Correct use of glucocorticoids in rheumatism

Glucocorticoids are widely used in rheumatic immune diseases because of their powerful anti-inflammatory and immunosuppressive effects

Commonly used clinically used types of glucocorticoids

Most patients with rheumatic immune diseases need to take long-term medication to control the disease, and clinically apply more potent glucocorticoids

Some patients also use short-acting and long-acting glucocorticoids for rheumatic immune diseases

Application of glucocorticoids in rheumatic immune diseases

Long-term use of maintenance doses

Dosage: 2.

Drugs and methods of administration: prednisone (dragon), methylprednisolone, triamcinolone; Oral

Indications: for the treatment

In small doses

Dosage: <0.

Drugs and methods of taking drugs: mainly prednisone (dragon), methylprednisolone, triamcinolone; Mainly

Indications: for initial treatment

Medium dose

Dosage: 0.

Drugs and methods of taking drugs: mainly prednisone (dragon), methylprednisolone, triamcinolone, hydrocortisone succinate; Intravenous or oral application

Indications: for initial treatment

Large doses

Dosage: > 1.

Medications and methods: prednisone (dragon), methylprednisolone, triamcinolone; Intravenous or oral application

Indications: for the initial treatment

Shock dose

Dose: 7.

Drugs and methods of administration: mainly intravenous injection
of methylprednisolone.

Indications: for particularly critical or potentially life-threatening rheumatic immune diseases
.

In addition to oral administration, another use of glucocorticoids is intra-articular injection, such as co-betamethasone injection and triamcinolone acetonide, the former of which is most commonly used
.
This is one of the means of treating joint inflammation and reducing adverse reactions caused by systemic
medications.
It has a positive effect
on relieving severe joint pain and early joint contractures, maintaining joint physiological function and reducing joint cavity effusion.

Adverse reactions of glucocorticoids and their treatment

Adverse reactions of glucocorticoids

• Glucocorticoids inhibit osteoblast activity and increase calcium and phosphorus excretion, leading to osteoporosis and fractures
.

• Muscle atrophy and nitrogen loss
.

• Promotes exacerbation of diabetes or induces hyperglycemia
.

• Delays wound healing and increases the chance of
infection.

How to circumvent the effects of adverse reactions

In general, the side effects of glucocorticoids are also affected
by factors such as the variety of drugs, dosage, course of treatment, dosage form and usage.

osteoporosis

Osteoporosis is one
of the most common and well-known side effects of long-term glucocorticoid use.
Once it occurs, it is likely to induce fragility fractures
.

Countermeasures: for patients with prednisone doses ≥ 7.
5 mg/day and planned to continue treatment for more than 3 months, it is recommended to give calcium supplementation and vitamin D at the same time as starting hormone use; For patients at high risk of fracture, the addition of bisphosphonates is recommended to prevent osteoporosis
.

If the patient has new unilateral or bilateral hip pain after using glucocorticoids, he should seek medical examination in time to exclude adverse reactions such as osteoporosis and necrosis of the femoral head.

Inhibitor modulation capacity

If the hormone is used for a long time, it may inhibit the patient's own ability
to regulate hormones.

Countermeasures: Reduce the amount
as appropriate according to the doctor's advice.

Hormone withdrawal reaction

If the patient suddenly stops the drug, interrupts the exogenous hormones, and the secretion of hormones in the body has not increased accordingly, it will cause a series of symptoms, such as nausea, vomiting, anorexia, fatigue, hypotension, hypoglycemia, body temperature regulation disorders, etc.
, called hormone withdrawal reaction
.

Countermeasures: These symptoms can quickly disappear
by continuing to supplement with small doses of glucocorticoids.

Caution before corticosteroids are taken

• If you have high blood pressure, diabetes, peptic ulcer, cataracts, glaucoma, chronic infections, dyslipidemia, and a combination of NSAIDs, you should inform your doctor
.

• During glucocorticoid use, a low-sodium, high-potassium, high-protein diet should be used, including reducing salt intake and consuming more potassium-rich vegetables and fruits such as beans, cauliflower, spinach, bitter melon, bananas, cherries, strawberries, etc
.

• When using hormones for more than 3 months, lifestyle adjustments, regardless of dosage, include smoking cessation, avoidance of excessive alcohol consumption, proper sun exposure, adequate functional exercise and fall prevention, along with calcium supplementation and regular or active vitamin D
.

Glucocorticoids are the basic drugs for many rheumatic immune diseases, which save the lives of a large number of patients with severe rheumatic immune diseases and reduce the disability rate of
patients.
But at the same time, it also has many adverse reactions
.
Therefore, when glucocorticoids are used in clinical practice, attention should be paid to avoiding the occurrence
of serious adverse reaction events.

References:

[1] Zeng Xiaofeng,Tian Xinping.
Rheumatic immunity: the normative use of glucocorticoids is an art[N].
Health News, 2019-12-03(006).

[2] Li Guangyu,Wang Mingxia.
How to turn a double-edged sword into a sharp sword- glucocorticoids still need to be cautious in the treatment of rheumatic immune diseases[J].
Chinese Prescription Drugs, 2010(07):21-23.

[3] Xu Dong,Shi Qun,Zhang Xuan.
The use of glucocorticoids in the treatment of rheumatic immunopathy[J].
Chinese Journal of Practical Internal Medicine,2013,33(10):775-778.