الفهرس 
Comparison between high-dose and low-dose pulse methylprednisolone in the treament of acute flares of Systemic lupus erythromatosis
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Abstract
The aim of our study was to compare between high dose and low dose of methylprednisolone in treatment of acute flare in patients with systemic lupus erythematous in terms of efficacy and side effects
We collected the data of 472 diagnosed with SLE, who have been admitted to or came for follow up visits at the Department of Rheumatology and Rehabilitation, Kasr Al-Ainy.Patients were randomized into two major groups;
the high dose group includes patients who received 3-5 grams of methylprednisolone, and the low dose group includes patients who received 1.5 grams or less. A comparison of efficacy assessed as well as the adverse events between both groups was done.
This study included 430 (91.1%) females and 42 (8.9%) males. They had a mean age of 28.2±8.6 years whereas the age of onset mean was 22±7.8 years.The percentage of decline in SLEDAI after three months of therapy was significantly higher in the low dose group with 88% decline from the baseline
versus 82% in the high dose group (p=0.014). On the other hand the percentage change at 1 month (p=0.115) and 6 months (p=0.4) didn’t show a statistically significant difference between both groups. The analysis of the subgroup of patients with proliferative nephritis revealed no significant difference in renal SLEDAI at 1 month (p=0.9), 3 months (p=0.8) and 6 months (p=0.7) between the low dose and the high dose.
Infections were the most prevalent side effect with a significantly higher incidence in the high dose group (p<0.001). Elevated blood sugar (p<0.001), elevated blood pressure) (p<0.001) and osteonecrosis (p=0.03) were also more prevalent in the high dose group. In the sup group of patients with proliferative nephritis, infections (p<0.001), elevated blood sugar (p<0.001), and elevated blood pressure (p<0.001), were also more prevalent in the high dose group.
High dose pulsed methylprednisolone showed comparable efficacy to low regimen yet with increased incidence of adverse events.