Prednisolone is the most common in the UK - give 0.75-1.0 mg per kg for 6-10 weeks then reduce to maintenance level. In the USA, prednisone is preferred - equipotent but with more mineralocorticoid activity.
Modern consensus is that there is no place for pulsed therapy in routine treatment because of the potential dangers, the expense and no proven benefit. Pulsed regimes such as high dose (1g) iv. methylprednisolone for 3 days should be reserved for special circumstances such as failure to respond to high dose oral steroids, or the rapid treatment of disease flares in patients already compromised by cumulative side effects.
Alternate day steroids are associated with fewer Cushingoid side effects and are of use in maintenance treatment but not in the management of acute disease flares.
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