Abstract
Abstract: :
Purpose: Low dose systemic corticosteroids (insufficient to induce iatrogenic Cushing syndrome) are well-tolerated and often used as a monotherapy for rheumatoid arthritis and sarcoidosis to avoid other systemic immunosuppressive treatment. The aim of this study was to identify a subgroup of patients with chronic uveitis that could be treated with low dose systemic corticosteroids alone . Methods: We included consecutive patients attending the Interdisciplinary Uveitis Center Heidelberg from April 2001 to December 2002 that met the following criteria: previous successful treatment with a tapering regimen of prednisone, and relapse after complete cessation. The next cycle of systemic prednisone treatment was tapered down until dosage was below or equal 10 mg prednisone per day without relapse of disease for at least 60 days. Kaplan-Meier-curve was used to calculate time of observation and probability of successful therapy. Results: A total of 16 patients (12 female and 4 male) were included with a median age of 38,5 years (range 31- 81 years). Side-effects were not observed. Systemic associations were found in 6 patients: 4 patients were diagnosed with sarcoidosis, one with Lyme disease and one with multiple sclerosis. After a median observation period of 112,5 days (range 75 - 670 days), 12 patients were stable with regard to visual acuity and inflammatory signs on a median final prednisone dose of 4 mg (range 1 - 7,5 mg) One patient had to stop therapy after 120 days for diagnostic reasons and in two patients the dosage of prednisone had to be increased because of new inflammatory episodes after a quiet period of 105/450 days on 1/5 mg Prednisone, respectively. Another patient ceased therapy after 90 days without relapse for personal reasons. Conclusions: This pilot study suggests that low dose systemic prednisone therapy can be useful as a longterm treatment in a subgroup of patients with chronic uveitis. Even 1 mg prednisone/day seems to prevent a relapse of uveitis. Such therapy may be a therapeutic alternative to other systemic immunosuppressive regimens.
Keywords: corticosteroids • uveitis-clinical/animal model • inflammation