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What is low-dose corticosteroid therapy in juvenile idiopathic arthritis?

A worldwide, questionnaire-based survey

Was versteht man unter „Low-dose“-Kortikosteroidtherapie bei juveniler idiopathischer Arthritis?

Ergebnisse einer weltweiten Umfrage.

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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Fragestellung

Es sollte herausgefunden werden, was Kinderrheumatologen unter einer niedrigdosierten Kortikosteroid-Langzeittherapie (low-dose, long-term corticosteroid therapy) verstehen.

Methoden

Kinderrheumatologen aus Amerika, Australien, Israel und Europa wurden mit Hilfe eines standardisierten Fragebogens nach ihrer persönlichen Definition für eine „ low-dose, long-term corticosteroid therapy“ gefragt.

Resultate

Von 99 zurückgeschickten Fragebogen waren 92 auswertbar. Die im Rahmen einer Langzeittherapie noch als niedrig angesehene Kortikosteroiddosis betrug im Mittel 0,26 ± 0,14 mg Prednisolon/kgKG/d (minmax = 0,04–0,50 mg, n = 92). Dabei waren die Mittelwerte aus Nordeuropa (0,29 ± 0,12, n = 9),Westeuropa (0,42 ± 0,14, n = 7), Südeuropa (0,30 ± 0,14, n = 9), Osteuropa (0,25 ± 0.14, n = 6) und Nordamerika (0,33 ± 0,17, n = 16) höher als aus Mitteleuropa (0,19 ± 0,09, n = 43).

Schlussfolgerung

Die Vorstellungen der Kinderrheumatologen, was unter einer niedrigdosierten Kortikosteroid-Langzeittherapie zu verstehen sei, unterscheiden sich im internationalen Vergleich um den Faktor zehn. Die Ursache dieser bemerkenswerten Differenz und die Auswirkungen der unterschiedlichen Behandlung auf den Langzeitverlauf sollten untersucht werden. Eine international akzeptierte Definition einer „low-dose, long-term corticosteroid therapy“ sollte entwickelt und dann in prospektiven Studien überprüft werden.

Summary

Objective

To determine pediatric rheumatologists’ personal definitions of systemic low-dose, long-term (> 4 weeks) corticosteroid therapy of juvenile idiopathic arthritis (JIA).

Methods

Pediatric rheumatologists from America, the Near East (Israel), Australia and Europe were asked for their personal definition of a low-dose long-term corticosteroid therapy of JIA with the aid a standardized questionnaire.

Results

Of 99 questionnaires returned, 92 were evaluable. The dosage still considered low turned out to be 0.26 ± 0.14 mg prednisolone/kgBW/day (min-max = 0.04–0.50 mg, n = 92). Higher dosages were indicated from Northern Europe (0.29 ± 0.12, n = 9), Western Europe (0.42 ± 0.14, n = 7), Southern Europe (0.30 ± 0.14, n = 9), Eastern Europe (0.25 ± 0.14, n = 6) and North America (0.33 ± 0.17, n = 16) than from Central Europe (0.19 ± 0.09, n = 43).

Conclusion

Pediatric rheumatologists’ personal definitions of low-dose, long-term corticosteroid therapy vary within a wide range. The reason for these differences and the impact on patients should be investigated. In addition, a generally accepted definition for lowdose, long-term corticosteroid therapy should be developed and subsequently examined in studies.

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Additional information

Instead of the old terms “juvenile rheumatoid arthritis” or “juvenile chronic arthritis”, the new ILAR-WHO nomenclature “juvenile idiopathic arthritis” is used throughout the paper.

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Michels, H. What is low-dose corticosteroid therapy in juvenile idiopathic arthritis?. Z Rheumatol 59 (Suppl 2), II127–II130 (2000). https://doi.org/10.1007/s003930070008

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  • DOI: https://doi.org/10.1007/s003930070008

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