本日ステロイドのdose のことが回診で話題になりました。以下のような論文がありましたので
ご提示します。


Clin Exp Rheumatol 1999 Jul-Aug;17(4):441-6 Related Articles, Links  


Functional outcome of myositis patients: can a low-dose glucocorticoid regimen 
achieve good functional results?

Nzeusseu A, Brion F, Lefebvre C, Knoops P, Devogelaer JP, Houssiau FA.

Department of Rheumatology, Universite Catholique de Louvain, Brussels, 
Belgium. houssiau@ruma.ucl.ac.be

OBJECTIVE: During the last few years, in an attempt to reduce the side effects 
of glucocorticoid (GC) therapy, we have been treating polymyositis-
dermatomyositis (PM-DM) patients with a lower starting dose of GC than is 
classically recommended. In order to validate this approach, we performed a 
functional re-evaluation of these PM-DM patients. METHODS: A comprehensive 
protocol evaluating muscle strength, muscle function, CK levels, persistence of 
spontaneous activity on electromyography, disability in daily life activities 
and degree of dependence was applied in 25 non-cancer-associated biopsy-proven 
PM-DM patients, 15 of whom had been treated with a high-dose regimen (i.e. > 
0.5 mg prednisolone/kg/day) and 10 with a low-dose regimen (i.e. < or = 0.5 mg 
prednisolone/kg/day). RESULTS: Our results indicate that the functional outcome 
of PM-DM patients given a low-dose starting regimen of GC does not differ from 
that observed in patients given higher doses. Interestingly, vertebral 
fractures were less common in patients treated with lower GC doses. 
CONCLUSIONS: Although our analysis has certain shortcomings, including the 
small number of patients investigated and their uncontrolled assignment to a 
low-dose or a high-dose GC regimen, the results of this retrospective study 
suggest that a low-dose starting regimen of GC can achieve a good functional 
outcome in PM-DM patients, with a reduction of treatment-related disability. 
This approach would be welcome as a step forward should it be validated by a 
longitudinal study.

[2002年11月20日 12時57分12秒]