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[Systemic corticosteroid therapy in rheumatology, advantages and risks]
J C Gerster1, A K So, P Burckhardt
1Service de Rhumatologie, Médecine Physique et Réhabilitation, CHUV, Lausanne.
Praxis
|September 25, 1998
Summary
Corticosteroids are vital for treating rheumatoid arthritis and polymyalgia rheumatica, especially when other treatments fail. Long-term use requires calcium and vitamin D to prevent bone loss, with Deflazacort offering a potential solution.
Area of Science:
- Rheumatology
- Endocrinology
- Pharmacology
Context:
- Corticosteroids are frequently used in managing autoimmune conditions.
- Their role in rheumatoid arthritis (RA) treatment is significant, particularly after conventional therapies prove insufficient.
- In cases of systemic involvement or polymyalgia rheumatica (PMR), corticosteroids are often initiated earlier and at higher doses.
Purpose:
- To outline the established role of corticosteroids in managing rheumatoid arthritis and polymyalgia rheumatica.
- To highlight the indications for corticosteroid use in these conditions, including treatment failure and systemic disease.
- To address the significant risks associated with long-term corticosteroid therapy, such as infection and bone demineralization.
Summary:
- Corticosteroids are a key treatment for rheumatoid arthritis (RA) when non-steroidal anti-inflammatory drugs or foundational therapies are ineffective.
- For polymyalgia rheumatica (PMR), corticosteroids are the primary treatment, irrespective of concurrent temporal arteritis.
- Long-term corticosteroid use increases infection risk and bone demineralization, necessitating systematic calcium and vitamin D supplementation.
- Deflazacort, a specific corticosteroid, may mitigate calcium loss and reduce bone demineralization.
Impact:
- Informs clinical practice regarding the appropriate use of corticosteroids in RA and PMR.
- Emphasizes the critical need for proactive management of side effects, particularly bone health, in patients on long-term corticosteroid therapy.
- Suggests Deflazacort as a potentially bone-sparing alternative for long-term corticosteroid treatment.