Corticosteroid Rheumatoid Arthritis

The outer layer or cortex of the adrenal gland is the source of a large group of sub stances known as corticosteroids Like the bile acids they are derived from cholesterol by oxidation with cleavage of a portion of the alkyl substituent on the D ring Cortisol IS the most abundant of the corticosteroids but cortisone is probably the best known Cortisone is commonly prescribed as an antiinflammatory drug especially m the treat ment of rheumatoid arthritis... 

The corticosteroids may be used to treat rheumatic disorders such as ankylosing spondylitis, rheumatoid arthritis, gout, bursitis (inflammation of the bursa, usually the bursa of the shoulder), and osteoarthritis. 

Corticosteroids do not heal illnesses, but they are widely used in various conditions when it is necessary to utilize their anti-inflammatory, immunosuppressant, and mineralo-corticoid properties. In addition, they are used in replacement therapy for patients who have adrenal insufficiency. Corticosteroids can be used in vital situations for asthma, severe allergic reactions, and transplant rejections. They are effective in noninfectious granulomatous diseases such as sarcoidosis, collagen vascular disease, rheumatoid arthritis, and leukemia. Steroids are used as lotions, ointments, etc. in treating a number of dermatological and ophthalmologic diseases. 

Darmawan J, Nasution AR, Rasker JJ, Zhao DB, Soorosh GS, Chen SL et al. Sustained clinical and radiological remission in DMARD refractory rheumatoid arthritis treated with step-down bridge combination therapy of five immunosuppressants without corticosteroids in a 6 years observation in Asia - WHO-ILAR COPCORD Stage II Treatment. APLAR J Rheumatol 2007 10 in press. 

The use of corticosteroids is often suggested for elderly patients with chronic tophaceous gout, since gout in the older individual often displays symptoms similar to those of rheumatoid arthritis. Patients can be given short-term administration of corticosteroids, especially for acute flare-ups. The concomitant use of alcohol, nonsteroidal antiinflammatory drugs, and most diuretics should be avoided. 

As soon as corticosteroids, such as cortisone, were used in the treatment of rheumatoid arthritis (glucocorticoid activity), important undesirable side effects appeared (sodium retention). In view of lowering the sodium retention, while increasing the anti-inflammatory activity. Fried performed various chemical modifications. Thus, he could observe that introducing a fluorine atom at the 9a position of the hydrocortisone acetate highly enhanced (11 times) the glucocorticoid activity, while the undesired sodium retention was lowered [130]. 

Corticosteroids have been used in 60-70% of rheumatoid arthritis patients. Their effects are prompt and dramatic, and they are capable of slowing the appearance of new bone erosions. Corticosteroids may be administered for certain serious extra-articular manifestations of... 

Kotha P, McGreevy MJ, Kotha A, Look M, Weisman MH. Early deaths with thrombolytic therapy for acute myocardial infarction in corticosteroid-dependent rheumatoid arthritis. Clin Cardiol 1998 21(ll) 853-6. 

Shuster S, Raffle EJ, Bottoms E. Skin collagen in rheumatoid arthritis and the effect of corticosteroids. Lancet 1967 2 525. 

Garton MJ, Reid DM. Bone mineral density of the hip and of the anteroposterior and lateral dimensions of the spine in men with rheumatoid arthritis. Effects of low-dose corticosteroids. Arthritis Rheum 1993 36(2) 222-8. 

Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. Effects of low dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol 1995 22(6) 1055-9. 

Rennie MJ. Muscle protein synthesis in patients with rheumatoid arthritis effect of chronic corticosteroid therapy on prostaglandin F2 alpha availability. Eur J Clin Invest 1991 21(4) 406-12. 

Kimura Y, Fieldston E, Devries-Vandervlugt B, Li S, Imundo L. High dose, alternate day corticosteroids for systemic onset juvenile rheumatoid arthritis. J Rheumatol 2000 27(8) 2018-24. 

Gotzsche PC, Johansen HK Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis. Cochrane Database SystRev. 2004 CD000189. 

Jacobs J fy Geenen R, Evers AW, et al. Short term effects of corticosteroid pulse treatment on disease activity and the wellbeing of patients with active rheumatoid arthritis. Ann Rheum Dis. 2001 60 61-64. 

Corticotropin (corticotrophin adrenocorticotrophin ACTH) is a straight-chain polypeptide with39 amino acid residues, and its function is to control the activity of the adrenal cortex, particularly the production of corticosteroids. Secretion of the hormone is controlled by corticotropin-releasing hormone (CRH) from the hypothalamus. ACTH was formerly used as an alternative to corticosteroid therapy in rheumatoid arthritis, but its value was limited by variable therapeutic response. ACTH may be used to test adrenocortical function. It has mainly been replaced for this purpose by the synthetic analoguetetracosactide (tetracosactrin) (Figure 7.10), which contains the first 24 amino acid residues of ACTH, and is preferred because of its shorter duration of action and lower allergenicity. 

Effective in therapy of rheumatoid arthritis, especially in conjunction with corticosteroid 412... 

Corticosteroids have been used in 60-70% of rheumatoid arthritis patients. Their effects are prompt and dramatic, and they are capable of slowing the appearance of new bone erosions. Corticosteroids may be administered for certain serious extra-articular manifestations such as pericarditis or eye involvement or during periods of exacerbation. When prednisone is required for long-term therapy, the dosage should not exceed 7.5 mg daily, and gradual reduction of the dose should be encouraged. Alternate-day corticosteroid therapy is usually unsuccessful in rheumatoid arthritis. 

Corticosteroids have a range of activity. They have potent antiinflammatory and immunosuppressive activity. Many synthetic drugs are available as corticosteroids. In appropriate doses, these are used as replacement therapy in adrenal insufficiency. The topical application of corticosteroids is safer when compared with systemic use. Corticosteroids should be used in smaller doses for the shortest duration of time. A high dose may be used for life-threatening syndromes or diseases. A tapering pattern of withdrawal should be followed to avoid complications of sudden withdrawal. Systemic therapy is indicated in a variety of conditions. These are administered by intraarticular injections with aseptic conditions for rheumatoid arthritis and osteoarthritis. In skin diseases, such as eczema, contact dermatitis, and psoriasis, corticosteroids are used topically. In some cases, steroids are combined with antimicrobial substances such as neomycin. 

Corticosteroids—a group of anti-inflammatory drugs similar to the natural corticosteroid hormones produced by the cortex of the adrenal glands. The disorders that often improve upon corticosteroid treatment include asthma, allergic rhinitis, eczema, and rheumatoid arthritis. 

Posterior subcapsular cataracts (PSCs) can occur with all routes of administration (Figure 12-2), including systemic, topical, cutaneous, nasal aerosols, and inhalation corticosteroids. In a study of 44 rheumatoid arthritis patients treated with various steroids, including prednisone and dexamethasone, 17 (39%) developed bilateral PSCs. Dosage and duration of therapy appeared to be correlated with the incidence of cataract development. Patients who received prednisone therapy for 1 to 4 years showed an 11% incidence if the dose range was less than 10 mg/day a 30% incidence if the dose was... 

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