Outcome of Henoch–Schönlein purpura 8 years after treatment with a placebo or prednisone at disease onset
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Corticosteroids have been shown not to prevent the development of Henoch–Schönlein nephritis. However, long-term follow-up data are scarce.
The long-term outcome of patients in a randomized placebo-controlled prednisone study was evaluated 8 years later with a health questionnaire completed by 160/171 (94%) patients and by urine and blood pressure screening (138/171, 81%).
Twelve patients had hematuria and/or proteinuria and seven had hypertension. The patients with nephritis at onset of Henoch–Schönlein purpura (HSP) had an increased risk of hypertension and/or urine abnormalities (odds ratio 3.6, p = 0.022, 95% confidence interval 1.3–10.0). There were no differences between the prednisone and placebo groups. Recurrences of purpura were reported by 15 patients, with some recurrences continuing for 10 years. All five reported pregnancies were complicated by proteinuria. Four patients presented with hematuria and/or proteinuria at the control visit, and four had hypertension. Of these, two had a decreased estimated glomerular filtration rate.
HSP has a good long-term prognosis in unselected patients, although skin relapses with/without late-onset nephritis may occur, even a decade after the initial disease. Urine and blood pressure abnormalities 8 years after HSP are associated with nephritis at its onset. Early prednisone treatment does not affect the outcome and should not be routinely used.
KeywordsVasculitis Glomerulonephritis Hypertension Recurrences Pregnancy Familial cases Corticosteroids
We thank Helena Moilanen, a registered nurse, for helping in organizing the laboratory tests throughout the country. We also thank all of the health care centers and hospitals that helped us by screening the patients for this study. This work was supported by grants from the Alma and K. A. Snellman Foundation, Oulu, Finland, and the Finnish Kidney and Liver Association.
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