Comparison of Systemic Corticosteroid Therapy Practices Between Pediatric and Adult Rheumatologists: A Multicenter Survey Study

INTRODUCTION: The indications, dosage, and duration of systemic corticosteroid treatment may vary among pediatric rheumatologists (PRs) and adult rheumatologists (ARs) in daily clinical practice. This study aims to evaluate and compare practices, perceptions, and attitudes of PRs and ARs regarding the use of systemic corticosteroids. METHODS: An online survey was administered to rheumatologists in Türkiye to assess their use of systemic corticosteroids in the management of rheumatic diseases. The questionnaire addressed preferred corticosteroid formulations, dosing and tapering strategies, monitoring and preventive measures for adverse effects, and vaccination practices. RESULTS: Sixty PRs and 40 ARs participated in the study. Prednisolone was most commonly preferred by PRs while almost all ARs used methylprednisolone. Weight-based dosing was favored by PRs whereas ARs preferred fixed-dose regimens. PRs more frequently preferred longer pulse corticosteroid therapy, whereas ARs most commonly used a 3-day pulse regimen. In contrast, ARs reported significantly longer durations of bridging and maintenance therapy. Delirium was reported significantly more often by ARs as a complication (p = 0.026). In pre-treatment evaluation, PRs more commonly assessed peripheral blood smear (p < 0.001) whereas ARs more frequently screened for hepatitis serology (p = 0.014). As preventive strategies, PRs were significantly more likely to request ophthalmologic examination (p = 0.005). Immunization assessment for meningococcal, measles-mumps-rubella, and varicella vaccines was significantly more common among PRs (p > 0.005, for all). CONCLUSION: Significant heterogeneity exists between PRs and ARs in systemic corticosteroids practices, highlighting the need for age-specific standardized protocols for dosing, preventive strategies, and complication monitoring. Graphical abstract available for this article.