A review of the rational use of corticosteroids

Understanding of the use of corticosteroids has been aided by knowledge of their effect on cellular protein synthesis and by an appreciation of how modification of their molecular structure alters their pharmacological action. Their ability to modulate the immune response and to diminish inflammation make them useful in rheumatology, respiratory diseases, allergies, endocrine and metabolic disorders, blood disorders, gastro-intestinal diseases, neurological and muscular diseases, renal diseases, cardiovascular disorders and skin diseases. They have been widely tried empirically and, sometimes, they have proved unequivocally effective. Often there has been a need for cooperative clinical trials to establish their efficacy, and initial enthusiasm for corticosteroids has been tempered by a better appreciation of their limitations, especially in infections and ophthalmology. Those areas where either controlled trials or other persuasive evidence has established a place for their use are reviewed.