Prolonged use of large intravenous steroid pulses in the rheumatic diseases of children.

Nineteen children with rheumatic diseases refractory to standard treatment were given repeated large "pulses" of corticosteroid therapy. The pulses consisted of four repeated doses of 500 mg of hydrocortisone given intravenously over 20 to 30 minutes at six-hour intervals or of single intravenous injections of 30 mg/kg of methylprednisolone. All patients had temporary relief of signs or symptoms of inflammation. Complications were mild and only one child was removed from therapy because of a complication. Two children were judged to be treatment failures. Five patients have been weaned from all steroid treatment, and eight have required continued pulses at one- or two-week intervals as outpatients to maintain control. All of these have been able to reduce oral prednisone doses. Effects of the two forms of pulse appear similar. However, two children responded to the series of injections of hydrocortisone but not to single doses of methylprednisolone. Pulses have been given for periods up to three years without evident toxicity. Further work to define doses, schedules, and optimal drug is needed since this approach to steroid use appears effective and relatively nontoxic.