Oxford Paediatric and Adolescent Rheumatology Centre OxPARC Methylprednisolone protocol for Juvenile Idiopathic Arthritis and Connective Tissue Disorders Methylprednisolone is given in pulses, either as a single dose (before physical rehabilitation or another drug eg. Cyclophosphamide, infliximab), or in a set of 3 doses on consecutive days (for very active and extensive inflammation). This can be repeated in the following weeks as necessary and is determined by the attending consultant. Each pulse consists of 30 mg/kg of methylprednisolone, up to a maximum of 1g. Each pulse is given over 60 minutes. Dilute as below. <20kg mix methylprednisolone in 50mls 0.9% sodium chloride ≥20kg mix methylprednisolone in 100mls 0.9% sodium chloride. Continue oral steroids except on days that methylprednisolone is given. Check: If not done recently, check FBC, ESR, CRP, U & Es and LFTs prior to the first infusion. TPR and BP before the start and every 15 minutes during the infusion. If the child becomes unwell (feels light-headed, dizzy, nauseous, or has increasing headache) during the infusion check TPR and BP and consider slowing or stopping the infusion. Inform rheumatology team (see contacts below). Monitor blood sugar closely in a diabetic patient (every 30 mins during infusion and 1 hour after). Mild common side effects requiring no intervention: Facial flushing, metallic taste in the mouth, hyperactivity, or mood changes. Side Effects requiring intervention: • Blood pressure rises by >30mmHg (Hypertension) • Blood pressure falls accompanied by symptoms such as light-headedness (Hypotension) • Severe tachycardia (>150 bpm or patient feels palpitations or light-headed) • Altered conscious state, seizures and psychosis Stop infusion and call doctor Contacts for Paediatric Rheumatology team at Nuffield Orthopaedic Centre . 1. Paediatric Rheumatology Nurse Specialists 01865 737341 email [email protected] 2. Dr Wilkinson (Consultant Paediatrician and Rheumatologist) via Secretary Hannah Trendall 01865 738049 (mob emergency only 07944723273). 3. Dr David (consultant Rheumatologist) – via Secretary as above. 4. Out of hours – On call Dr for Rheumatology via Switchboard 01865 741155 N.wilkinson/E.Inness/E.Kendall. Paediatric Rheumatology Methylprednisolone. Version 3 February 2012.