Abstract
In this chapter, we discuss important concepts that are useful to the neurologist using corticosteroids in disease management. Corticosteroids are one of the most common medications used to treat many inflammatory, autoimmune, and allergic conditions. Corticosteroids have genomic and non-genomic effects on cells. The two main genomic effects of corticosteroids are transactivation and transrepression. Many of the side effects of corticosteroids are mediated via transactivation, while the beneficial anti-inflammatory effects are mediated via transrepression. Low-dose corticosteroids are used as maintenance therapy for chronic autoimmune and inflammatory conditions. Higher doses of corticosteroids (including pulse therapy for organ- or life-threatening disease) are used for initial treatment and are tapered once the disease process is controlled. Major side effects of corticosteroids include lipodystrophy, weight gain, metabolic disorders, neuropsychiatric alterations, glucocorticoid-induced osteoporosis, increased infection risk, cataracts, and skin atrophy. The dose and duration of corticosteroids should be minimized to reduce the occurrence of these side effects. Optimizing therapeutic response and steps to minimize side effects are discussed in the text of this chapter.
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References
Burns CM. The history of cortisone discovery and development. Rheum Dis Clin N Am. 2016 Feb;42(1):1–14. vii.
Schacke H, Docke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther. 2002;96(1):23–43.
Stahn C, Buttgereit F. Genomic and nongenomic effects of glucocorticoids. Nat Clin Pract Rheumatol. 2008;4(10):525–33.
De Bosscher K, Van Craenenbroeck K, Meijer OC, Haegeman G. Selective transrepression versus transactivation mechanisms by glucocorticoid receptor modulators in stress and immune systems. Eur J Pharmacol. 2008;583(2–3):290–302.
Newton R. Molecular mechanisms of glucocorticoid action: what is important? Thorax. 2000 Jul;55(7):603–13.
Schacke H, Schottelius A, Docke WD, Strehlke P, Jaroch S, Schmees N, et al. Dissociation of transactivation from transrepression by a selective glucocorticoid receptor agonist leads to separation of therapeutic effects from side effects. Proc Natl Acad Sci U S A. 2004;101(1):227–32.
Buttgereit F, Brand MD, Burmester GR. Equivalent doses and relative drug potencies for non-genomic glucocorticoid effects: a novel glucocorticoid hierarchy. Biochem Pharmacol. 1999;58(2):363–8.
Buttgereit F, da Silva JA, Boers M, Burmester GR, Cutolo M, Jacobs J, et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis. 2002;61(8):718–22.
Duru N, van der Goes MC, Jacobs JW, Andrews T, Boers M, Buttgereit F, et al. Eular evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2013;72(12):1905–13.
Buttgereit F, Straub RH, Wehling M, Burmester GR. Glucocorticoids in the treatment of rheumatic diseases: an update on the mechanisms of action. Arthritis Rheum. 2004;50(11):3408–17.
Fardet L, Flahault A, Kettaneh A, Tiev KP, Genereau T, Toledano C, et al. Corticosteroid-induced clinical adverse events: frequency, risk factors and patient’s opinion. Br J Dermatol. 2007;157(1):142–8.
Curtis JR, Westfall AO, Allison J, Bijlsma JW, Freeman A, George V, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55(3):420–6.
Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30.
Judd LL, Schettler PJ, Brown ES, Wolkowitz OM, Sternberg EM, Bender BG, et al. Adverse consequences of glucocorticoid medication: psychological, cognitive, and behavioral effects. Am J Psychiatry. 2014;171(10):1045–51.
Lanza FL, Chan FK, Quigley EM. Practice parameters Committee of the American College of G. guidelines for prevention of nsaid-related ulcer complications. Am J Gastroenterol. 2009;104(3):728–38.
Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin N Am. 2016;42(1):157–76. ix–x.
Centers for Disease Control and Prevention. Recommended adult immunization schedule-United States. 2015 [cited 2016 October 5]; Available from: http://www.cdc.gov/vaccines/schedules/hcp/adult.html
Center for Disease Control and Prevention. Shingles (herpes zoster). 2014 [cited 2016 October 5]; Available from: https://www.cdc.gov/shingles/vaccination.html
Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc. 1996;71(1):5–13.
Anonymous. Targeted tuberculin testing and treatment of latent tuberculosis infection. American thoracic society. MMWR Recomm Reps. 2000;49(RR-6):1–51.
