How is HSP treated?
• Arthritis responds to NSAIDs.
• Edema responds to steroids.
• Abdominal pain with positive test for blood in stool should be treated with steroids.
• Evaluate for and treat infection (e.g., group A β-hemolytic Streptococci, Helicobacter pylori ).
• Recurrent skin purpura may respond to dapsone.
• Aggressive treatment (high-dose or IV pulse corticosteroids) for children with poor prognostic signs.
• Severe nephritis: high-dose IV pulse methylprednisolone plus azathioprine or cyclophosphamide; angiotensin-converting enzyme inhibitors for proteinuria.
• Recurrent hospitalizations for chronic HSP with GI manifestations may benefit from B-cell depletion with rituximab.
Pearl: Corticosteroid therapy helps arthritic and abdominal symptoms but may not prevent nephritis or subsequent recurrences.
