AN OVERVIEW OF THE TREATMENT OF CHILDHOOD SLE

Current recommendations for the treatment of pediatric SLE are from un controlled trials, case reports, retrospective descriptive data or ext ra-polation from studies in adults. Glucocorticoids are the mainstay o f therapy and the doses depend on the disease severity. Diffuse prolif erative glomerulonephritis (DPGN) requires high-dose prednisone for pr olonged periods of time. We suggest the addition of azathioprine for D PGN at the time of diagnosis of DPGN and reserve cyclophosphamide for refractory cases. While we do not recommend the routine use of cycloph osphamide in this or other forms of lupus nephritis, others advocate t he aggressive use of intravenous cyclophosphamide and prednisone. Seve re central nervous system disease should be treated with high dose pre dnisone and immunosuppressive agents are reserved for life-threatening disease or steroid failure or dependency. We suggest the routine use of hydroxychloroquine in all cases of SLE at a dose of 5 mg/kg/day (ma ximum of 400 mg/day). Methotrexate has been recently used with some su ccess in both children and adults, the safety profile appears to be ve ry good and therefore further studies of this drug are warranted. Coll aboration in the development of a limited number of defined treatment protocols and large scale collection of data on a multicenter and mult inational basis is needed if we hope to improve the outcome of patient s with severe disease.