Buckley L, Guyatt G, Fink HA et al., 2017 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthr Rheum, 2017; 69: 1521–37.
Berthon BS, MacDonald-Wicks LK, Wood LG. A systematic review of the effect of oral glucocorticoids on energy intake, appetite, and body weight in humans. Nutr Res. 2014;34(3):179–90.
Schoepe S, Schacke H, May E, Asadullah K. Glucocorticoid therapy-induced skin atrophy. Exp Dermatol. 2006;15(6):406–20.
Fardet L, Petersen I, Nazareth I. Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. Am J Psychiatry. 2012;169(5):491–7.
Fardet L, Petersen I, Nazareth I. Prevalence of long-term oral glucocorticoid prescriptions in the Uk over the past 20 years. Rheumatology. 2011;50(11):1982–90.
Canalis E, Mazziotti G, Giustina A, Bilezikian JP. Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int. 2007;18(10):1319–28.
Rizzoli R, Biver E. Glucocorticoid-induced osteoporosis: who to treat with what agent? Nat Rev Rheumatol. 2015;11(2):98–109.
Natsui K, Tanaka K, Suda M, Yasoda A, Sakuma Y, Ozasa A, et al. High-dose glucocorticoid treatment induces rapid loss of trabecular bone mineral density and lean body mass. Osteoporos Int. 2006;17(1):105–8.
Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Use of oral corticosteroids and risk of fractures. J Bone Miner Res Off J Am Soc Bone Miner Res 2000;15(6):993–1000.
Ramsey-Goldman R, Dunn JE, Huang CF, Dunlop D, Rairie JE, Fitzgerald S, et al. Frequency of fractures in women with systemic lupus erythematosus: comparison with United States population data. Arthritis Rheum. 1999;42(5):882–90.
van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology. 2000;39(12):1383–9.
Buehring B, Viswanathan R, Binkley N, Busse W. Glucocorticoid-induced osteoporosis: an update on effects and management. J Allergy Clin Immunol. 2013;132(5):1019–30.
Whittier X, Saag KG. Glucocorticoid-induced osteoporosis. Rheum Dis Clin N Am. 2016;42(1):177–89. x.
Lekamwasam S, Adachi JD, Agnusdei D, Bilezikian J, Boonen S, Borgstrom F, et al. A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. Osteoporos Int. 2012;23(9):2257–76.
Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum. 2003;48(11):3224–9.
Saag KG, Zanchetta JR, Devogelaer JP, Adler RA, Eastell R, See K, et al. Effects of teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: thirty-six-month results of a randomized, double-blind, controlled trial. Arthritis Rheum. 2009;60(11):3346–55.
Powell C, Chang C, Naguwa SM, Cheema G, Gershwin ME. Steroid induced osteonecrosis: an analysis of steroid dosing risk. Autoimmunity reviews. Review. 2010;9(11):721–43.
Franchimont D. Overview of the actions of glucocorticoids on the immune response: a good model to characterize new pathways of immunosuppression for new treatment strategies. Ann N Y Acad Sci. 2004;1024:124–37.
Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11(6):954–63.
Cutolo M, Seriolo B, Pizzorni C, Secchi ME, Soldano S, Paolino S, et al. Use of glucocorticoids and risk of infections. Autoimmun Rev. 2008;8(2):153–5.
Jones R 3rd, Rhee DJ. Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol. 2006;17(2):163–7.
Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991;114(9):735–40.
Wei L, MacDonald TM, Walker BR. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004;141(10):764–70.
Souverein PC, Berard A, Van Staa TP, Cooper C, Egberts AC, Leufkens HG, et al. Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart. 2004;90(8):859–65.
Maradit Kremers H, Reinalda MS, Crowson CS, Davis JM 3rd, Hunder GG, Gabriel SE. Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica. Arthritis Rheum. 2007;57(2):279–86.
Buttgereit F, Burmester GR, Lipworth BJ. Inflammation, glucocorticoids and risk of cardiovascular disease. Nat Clin Pract Rheumatol. 2009;5(1):18–9.
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Lim, S.Y., Bolster, M.B. (2019). Corticosteroids. In: Cho, T., Bhattacharyya, S., Helfgott, S. (eds) Neurorheumatology. Springer, Cham. https://doi.org/10.1007/978-3-030-16928-2_28
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