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Topics:
Rheumatology • Systemic sclerosis • Scleroderma • Dermatology • Systemic autoimmune diseases
What considerations do you take when using prednisone in patients with systemic sclerosis?
Given the concern for precipitating renal crisis, are there certain patient characteristics you screen for, or certain doses or durations you prefer to avoid in these patients?
Answer from: at Academic Institution
We tend to have a very high threshold for using systemic steroids in patients with systemic sclerosis and when we do, we try to limit it to less than 15 mg/day of prednisone. There is no clear evidence that it improves or slows down disease activity/progression even in the very early inflammatory ("...
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Answer from: at Academic Institution
As a rule, I try to avoid using systemic glucocorticoids in patients with Systemic sclerosis and counsel patients to reach out to me when someone wants to start them on steroids for any indication to weigh the risk vs benefit ratio of the situation.
The risk of renal crisis is very real, and even i...
Answer from: at Academic Institution
Agree with avoiding the use of oral glucocorticoids in systemic sclerosis when possible. In addition to the excellent responses above, I would also add a role for ambulatory home blood pressure monitoring periodically in high-risk patients going on oral prednisone for a short course, especially if p...