How to properly use glucocorticoids in patients with rheumatism?

*For medical professionals only for reference Serious adverse reactions caused by glucocorticoids are one of the causes of death in patients with rheumatic immune diseases.
Because of their strong anti-inflammatory and immunosuppressive effects, glucocorticoids are widely used in rheumatic immune diseases
.

However, the adverse effects of glucocorticoids determine the limitations of its use
.

The purpose of this paper is to discuss how to rationally and effectively apply glucocorticoids in rheumatic immune diseases
.

1.
Types of glucocorticoids commonly used in clinical Most patients with rheumatic immune diseases need long-term medication to control the disease, and medium-acting glucocorticoids are often used clinically
.

Some patients also use short-acting and long-acting glucocorticoids to treat rheumatic immune diseases
.

Among them, short-acting preparations are mostly short-term intravenous application, and long-acting preparations are mostly temporary intramuscular injection or intra-articular injection
.

Commonly used glucocorticoid drugs are shown in the table below
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2.
Application of glucocorticoids in rheumatic immune diseases Glucocorticoid dosage application choice NO.
1 Long-term use maintenance dosage: 2.
5-15.
0 mg/d
.

Drugs and medication methods: prednisone (Long), methylprednisolone, triamcinolone; orally
.

Indications: For the treatment of various rheumatic immune diseases
.

NO.
2 Small dose: <0.
5 mg/(kg·d)
.

Drugs and medication methods: mainly prednisone (Long), methylprednisolone, triamcinolone; oral administration
.

Indications: For the initial treatment of primary chronic rheumatic immune diseases
.

NO.
3 Moderate dose: 0.
5-1.
0 mg/(kg·d)
.

Drugs and medication methods: mainly prednisone (Long), methylprednisolone, triamcinolone, hydrocortisone succinate; intravenous or oral application
.

Indications: For the initial treatment of subacute rheumatic immune diseases
.

NO.
4 High-dose dose: >1.
0 mg/(kg·d)
.

Drugs and medication methods: prednisone (Long), methylprednisolone, triamcinolone; intravenous or oral application
.

Indications: For the initial treatment of acute and/or potentially life-threatening worsening rheumatic immune diseases
.

NO.
5 Shock dose: 7.
5-30.
0 mg/(kg·d), maintained for 1 day or several days
.

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 compound betamethasone injection and triamcinolone acetonide, the former being the most commonly used
.

This is one of the means of treating joint inflammation and reducing adverse reactions caused by systemic drugs
.

It has a certain positive effect on relieving severe joint pain and early joint contracture, maintaining joint physiological function and reducing joint cavity effusion
.

3.
Adverse reactions of glucocorticoids and treatment methods (1) Adverse reactions of glucocorticoids Glucocorticoids can inhibit the activity of osteoblasts, increase the excretion of calcium and phosphorus, and cause osteoporosis and fractures
.

Muscle atrophy and nitrogen loss
.

To promote the exacerbation of diabetes or induce hyperglycemia
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Delay wound healing and increase the chance of infection
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(2) How to avoid the effects of adverse reactions Generally speaking, the side effects of glucocorticoids are also affected by factors such as the type of medication, dosage, course of treatment, dosage form and usage
.

For patients, the most effective way to avoid side effects is to cooperate with the doctor to use it rationally
.

01 Osteoporosis Osteoporosis is one of the most common and well-known side effects of long-term glucocorticoid use
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Once it occurs, it is likely to induce fragility fractures
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Countermeasures: For patients who use prednisone at a dose of ≥7.
5 mg/d and plan to continue treatment for more than 3 months, it is recommended to supplement calcium and vitamin D at the same time as starting hormones; for patients at high risk of fracture, it is recommended to add calcium and vitamin D.
Use bisphosphonates to prevent osteoporosis
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If the patient has new unilateral or bilateral hip pain after taking glucocorticoids, he should seek medical examination in time to rule out adverse reactions such as osteoporosis and femoral head necrosis
.

02 Inhibition of hormone regulation ability Long-term use of hormones may inhibit the patient's own ability to regulate hormones
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Countermeasures: Reduce the dose as prescribed by the doctor
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03 Hormone withdrawal reaction If the patient suddenly stops the drug and interrupts the exogenous hormone, and the hormone secretion in the body has not increased accordingly, it will cause a series of symptoms, such as nausea, vomiting, anorexia, fatigue, hypotension, hypoglycemia, thermoregulation Disorders, etc.
, are called hormone withdrawal reactions
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Countermeasures: By continuing to supplement low-dose glucocorticoids, the above symptoms can disappear quickly
.

(3) The following 3 points must be known before taking glucocorticoids.
If you have high blood pressure, diabetes, peptic ulcer, cataract, glaucoma, chronic infection, dyslipidemia and concomitant use of non-steroidal anti-inflammatory drugs, you need to inform your doctor
.

During the use of glucocorticoids, a low-sodium, high-potassium and high-protein diet should be used, including reducing salt intake and eating more vegetables and fruits rich in potassium such as beans, cauliflower, spinach, bitter gourd, bananas, cherries, strawberries,
etc.

When using hormones for more than 3 months, regardless of the dose, life>
.

Glucocorticoids are the basic drugs for many rheumatic immune diseases.
It saves the lives of a large number of severe rheumatic immune diseases and reduces the disability rate of patients
.

But at the same time, it also has many adverse reactions, even fatal side effects
.

Therefore, glucocorticoids are a double-edged sword for patients with rheumatic immune diseases
.

The majority of rheumatologists should pay attention to avoiding the occurrence of serious adverse reactions when applying it clinically
.

References: [1] Zeng Xiaofeng, Tian Xinping.
Rheumatic immunity: the standard use of glucocorticoids is an art [N].
Health News, 2019-12-03(006).
[2] Li Guangyu, Wang Mingxia.
Double-edged sword How to become a sharp sword - Glucocorticoids still need to be used with caution in the treatment of rheumatic immune diseases[J].
Chinese Prescription Drugs, 2010(07):21-23.
[3] Xu Dong, Shi Qun, Zhang Xuan.
Glucocorticoids Use in the treatment of rheumatism and immune diseases[J].
Chinese Journal of Practical Internal Medicine, 2013, 33(10): 775-778.
Source: Fosun Health Doctor Duan Responsible Editor: Juzi Copyright Statement -The medical community strives for the accuracy and reliability of its published content when it is approved, but does not make any commitments and guarantees about the timeliness of the published content and the accuracy and completeness of the cited materials (if any), and does not assume any any liability arising out of the date of such content, possible inaccuracies or incompleteness of the material cited
.

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.