PREVENTION OF RELAPSES IN SYSTEMIC LUPUS-ERYTHEMATOSUS

Many relapses of systemic lupus erythematosus (SLE) are preceded by a rise in antibodies against double-stranded DNA (anti-dsDNA). We invest igated whether these relapses can be prevented by giving prednisone wh en a rise in anti-dsDNA occurs. 156 patients with SLE were studied. An ti-dsDNA was measured by Farr assay monthly. When a rise in anti-dsDNA was found, patients were randomly assigned either conventional treatm ent or 30 mg prednisone added to the current daily dose and tapering o ff to baseline over 18 weeks. A rise in anti-dsDNA was detected in 46 patients (24 assigned conventional treatment and 22 prednisolone). The relapse rate was higher in the conventional group than in the prednis olone group (20 vs 2, p<0 . 001). Although rises in anti-dsDNA in the prednisone group were treated with additional prednisone, the cumulati ve oral doses of prednisone in the two groups did not differ significa ntly (p=0 . 025). 7 major relapses requiring additional cytotoxic immu nosuppressive treatment occurred in the conventional group Versus 2 in the prednisone group. Treatment with prednisone as soon as a signific ant rise in anti-dsDNA occurs prevents relapse in most cases, without increasing the cumulative dose of prednisdone given.