The role of corticosteroid therapy in infection

Systemic low-dose glucocorticoid treatment in rheumatoid arthritis

Glucocorticoids provide a large, immediate improvement in the symptoms of rheumatoid arthritis. At doses acceptable for long-term treatment, however, symptoms gradually re-emerge. Relatively low doses of glucocorticoids can, for several years, substantially retard the rate of joint destruction shown on radiographs. This differential effect implies the coexistence of two pathologic processes within diseased joints. Long term, low dose glucocorticoid therapy probably increases the risk of serious adverse effects, but an evidence-based case can be made for the limited use of low dose glucocorticoid treatment in early disease.

The efficacy and safety of low-dose corticosteroids for rheumatoid arthritis

Low-dose corticosteroids (defined as less than or equal to 10 mg/d of prednisone or equivalent) are used increasingly for the management of rheumatoid arthritis. They are frequently substituted for nonsteroidal antiinflammatory drugs (NSAIDs), particularly in patients with gastrointestinal or other intolerance to NSAIDs, or as "bridge therapy" while patients await the benefits of delayed-acting, disease-modifying agents. Despite their clinical acceptance, published data concerning efficacy are meager. Adverse effects to low-dose corticosteroids are not so frequent nor so severe as those that occur with higher doses. Nevertheless, alterations in glucose metabolism, cutaneous atrophy, cataracts, and glaucoma are common. Osteoporosis, steroid-myopathy, a steroid-withdrawal syndrome, and dysfunction of the hypothalamic-pituitary-adrenal axis appear in some patients. Osteonecrosis, gastrointestinal, cardiovascular, infectious, or neurological complications probably do not occur. Fetal wastage, prematurity, or congenital malformations have not been proven with this dosage.

Oral glucocorticoids and their complications. A review

Glucocorticoid preparations form one of the cornerstones of the modern medical pharmacopeia. This class of medications has been especially useful to dermatologists, who are purported to be among its most prolific users. Oral glucocorticoids, available now for over 30 years, are prescribed to over 7% of hospitalized patients. Of this group, some 17% may experience adverse effects. It behooves any physician who uses these powerful agents to be aware of the potential complications and side effects. In this article we have undertaken to summarize and discuss selective examples of this rapidly growing segment of the literature.