Corticosteroids autoimmune disease

The immunosuppressive effects of corticosteroids are employed in organ transplantation programs in combination with other immunosuppressive modalities, for the management of a variety of autoimmune diseases and to suppress allergic reactions. 

Corticosteroids, often given in conjunction with azathioprin, improve hepatic function and may reduce the risk of advancing autoimmune disease-associated cirrhosis. 

Although corticosteroids possess immunosuppressive properties, their real value is in controlling the inflammation that can accompany transplantation and autoimmune disorders. Virtually all phases of the inflammatory process are affected by these drugs. Corticosteroid therapy alone is successful in only a limited number of autoimmune diseases, such as idiopathic thrombocytopenia, hemolytic anemia, and polymyalgia rheumatica. 

Advantage is taken of the properties of antimctabolitcs in chemotherapy. In cancer chemotherapy, several antimetabolites are used. These include methotrexate, 6-mercaptopunne, 6-thioguanine, 5-fluorouracil, and cystine arabinoside. In the chemotherapy of metastatic breast cancer, 5-fluorouracil and methotrexate, in combination with cyclophosphamide, have been used. Antimetabolites, sometimes along with corticosteroids, are used in the therapy of various autoimmune diseases, such as thrombocytenic purpura, thyroiditis, Goodpasture s syndrome, among others. 

Melatonin has been shown to boost certain parts of the immune system. It boosts the activity of natural killer cells, a type of immune cell. It also prevents apoptosis, a type of destruction of T-lymphocytes, which are other important immune cells found in the bloodstream. Melatonin also limits the effect of corticosteroids on the immune system Corticosteroids are very potent drugs that are sometimes used to inhibit the immune system. Some people have autoimmune diseases in which their immune system attacks the cells of their own bodies. Physicians frequently prescribe corticosteroids for these individuals. 

Resurgence of chronic disease which has progressed in severity although its consequences have been wholly or partly suppressed, i.e. a catching-up phenomenon, is an obvious possible consequence of withdrawal of effective therapy, e.g. levodopa in Parkinson s disease in corticosteroid withdrawal in autoimmune disease there may be both resurgence and rebound. 

Myasthenia gravis is a progressive disorder characterized by muscle weakness eye muscles are often the first affected. Research has shown it to be an autoimmune disease in which the victim forms antibodies to his or her nicotinic acetylcholine receptors at motor endplates. It is characterized by fatigability and weakness of the skeletal muscles, especially those of the eyes. Approximately 90% of the patients have droopy eyelids and double vision. Treatments include corticosteroids and thymectomy to reduce the actions of the immune system and anti-ChE agents such as pyridostigmine to improve the effectiveness of the receptors that remain. 

Ideally, stress hormones damp down an immune response that has run its course. When the HPA axis is continually running at a high level, however, the damping down can have a downside, leading to decreased ability to release the interleukins and fight infection. [...] Conversely, there is evidence that a depressed HPA axis, resulting in too little corticosteroid, can lead to a hyperactive immune system and increased risk of developing autoimmune diseases - diseases in which the immune system attacks the body s own cells.19... 

Fomierly, adrenal gland destruction was often due to tuberculosis autoimmune disease is now the main cause of primary adrenal failure. Both cortisol and itldosterone production may be affected. Secondary failure to produce cortisol is more common. Frequently, this is due to long-standing suppression and subsequent impairment of the hypothalamic-pituitary-adrenocortical axis from therapeutic administration of corticosteroids. The causes of adrenal insufficiency are summarized in Figure 2. 

The corticosteroid prednisone is used extensively as an immunosuppressant in autoimmune diseases and organ transplantation. Glucocorticoids have multiple actions, including those described. The answer is (E). 

Theoretically, astragalus could be incompatible with immune suppressant drugs such as cyclosporine and corticosteroids (Upton 1999). A limited number of human studies have indicated that astragalus increases the therapeutic effects of corticosteroids and cyclophosphamide in patients with autoimmune disease (Cai et al. 2006 Pan et al. 2008 Su et al. 2007), while animal studies have indicated a reversal of cyclophosphamide-induced immune suppression (Chu et al. 1988b, 1988c). 

Corticosteroids are commonly used to reduce inflammation (innate immunity), treat autoimmune diseases such as systemic lupus erythematosus (SLE), and as a prophylactic measure to prevent transplant rejection. The adrenocorticosteroid prednisone is often coadministered with other immunosuppressives such as cyclosporine and azathioprine [36]. 

Osteoporosis is a metabolic bone disease characterized by low bone mass and micro-architectural deterioration of bone tissue. This will lead to bone fragility and consequent increase in bone fracture risk. Mean bone mineral density (BMD) is measured with dual X-ray absorptiometry (DEXA) and expressed in Tsc (Tscore). WHO standards are a Tsc that is 1 standard deviation (SD) below mean BMD is graded as normal bone, Tsc between 1 and 1.5 SD below mean BMD is graded as osteopenia and a Tsc of more than 2.5 SD below mean BMD is graded as osteoporosis. When the Tsc is below 1.5 SD mean BMD prevention of osteoporosis must be initiated. Primary osteoporosis is caused mainly by hormone deflciency in both women and men. Secondary osteoporosis may result from endocrine, metabolic, nutritional and autoimmune causes or from immobility because of trauma. Also the use of medicaments such as corticosteroids may be contributing. 

Topical corticosteroids are most useful in inflammatory dermatoses, such as eczematous dermatitis and psoriasis they may also be helpful in other skin diseases that have a prominent inflammatory component, such as autoimmune blistering diseases (e.g., bullous pemphigoid and pemphigus vulgaris) and lupus erythematosus. 

Autoimmune hepatitis typically occurs in females, at puberty and between the ages of 40 and 70. It can also occur in males at any age. It may present in a number of ways as a mild hepatitis, as a severe acute hepatitis or as established cirrhosis. The functioning capacity of the liver will vary depending on the stage of disease. The diagnosis of AIH is based on serum biochemistry, liver histology, and the presence of certain autoantibodies in the serum. Exclusion of other potential causes of hepatitis, e.g. hepatitis B or C, alcohol consumption, is needed before a definitive diagnosis can be made. There are no featnres that are specifically indicative of AIH, but it usually responds to treatment with corticosteroids. Once remission is indnced azathioprine or... 

Osteoporosis is also common in those on long-term corticosteroid therapy (for example patients with autoimmune hepatitis or coexisting inflammatory bowel disease). Patients with chronic liver disease may also have other risk factors for osteoporosis related to their disease state. These include vitamin D deficiency, excessive alcohol consumption, poor diet, physical inactivity and low body mass index. Oestrogen deficiency in the postmenopausal stage further increases the risk. 

Te use of NSAIDS and other anti-inflammatory therapies are similar to those used in other autoimmune arthritic disorders. Corticosteroid injections for severe pain and inflammation at specific joints are standard therapy. For severe forms of the disease immunomoduladng and-rheumatic drugs such as methodexate and sulfasalazine are effecdve. As with other similar disorders, the biologic TNF a inhibitors are currently prescribed for severe Reiter s synchome. 

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