Godfrey B.S. Iyalomhe and Sarah I. Iyalomhe
Uncontrolled and irrational use, coupled with easy availability, low cost and the quick onset of drug action which relieves symptoms, have led to the widespread misuse and abuse of corticosteroids (CSs) by some healthcare professionals and many patients. The aim of this review, therefore, is to attempt a summary of the current use of CSs in Rheumatology. A manual literature and internet (Google, Medline, Embase, HINARI, Cochrane Database) search showed that CSs have a wide range of biological actions including anti-inflammatory and immunosuppressive effects. They can improve the symptoms of patients with rheumatic diseases. They may also have a disease-modifying effect in rheumatoid arthritis (RA), but they are not first-line treatment. Adverse effects (AEs) which may be many are related to the dose and duration of treatment. Patients should be aware of this and be prescribed the lowest effective dose and for the shortest time. Recent trials, utilizing novel chronotherapeutic modified-release (MR) Prednisone formulation given at bedtime, have demonstrated a clinically relevant decrease of morning-stiffness of the joints. Dissociated steroids or selective glucocorticoid receptor agonists (SEGRAs), that dissociate transrepression from transactivation, have shown promising results in collagen induced arthritis. The need of the hour is to strike a balance between CS efficacy and adverse effects while individualising treatment. Enlightenment of healthcare professionals and the public is imperative to guide against the inappropriate and injudicious use.
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