Corticosteroids

Serious adverse effects are produced by long-term, high-dose exposure to the corticosteroids; therefore, these drugs are not agents of choice for the treatment of rheumatic disease. In general, the use of low-dose corti-costeroids avoids significant side effects (e.g. fluid retention, osteoporosis, GI bleeding, immunosuppression) but does not completely control the disease. However, for patients whose disease is refractory to other agents or who cannot tolerate the side effects of other DMARDs, a corticosteroid such as prednisone may be used to control symptoms. Low-dose corticosteroids may also be used as an alternative to more toxic DMARDs in pregnant, elderly, or debilitated individuals. Intraarticular injection of corticosteroids can control acute inflammation of a specific joint without causing systemic side effects. High-dose steroids can control severe systemic manifestations of autoimmune disease, such as iritis, pericarditis, nephritis, or vasculitis. Following discontinuation of corticosteroid treatment, rebound joint deterioration is common.

A detailed discussion of the pharmacodynamics, mechanism of action, and adverse effects of the corti-costeroids and their role in therapeutics can be found in Chapter 60.

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