Very limited data are available on pharmacologic treatment of Henoch-Schönlein purpura (HSP). Nonsteroidal anti-inflammatory drugs (NSAIDs) may help joint pain and do not seem to worsen the purpura; however, they 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. Other drugs are currently under investigation.
Immunosuppressive agents decrease inflammation by suppressing migration of polymorphonuclear leukocytes (PMNs) and reversing increased capillary permeability.
Cyclosporine is a cyclic polypeptide immunosuppressant agent consisting of 11 amino acids. It is produced as a metabolite by the fungus species Beauveria nivea. Chemically, cyclosporine is designated as [R-[R*,R*-(E)]]-cyclic(L-alanyl-D-alanyl-N-methyl-L-leucyl-N-methyl-L-leucyl-N-methyl-L-valyl-3-hydroxy-N,4-dimethyl-L-2-amino-6-octenoyl-L-α-amino-butyryl-Nmethylglycyl-N-methyl-L-leucyl-L-valyl-N-methyl-L-leucyl).
Methylprednisolone decreases inflammation by suppressing PMN migration and reversing increased capillary permeability.
Prednisone is an immunosuppressant used to treat autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. It stabilizes lysosomal membranes and suppresses lymphocyte and antibody production.
Corticosteroids act as potent inhibitors of inflammation. They may cause profound and varied metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their modification of the immune response of the body.
Cyclophosphamide is an alkylating agent that is chemically related to nitrogen mustards. It is a cyclic polypeptide that suppresses some humoral activity. Cyclophosphamide is transformed in the liver to active alkylating metabolites, which interfere with the growth of rapidly proliferating cells. When cyclophosphamide is used in autoimmune diseases, its mechanism of action is thought to involve immunosuppression through destruction of immune cells by DNA cross-linking.
Analgesic agents are most commonly used for the relief of mild-to-moderate pain. Although the effects of NSAIDs in the treatment of pain tend to be patient-specific, ibuprofen usually is the drug of choice for initial therapy; other options include flurbiprofen, ketoprofen, and naproxen. Some analgesics (eg, acetaminophen and ibuprofen) are also effective for treating fever.
Ibuprofen is the drug of choice for treatment of mild-to-moderate pain, if not contraindicated; it is also effective for treating fever. Ibuprofen inhibits inflammatory reactions and pain, probably by decreasing the activity of cyclooxygenase, thereby inhibiting prostaglandin synthesis.
Acetaminophen is effective for treating fever and relieving mild-to-moderate pain. It inhibits the action of endogenous pyrogens on heat-regulating centers; it also reduces fever by a direct action on the hypothalamic heat-regulating centers, thereby, in turn, increasing the dissipation of body heat via sweating and vasodilation.
Flurbiprofen has analgesic, antipyretic, and anti-inflammatory effects. It may inhibit cyclooxygenase, causing inhibition of prostaglandin biosynthesis.
Ketoprofen is used for relief of mild-to-moderate pain and inflammation.
Naproxen is used for relief of mild-to-moderate pain. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby reducing prostaglandin synthesis.
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