
Clinicians often use corticosteroids to treat subcutaneous edema and nephritis, but few prospective placebo-controlled studies have demonstrated their effectiveness. Randomized controlled trials do not support the use of steroids to prevent or treat renal disease.[6] [7] Some authors recommend steroids and others do not. Good, large, prospective studies regarding the treatment of Henoch-Schönlein purpura (HSP) are lacking.[8, 9, 10]
Prednisone in a dose of 1 mg/kg/d for 2 weeks and then tapered over 2 more weeks has been shown to improve gastrointestinal and joint symptoms.[11]
Other treatment regimens have included IV or oral steroids with or without any of the following: azathioprine, cyclophosphamide, cyclosporine, dipyridamole, plasmapheresis, high-dose IV immunoglobulin G (IVIg), danazol, or fish oil. One study of 12 patients with severe Henoch-Schönlein purpura (HSP) nephritis indicated that patients did well with a treatment of methylprednisolone at 30 mg/kg/d for 3 days followed by oral corticosteroids at 2 mg/kg/d for 2 months, cyclophosphamide at 2 mg/kg/d for 2 months, and dipyridamole at 5 mg/kg/d for 6 months.[12]
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Class Summary
These agents are most commonly used for the relief of mild to moderately severe pain. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen usually is the DOC for initial therapy. Other options include flurbiprofen, ketoprofen, and naproxen.
Ibuprofen (Ibuprin, Advil, Motrin)
DOC for treatment of mild to moderately severe pain, if no contraindications. Inhibits inflammatory reactions and pain, probably by decreasing activity of enzyme cyclooxygenase, which results in inhibition of prostaglandin synthesis.
Flurbiprofen (Ansaid)
Has analgesic, antipyretic, and anti-inflammatory effects; may inhibit enzyme cyclooxygenase, causing inhibition of prostaglandin biosynthesis.
Ketoprofen (Oruvail, Orudis, Actron)
Used for relief of mild to moderately severe pain and inflammation.
Naproxen (Anaprox, Naprelan, Naprosyn)
Used for relief of mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing activity of enzyme cyclooxygenase, which results in decrease of prostaglandin synthesis.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, they modify the body's immune response to diverse stimuli.
Prednisone (Deltasone, Sterapred, Orasone)
Useful in treatment of inflammatory and autoimmune reactions. By reversing increased capillary permeability and suppressing PMN activity, may decrease inflammation.
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Chartapisak W, Opastirakul S, Hodson EM, Willis NS, Craig JC. Interventions for preventing and treating kidney disease in Henoch-Schonlein Purpura (HSP). Cochrane Database Syst Rev. Jul 8 2009;CD005128. [Medline].
[Best Evidence] Chartapisak W, Opastiraku S, Willis NS, Craig JC, Hodson EM. Prevention and treatment of renal disease in Henoch-Schonlein purpura: a systematic review. Arch Dis Child. Feb 2009;94(2):132-7. [Medline].
Saulsbury FT. Clinical update: Henoch-Schonlein purpura. Lancet. Mar 24 2007;369(9566):976-8. [Medline].
Huber AM, King J, McLaine P, Klassen T, Pothos M. A randomized, placebo-controlled trial of prednisone in early Henoch Schonlein Purpura [ISRCTN85109383]. BMC Med. Apr 2 2004;2:7. [Medline].
[Best Evidence] Ronkainen J, Koskimies O, Ala-Houhala M, et al. Early prednisone therapy in Henoch-Schonlein purpura: a randomized, double-blind, placebo-controlled trial. J Pediatr. Aug 2006;149(2):241-7. [Medline].
Flynn JT, Smoyer WE, Bunchman TE, Kershaw DB, Sedman AB. Treatment of Henoch-Schonlein Purpura glomerulonephritis in children with high-dose corticosteroids plus oral cyclophosphamide. Am J Nephrol. Mar-Apr 2001;21(2):128-33. [Medline].
Szer IS. Henoch-Schonlein purpura: when and how to treat. J Rheumatol. Sep 1996;23(9):1661-5. [Medline].
[Best Evidence] Weiss PF, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of corticosteroid on Henoch-Schonlein purpura: a systematic review. Pediatrics. Nov 2007;120(5):1079-87. [Medline].
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