Systemic corticosteroids for SLE in children and adolescents

Note: Systemic corticosteroids may be used (in addition to hydroxychloroquine) for severe organ- or life-threatening features of SLE in children and adolescents.

Systemic corticosteroids are commonly used, in addition to hydroxychloroquine, for severe organ- or life-threatening features of SLE (eg kidney or central nervous system (CNS) disease), but they are usually not required for mild disease. For severe disease, moderate- to high-dose corticosteroids are usually required. Systemic corticosteroids should only be used in children and adolescents under specialist supervision. Specific regimens for children and adolescents with SLE are nuanced, depending on the clinical features present and their severity. Pulse intravenous corticosteroids are occasionally used, or moderate- to high-dose oral corticosteroids (eg prednisolone [or prednisone] 10 to 60 mg orally daily).

Note: Systemic corticosteroids should only be used under specialist supervision for SLE in children and adolescents.

Systemic corticosteroids can impact normal growth in children and adolescents, and adversely affect the normal, dramatic accrual in bone density that occurs in the pre- and early teen years. Corticosteroid-induced changes in body habitus (eg Cushingoid features, hair loss, striae) can also have a profound psychological impact on adolescents. Adherence to therapy can therefore be difficult.

Tapering oral corticosteroids in children and adolescents with SLE is complex and must be managed by a specialist. For additional considerations specific to systemic corticosteroid use, see Specific considerations for use of systemic corticosteroids.

Note: Tapering oral corticosteroids in children and adolescents with SLE is complex and must be managed by a specialist.