The short-term role of corticosteroid therapy for pulmonary arterial hypertension associated with connective tissue diseases: Report of five cases and a literature review

M. Kato, H. Kataoka, T. Odani, Y. Fujieda, Kotaro Otomo, K. Oku, T. Horita, S. Yasuda, T. Atsumi, H. Ohira, I. Tsujino, M. Nishimura, T. Koike

研究成果: Review article

23 引用 (Scopus)

抄録

Pulmonary arterial hypertension (PAH) is a life-threatening complication in connective tissue diseases (CTD). It remains controversial whether immunosuppressive therapy is useful for PAH associated with CTD (PAH-CTD). The Dana Point algorithm does not refer such treatments in patients with PAH-CTD due to the lack of evidence. However, some case reports have shown the potential efficacy of immunosuppression for PAH-CTD. Here we report five cases of PAH-CTD treated with corticosteroids and discuss the current management of PAH-CTD with immunosuppressive agents. Our cases consisted of three active systemic lupus erythematosus (SLE), a quiescent SLE and an active polymyositis. WHO functional classes at baseline were class III in three cases and class II in two. Median follow-up period was 44 (28-92) weeks. PAH was diagnosed by right heart catheterization in all cases (median pulmonary arterial pressure was 45 (29-49) mmHg). All patients received 1 mg/kg of prednisolone (PSL) for 2-4 weeks, followed by appropriate dose reduction. Methylprednisolone pulse therapy was performed in patients resistant to the high dosage of PSL. Four patients received vasodilators in combination. The therapy as above improved WHO functional class 4 weeks after the initiation of PSL in all the patients. Two patients required dose increase or additional administration of vasodilators due to the dose reduction of PSL. Corticosteroid therapy may be effective for PAH-CTD at least in the short term, even in low general activity of CTD or moderate PAH. Our experience suggests that corticosteroid therapy, by itself or in conjunction with standard vasodilators, is effective for PAH-CTD patients.

元の言語English
ページ(範囲)1047-1056
ページ数10
ジャーナルLupus
20
発行部数10
DOI
出版物ステータスPublished - 2011 10 1
外部発表Yes

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Connective Tissue Diseases
Pulmonary Hypertension
Adrenal Cortex Hormones
Prednisolone
Vasodilator Agents
Therapeutics
Immunosuppressive Agents
Systemic Lupus Erythematosus
Polymyositis
Methylprednisolone
Cardiac Catheterization
Immunosuppression
Arterial Pressure
Lung

ASJC Scopus subject areas

  • Rheumatology

これを引用

The short-term role of corticosteroid therapy for pulmonary arterial hypertension associated with connective tissue diseases : Report of five cases and a literature review. / Kato, M.; Kataoka, H.; Odani, T.; Fujieda, Y.; Otomo, Kotaro; Oku, K.; Horita, T.; Yasuda, S.; Atsumi, T.; Ohira, H.; Tsujino, I.; Nishimura, M.; Koike, T.

:: Lupus, 巻 20, 番号 10, 01.10.2011, p. 1047-1056.

研究成果: Review article

Kato, M, Kataoka, H, Odani, T, Fujieda, Y, Otomo, K, Oku, K, Horita, T, Yasuda, S, Atsumi, T, Ohira, H, Tsujino, I, Nishimura, M & Koike, T 2011, 'The short-term role of corticosteroid therapy for pulmonary arterial hypertension associated with connective tissue diseases: Report of five cases and a literature review', Lupus, 巻. 20, 番号 10, pp. 1047-1056. https://doi.org/10.1177/0961203311403347
Kato, M. ; Kataoka, H. ; Odani, T. ; Fujieda, Y. ; Otomo, Kotaro ; Oku, K. ; Horita, T. ; Yasuda, S. ; Atsumi, T. ; Ohira, H. ; Tsujino, I. ; Nishimura, M. ; Koike, T. / The short-term role of corticosteroid therapy for pulmonary arterial hypertension associated with connective tissue diseases : Report of five cases and a literature review. :: Lupus. 2011 ; 巻 20, 番号 10. pp. 1047-1056.
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abstract = "Pulmonary arterial hypertension (PAH) is a life-threatening complication in connective tissue diseases (CTD). It remains controversial whether immunosuppressive therapy is useful for PAH associated with CTD (PAH-CTD). The Dana Point algorithm does not refer such treatments in patients with PAH-CTD due to the lack of evidence. However, some case reports have shown the potential efficacy of immunosuppression for PAH-CTD. Here we report five cases of PAH-CTD treated with corticosteroids and discuss the current management of PAH-CTD with immunosuppressive agents. Our cases consisted of three active systemic lupus erythematosus (SLE), a quiescent SLE and an active polymyositis. WHO functional classes at baseline were class III in three cases and class II in two. Median follow-up period was 44 (28-92) weeks. PAH was diagnosed by right heart catheterization in all cases (median pulmonary arterial pressure was 45 (29-49) mmHg). All patients received 1 mg/kg of prednisolone (PSL) for 2-4 weeks, followed by appropriate dose reduction. Methylprednisolone pulse therapy was performed in patients resistant to the high dosage of PSL. Four patients received vasodilators in combination. The therapy as above improved WHO functional class 4 weeks after the initiation of PSL in all the patients. Two patients required dose increase or additional administration of vasodilators due to the dose reduction of PSL. Corticosteroid therapy may be effective for PAH-CTD at least in the short term, even in low general activity of CTD or moderate PAH. Our experience suggests that corticosteroid therapy, by itself or in conjunction with standard vasodilators, is effective for PAH-CTD patients.",
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