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Arthritis and Rheumatism

Is Prednisone Better Than Cellcept or Imuran For Treating HSP?

03/21/2008

Question:

I have been diagnosed with HSP and have been on Prednisone for several years and am now taking 5 mg daily. The vaculitis that HSP gives me is under control and so is the sweeling of my ankles and legs. My doctor wants to take me off Prednisone and continue with Cellcept of 500 mg, 3 times daily, and then perhaps in the long term wean me completely off Cellcept. Is Cellcept or Imuran better choices than Prednisone at the level that I am taking now?

Answer:

Henoch-Schönlein Purpura (HSP) is a type of small-vessel vasculitis. Many cases may resolve spontaneously without the use of corticosteroids (ie, Prednisone). However, severe cases, especially those leading to kidney involvement, have warranted treatment with corticosteroids. In many diseases where individuals are treated with corticosteroids for a prolonged period of time, alternative agents are used to maintain disease stability or remission, while at the same time allowing a decrease in corticosteroid dosing. Mycophenolate mofetil (Cellcept) and azathioprine (Imuran) are two such "steroid-sparing" agents. If such an agent is used, one of the goals is to minimize the potential adverse effects of corticosteroids by allowing reduced dosing of the steroid or even complete discontinuation of the medicine.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University