From the Guidelines
The initial treatment for Henoch-Schonlein purpura (HSP) is primarily supportive care, as most cases resolve spontaneously within 4-6 weeks. This approach includes:
- Adequate hydration
- Rest
- Pain management with acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (10 mg/kg/dose every 6-8 hours, maximum 600 mg/dose) for joint pain and swelling
- Monitoring for complications, especially renal involvement, through regular urinalysis and blood pressure measurements For more severe symptoms, particularly those involving significant abdominal pain or renal manifestations, oral corticosteroids like prednisone (1-2 mg/kg/day, maximum 60-80 mg daily, for 1-2 weeks with gradual tapering) may be prescribed 1. The use of angiotensin blockade, such as ACE inhibitors or ARBs, may be considered in children with HSP and persistent significant proteinuria, as suggested by 1 and 1. However, the decision to initiate corticosteroid therapy should be based on individual patient assessment, taking into account the presence of nephrotic-range proteinuria and the lack of response to angiotensin blockade, as noted in 1. Severe cases with significant renal involvement, central nervous system complications, or gastrointestinal bleeding may require hospitalization and consultation with specialists. The rationale for this approach is that HSP is an immune-mediated vasculitis that typically follows a self-limiting course, with treatment aimed at managing symptoms and preventing complications rather than altering the underlying disease process. It is essential to prioritize supportive care and monitor patients closely, as the majority of cases will resolve without the need for more aggressive interventions, as implied by 1 and 1.
From the Research
Initial Treatment for Henoch-Schonlein Purpura (HSP)
The initial treatment for HSP is primarily supportive, as the condition spontaneously resolves in 94% of children and 89% of adults 2.
Supportive Treatment
- The primary intervention is supportive treatment, focusing on symptom relief and preventive therapy to reduce the risk of complications 3.
- Oral prednisone at 1 to 2 mg per kg daily for two weeks has been used to treat abdominal and joint symptoms 2.
Corticosteroid Use
- A meta-analysis found that corticosteroid use in children reduced the mean time to resolution of abdominal pain and decreased the odds of developing persistent renal disease 2.
- Early prednisone therapy was effective in reducing the intensity of abdominal pain and joint pain, and in treating renal symptoms, but did not prevent the development of renal symptoms 4.
Severe Renal Involvement
- Early aggressive therapy with high-dose steroids plus immunosuppressants is recommended for patients with severe renal involvement 2, 5.
- Treatment with high-dose corticosteroids plus oral cyclophosphamide has been shown to be safe and effective in reducing proteinuria and improving renal function in children with HSP nephritis 5.
Other Treatment Options
- Mycophenolate Mofetil has been used to treat HSP with gastrointestinal involvement, and has been shown to be effective in inducing and maintaining remission 6.