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722 A NEW LOOK AT THE EFFECT OF STEROIDS ON THE OUTCOME OF ABDOMINAL PAIN IN CHILDREN WITH HENOCH-SCHONLEIN PURPURA

Since the observation of Allen and Diamond, steroids have been frequently used for the treatment of abdominal pain in patients with Henoch-Schonlein Purpura (HSP). We retrospectively reviewed the outcome of 26 children with HSP who were admitted to the hospital from 1976 to 1984. Twenty-five had abdominal pain; fifteen (60%) were male; ten (40%) were female; ages ranged from 3-18 yrs. (x=8.5 yrs). Presenting findings included a typical rash in 21 (84%), arthritis in 17 (68%), a preceding infection in 8 (32%) and nephritis in 9 (36%). The duration of pain did not differ in those with or without hematuria, vomiting, melena, guaiac positive stool, leukocytosis, bandemia, elevated sedimentation rate or thrombocytosis (p> .05).Fourteen children (56%) were treated with steroids; 11/25 (44%) were not. The two groups did not differ with respect to treatment with IV hydration, bowel rest or NG suction. There was no difference between the two groups in resolution or total duration of pain (Chi square, p> .05). Abdominal complications included intussuseption in one child and ileal perforation in another, 40 days after starting steroid therapy.Conclusions: In this retrospective study, no clinical benefit was observed in those children who were treated with steroids. It, therefore, seems justified to conduct a prospective placebo controlled trial in children with HSP and abdominal pain to assess the true efficacy of steroid therapy.