Mechanisms of action, dosage schedules, and side effects of steroid therapy

Two themes are prominent in this year's literature dealing with glucocorticoids and musculoskeletal diseases. First, a high degree of attention has been focused on the use of high-dose intravenous methylprednisolone in rheumatoid arthritis. Despite a number of studies, however, opinion regarding its usefulness as a short-term, adjunctive therapy remains divided. Nonetheless, experience continues to support the view that intravenous methylprednisolone is associated with a relative lack of untoward effects. Second, attention has also been focused on steroid-induced osteoporosis. The heterogeneity of the impact of steroids on bone mineral density is perhaps surprising. The assumption that the effect of glucocorticoids on bone is uniformly large and sustained is clearly open to challenge, although the mechanisms underlying differences in host response are unclear. Definition of patients at higher risk for steroid-induced osteoporosis remains a priority.