Corticosteroids and the risk of scleroderma renal crisis: a systematic review

Abstract

Scleroderma renal crisis (SRC) has been associated with the use of corticosteroids (CS) in retrospective studies. Using an evidence-based approach, we undertook a systematic review of the literature to identify prospective studies in which scleroderma patients were administered CS to ascertain the risk of SRC in those patients. A comprehensive search was conducted using Medline, EMBASE, the Cochrane Library, and Web of Science. All original prospective clinical studies were eligible if they enrolled SSc patients newly treated with CS. Selected studies were reviewed, and data extraction was systematically performed for the dose and duration of the CS intervention as well as the occurrence of SRC. Twenty-six studies with a total of 500 SSc patients commencing new CS therapy were included in the systematic review. Ten definite cases of SRC, equivalent to a rate of 2%, were identified. In the subset of early diffuse patients, the rate of SRC was 4%. All 10 definite cases of SRC occurred in patients who received medium- to high-dose CS therapy. Seven cases occurred in the setting of stem cell transplant. CS are associated with SRC, although this may be due to confounding by disease severity and/or co-intervention. Great caution must continue to be exerted when initiating such therapy, especially in high doses and in the early diffuse subset of SSc patients.

Late-Onset Scleroderma Renal Crisis Induced by Tacrolimus and Prednisolone

“…1 Moderate to high dose corticosteroid use, equivalent to a dose of prednisolone of $15 mg, is recognized as a major risk factor for SRC. [3][4][5] The present patient had recurrent flares of progressive skin sclerosis. The first 2 flares were successfully treated by steroids.…”

“…The use of moderate to high doses of corticosteroids is recognized as a major risk factor for SRC [3][4][5] ; however, tacrolimus has never been reported to induce SRC. We herein report a case of late-onset SRC induced by tacrolimus and prednisolone.…”

Antineutrophil cytoplasm antibody-positive pulmonary-renal syndrome in a patient with diffuse cutaneous systemic sclerosis

“…The management of this case was complicated by the underlying diagnosis of SSc. It is known that corticosteroids may worsen the prognosis and symptoms of SSc 9. In an attempt to minimise cumulative corticosteroid dose, our patient was treated with a rapidly reducing dose, in addition to rituximab.…”

Interstitielle Nephritis bei rheumatischen Erkrankungen

“…Diese führt im Gegenteil sogar zu einer höheren Rate an terminaler Niereninsuffizienz [48]. Die Therapie mit Glukokortikoiden ist bei der systemischen Sklerose ebenfalls nicht unproblematisch, da von einem vermehrten Vorkommen an renalen Krisen berichtet wurde [52]. Eine interstitielle Nephritis mit gesteigerter extrazellulärer Matrix bei systemischer Sklerose ist, neben glomerulären und vaskulären Komplikationen, zwar beschrieben worden, deren Bedeutung ist jedoch unklar [38].…”