OBSERVATIONS ON THE USE OF PREDNISONE IN PATIENTS WITH PROGRESSIVE SYSTEMIC SCLEROSIS (DIFFUSE SCLERODERMA)

Abstract

Clinical observations are reported on 6 patients with progressive systemic sclerosis (diffuse scleroderma) who have received the synthetic steroid prednisone in oral doses of 20 to 30 mg/day, for periods up to 4.5 months. In addition to widespread skin changes, all patients presented evidence of visceral involvement, including the gastrointestinal tract, heart, lungs, and joints (synovitis). Prednisone was given following a period of base-line observation and placebo medication during which time patients were maintained on a diet with constant salt intake. Improvement in skin, with diminution in swelling, tightness, and hyperpigmenta-tion, was noted in all patients starting approximately 1 week after the beginning of prednisone therapy. Potent antirheumatic activity was displayed in 2 patients with active joint disease; relief of pain, tenderness, and swelling followed within a day of therapy. One patient with pulmonary involvement has experienced considerable symptomatic relief, with increased ventilatory capacity. Little change was noted in the gastrointestinal symptoms Untoward side effects in this group have thus far proved minimal. In all patients the erythrocyte sedimentation rate has fallen, and the C-reactive protein, when present, has disappeared. Only slight change was noted in serum protein concentrations. The hematocrit has increased in 1 patient. The potential usefulness of long-term therapy with prednisone remains to be assessed.