PULSE THERAPY IN JUVENILE RHEUMATOID ARTHRITIS WITH THE SYMPTOM OF PERICARDITIS

Abstract

Two patients suffering juvenile rheumatoid arthritis (JRA) with the symptom of pericarditis who were found unresponsive to high doses of conventional oral steroid therapy, were theated with pulse therapy.The first patient was admitted to the hospital again at the age of 6 11/12 due to the third recurrence. This patient, taking oral dose of prednisolone 2mg/kg daily, showed no improvement, but instead, he developed pericarditis on the 11th day after the treatment.The second patient is a 14 year 11 month old girl who was admitted to the hospital due to muscle pain and pericarditis along with fever and rheumatoid rash, which lasted for two weeks prior to this admission. For both patients a large amount of pericardial effusion was revealed by echocardiogram. Development of cardiac tamponade was being feared and there were discussion on the indication of pericardiocentesis. Inorder to improve pericarditis and acute systemic symtoms both patients received conventional pulse therapy of methylprednisolone 30mg/kg/day intravenously for three consecutive days a week for three weeks.From the first day of pulse therapy, the high fever declined. Pericardial effusion disappeared within the three weeks. The patients showed significantly better clinical responses. No side effects were observed during the pulse therapy except a slight moonface.Pulse therapy is indicated when the patients are unresponsive to high doses of conventional oral steroid therapy or have a risk of cardiac dysfunction to be developed.