Prednisone Dosing for Systemic Sclerosis Patients

Introduction to Prednisone Dosing

The British Journal of Dermatology recommends prednisone dosing for systemic sclerosis patients with skin involvement based on disease severity, with 0.5 mg/kg/day for mild disease, 0.75 mg/kg/day for moderate disease, and 1 mg/kg/day for severe disease 1, 2

For mild disease, the initial prednisone dose is 0.5 mg/kg/day, appropriate for patients with localized or limited skin involvement 1, 2
For moderate disease, the initial prednisone dose is 0.75 mg/kg/day, for patients with more extensive skin involvement but without severe systemic manifestations 1, 2
For severe disease, the initial prednisone dose is 1 mg/kg/day, for patients with extensive skin involvement and/or systemic manifestations 1, 2, 5

Assess clinical response after 1-3 weeks of initial therapy, and if inadequate response, increase dose to the next level 2
Begin tapering 15 days after disease control is achieved, and taper gradually with aim of reaching minimal effective dose within 4-6 months 2, 6
For maintenance, aim for prednisone ≤10 mg/day 4

Continue maintenance therapy for at least 12 months after normalization of skin findings, and consider steroid-sparing agents for patients requiring prolonged therapy 4
Provide calcium and vitamin D supplementation for all patients on prolonged steroid therapy, and consider DEXA scanning at 1-2 year intervals for patients on long-term steroids 4, 6
Bisphosphonate prophylaxis is recommended for high-risk patients on glucocorticoids >3 months, and vaccination against influenza and pneumococci is recommended 6
Higher doses of prednisone (>0.75 mg/kg/day) are associated with increased mortality and adverse effects, and avoid rapid discontinuation of therapy to prevent disease flare and adrenal insufficiency 1, 2