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Glucocorticosteroids in Relation to Inflammatory Disease

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  1. Pharmacology
  2. Mechanisms of action
  3. Clinical use of glucocorticisteroids
  4. General principles of therapy
  5. Systemic Glucocorticosteroid therapy
  6. Alteration to oral therapy
  7. Conclusions
  8. Bibliography

For more than 50 years, glucocorticosteroids have been important agents in treating diseases characterized by inflammation and exaggerated immune responses. The pioneering work of Hench and colleagues in rheumatoid arthritis showed the possible potency of these agents in such pathologic states. Although substantial advances have been made in understanding the mechanisms by which glucocorticosteroids exert beneficial effects, considerable gaps in knowledge remain. Despite extensive data regarding the in vitro and in vivo activities of these drugs, it is probable that glucocorticosteroids have different beneficial activities in different diseases.

[...] For inflammatory and immunologically related disorders, it is incumbent on the treating physician to determine that glucocorticosteroids are the appropriate form of treatment and that other nonglucocorticosteroid approaches are unlikely to be equally beneficial. When glucocorticosteroid treatment becomes desirable, if not mandatory, efforts must focus on minimizing glucocorticosteroid side effects, while maintaining therapeutic efficacy. Generally, these goals can be attained at least partially by using short-acting glucocorticosteroid medications at the lowest possible dose and the greatest dosing interval for the shortest period of time. [...]

[...] Failures may occur if the attempt to begin tapering is premature because the disease is still active, if the dose is reduced too rapidly, if the decrements in dose are too large, if not enough prednisone is administered on the day, or if glucocorticosteroid "withdrawal" symptoms (e.g., myalgias, arthralgias, fever) are confused with a recrudescence of the disease. In some instances, tapering can be facilitated by using glucocorticosteroid-sparing drugs that help control the primary disease as glucocorticosteroids are reduced. Nonsteroidal anti-inflammatory agents, cytotoxic drugs (e.g., methotrexate, azathioprine, and cyclophosphamide), and other agents may permit tapering to alternate-day glucocorticosteroid regimens. [...]

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