Kawasaki disease, also known as lymph node syndrome, mucocutaneous node disease, infantile polyarteritis and Kawasaki syndrome, was first described by Dr. Tomisaku Kawasaki in Japan. It is an inflammation of the middle-sized arteries (vasculitis). It affects many organs, including blood vessel walls, but the most serious effect is on the heart where it can cause severe aneurysmal dilations. Membranes of the mouth and eyes, as well as the skin usually becomes red and inflammed. Edema or swelling is often seen in the hands and feet and the lymph nodes found in the neck are often enlarged. Some degree of fever is also often noted. Twenty percent of children affected have cardiovascular sequelae.
A study was conducted to determine the effect of the addition of pulsed steroids to the standard regimen for treating Kawasaki disease.
In the treatment group, the patients received 30 mg/kg of methylprednisolonw over 2 – 3 hours while the control group received a placebo infusion. According to standard protocols, both groups received intravenous immune globulin and aspirin. Subjects also underwent echocardiography three times within the study.
The diiference in scores were not that significant between the steroid and usual care groups. The researchers conclude that inclusion of methylprednisolone in the primary therapy did not significantly improve coronary artery outcomes in children with KD.
From Medscape:
The authors also reviewed the results of post hoc analyses comparing the outcomes of subjects who required re-treatment with IVIG. In that group, those subjects who had received steroids initially then required re-treatment with IVIG had better coronary artery outcomes compared to the group who had received placebo and required re-treatment. While this was an interesting finding, it suggests the need to evaluate whether a subgroup of likely ‘nonresponders’ could be identified at enrollment to consider adding steroids to their treatment. It was not a primary outcome in this study, and so one should not view the findings of this trial in regard to children who required re-treatment as definitive (the authors do not do so). As the authors pointed out, this trial has many strengths that preceding trials did not — especially blind interpretation of the echocardiograms. So, while this trial does not completely preclude the use of steroids in KD (for example, those who do not respond to initial IVIG), it makes a very strong case that it is not beneficial to add pulse steroids to the primary treatment regimen in all cases of KD.
