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FRI0225 Glucocorticosteroid and cytotoxic therapy
  1. VI Vasiliev,
  2. MV Simonova,
  3. TN Safonova,
  4. NS Shornikova
  1. Department of Rheumatology, Institute of Rheumatology of RAMS, Moscow, Russia

Abstract

Objectives To assess the effect of long-term glucocorticosteroid (GCS) low doses and cytostatics taking on clinical-laboratory SS manifestations.

Methods 500 SS pts divided into 4 groups were included into the study. 1st group – 200 of SS pts had 5 mg of Prednisolone daily, 1.8 for a year, 0.9–1.8 for subsequent years and chlorobutin – 2 mg daily for a year, 360–720 mg for the next 5–15 years. 2nd group – 100 SS pts had Prednisolone according the same scheme and cyclophosphane 200 mg twice a month, 4.8 mg for a year, 2.4–4.8 g for the next 5–15 years. 3d group – 100 SS pts had Prednisolone according the same scheme for 5–15 years. 4th group – 100 SS pts had only substitution therapy. Reliable improvement of stomatological (decrease of salivary glands, disappearing or decrease of frequency of parotitis, increase of salivation), ophthalmologic (residing of cornea dystrophy) and some systemic manifestations disappearing of artralgia, regional lymphadenopathy, decrease of morning stiffness) were noticed only in the fist three groups of pts and in the 1st and 2nd groups it was more pronounced (<0.001). Only in the 1st and 2nd groups disappearing of purpura relapse in the third of pts. ESR, fibrinogens levels, general protein, G-globulins, 3 classes of immunoglobulins, CIC and RF titers decrease in 5 years was found only in the 1st and 2nd groups of pts (p < 0.001). Substantial improvement (1st, 2nd groups – 30%, 3d – 10%) and moderate improvement (1st, 2nd groups – 25%, 3d – 20%) was found only in pts with cytostatics and GCS therapy. 30% (1st and 2nd groups) and 40% (3d group) pts needed more potent therapy, whereas 60% (4th) of pts had therapy due to development of different stage of severity of systemic manifestations.

Conclusion Obtained data demonstrate the necessity of low doses of GCS and chlorobutin/cyclophosphane in early terms of SS with glandular manifestations. In some cases such therapy is effective during systemic manifestations of the disease which is not dangerous for the life of patient.

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