Medications for Scleroderma, Arthritis,
Autoimmune and Rheumatic Diseases |
| This page was written by Janey Willis and has not yet been medically edited. See Disclaimer. |
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| Glucocorticoids, Steroids (Prednisone) |
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| Overview of Glucocorticoids, Steroids |
Corticosteroids
strongly increase
the short-term risk of developing
scleroderma renal crisis! | Glucocorticoids are any of a group of steroid hormones, such as cortisone, that are produced by the adrenal cortex and are involved in carbohydrate, protein, and fat metabolism. Glucocorticoids have anti-inflammatory properties. They can be prescribed to dampen or stop the chronic inflammatory chain of events. Depending on the particular glucocorticoid that is used, inflammation can be affected at different points in the inflammatory pathway. |
| Glucocorticoids and steroids should never be stopped suddenly. Drug dosage must be tapered over time in order to allow the adrenal cortex to start producing the hormones that have been replaced by the drug. Always follow your doctor's tapering schedule when coming off these drugs. |
| Corticosteroids (such as prednisone) strongly increase the short-term risk of developing scleroderma renal crisis (kidney failure). It also causes a 70 percent increased risk of developing pneumonia. It is crucial to avoid corticosteroids in patients with systemic scleroderma. (Also see: What is Scleroderma? ) |
| Scleroderma Treatments and Clinical Trials ISN. |
| Use of Glucocorticoid, Steroids (Prednisone) with Autoimmune Diseases |
| Low-dose Prednisolone in Rheumatoid Arthritis (RA): Adverse Effects (AE) of Various Disease Modifying Antirheumatic Drugs (DMARD). Low-dose glucocorticoids retard radiological progression of RA and exhibit a differential effect on survival of DMARD and degree of AE due to DMARD. J Rheumatol April 15 2008 (Also See: Rheumatoid Arthritis and Medications: DMARDS ) |
| The German Network For Systemic Scleroderma - Use Of Corticosteroids And Immunosuppressive Therapy Varies Between Disease Subsets. The study reveals considerable variations of therapeutic regimens among different medical disciplines and, in particular, a high percentage of corticosteroid use. These data will form the framework for following and comparing the outcome of the development of therapeutic guidelines on a national and international level. N. Hunzelmann. AB0507 EULAR 2007. |
| Mycophenolate Mofetil and Intravenous Dexamethasone in the Treatment of Persistent Lupus Myelitis. Subsequent therapy with mycophenolate mofetil and continuous intravenous infusions of dexamethasone resulted in reduction of the lesion's size, disappearance of magnetic resonance imaging enhancement, and a complete recovery. J Rheumatol 2007;34:588-91 (Also see: Lupus ) |
| Corticosteroid Use in Rheumatoid Arthritis (RA): Prevalence, Predictors, Correlates, and Outcomes. Corticosteroid use is associated with adverse longterm outcomes, but the ability to discern causal associations is severely limited by confounding by indication. The idea of "once on corticosteroids, always on corticosteroids" is incorrect and applies to only a minority of patients. J Rheumatol 2007;34:696-705 4 April 2007. (Also see: Rheumatoid Arthritis ) |
| Combination of intravenous pulses of cyclophosphamide and methylprednizolone in patients with systemic sclerosis and interstitial lung disease. The results suggest that the employed combination is safe and effective, mainly in stabilizing the respiratory function of the patients. This goal is more realistic when treatment is given before significant functional compromise has ensued. PubMed. Rheumatol Int. 2007 Feb;27(4):357-61. (Also see: Pulmonary Fibrosis and Cyclophosphamide for Scleroderma Lung Disease ) |
| Glucocorticoid doses and Glucocorticoid Treatment Regimens in Rheumatology. J. Da Silva. SP0067 EULAR 2003. |
| General Side Effects of Glucocorticoid, Steroids (Prednisone) |
| Prednisone Side Effects include hirsutism (excessive body hair), weight gain, undesirable redistribution of body fat (buffalo hump and fat pads), glucose intolerance, hypertension, increased susceptibility to infection, bone thinning, easy bruising, mood swings, insomnia, avascular necrosis of bone, abdominal striae (stretch marks), cataracts, and acne. The Johns Hopkins Vasculitis Center. |
| Not Always Smooth Sailing. "Since being on prednisone, I've been up and down with my weight and up and down with the milligram dosage. I'm 19 and I've been on prednisone for 11 years." says Carlie Brinker. MDA. Quest. May-June 2007. |
| Appropriate Preventive Treatment Strategies to Minimize Glucocorticoid Adverse Effects. J. Kirwan. SP0068 EULAR 2003. |
| Weight Gain with Prednisone |
| Prednisone Weight Gain. Weight gain is usually the most dreaded side–effects of steroid use, incurred to some degree by nearly all patients who take them. In addition to causing weight gain, prednisone leads to a redistribution of body fat to places that are undesirable, particularly the face, back of the neck, and abdomen. The John Hopkins Vasculitis Center. |
| Will the weight I gained while taking prednisone ever go away? Prednisone causes the body to retain sodium (salt) and lose potassium. This combination can result in fluid retention, weight gain, and bloating. Measures that can be used to avoid fluid retention in the first place are eating a reduced sodium diet and increasing potassium intake through potassium-rich foods (such as bananas, cantaloupe, grapefruit, and lima beans). About.com. |
| Osteoporosis and Glucocorticoid, Steroids (Prednisone) |
| The Effects of Medications on Bone. Corticosteroids and cancer chemotherapeutic agents generally affect bone adversely and increase fracture. J Am Acad Orthop Surg, Vol 15, No 8, August 2007, 450-460. (Also see: Skeletal Involvement ) |
| Medical steroid's baffling connection to osteoporosis becomes clearer. Researchers have now identified osteoclasts, cells that dismantle old bone, as the essential link between osteoporosis and cortisone. EurekAlert! Washington University School of Medicine. 07/27/06. (Also see: Osteoporosis in Scleroderma) |
| Alfacalcidol Versus Plain Vitamin D in the Treatment of Glucocorticoid/ Inflammation-Induced Osteoporosis. Alfacalcidol plus calcium is highly superior to plain vitamin D3 plus calcium in the treatment of established GC (glucocorticoid) induced osteoporosis, and the latter should no longer be used as monotherapy. J Rheumatol 2005 September;32 Suppl 76:33-40. (Also see: Osteoporosis in Scleroderma) |
| Vertebral Fracture and Bone Mineral Density in Women Receiving High Dose Glucocorticoids for Treatment of Autoimmune Diseases. The pathology of vertebral fracture secondary to high dose glucocorticoid therapy is multifactorial and possibly involves lipid metabolism. J Rheumatol 2005 May;32:863-9. (Also see: Skeletal Involvement) |
| Etidronate Prevents High Dose Glucocorticoid Induced Bone Loss in Premenopausal Individuals with Systemic Autoimmune Diseases. The results suggest that etidronate could prevent high dose glucocorticoid induced bone loss in premenopausal individuals with systemic autoimmune diseases. J Rheumatol No. 1 Jan. 2004;31:163-6. (Also see: Medications) |
| Renal Crisis and Glucocorticoid, Steroids (Prednisone) |
Corticosteroids
strongly increase
the short-term risk of developing
scleroderma renal crisis! | Scleroderma Renal Crisis (SRC): Retrospective Multicenter Analysis of 50 Patients. Despite extensive ACEI (angiotensin-convertase inhibitors) use, scleroderma renal crisis (SRC) remains associated with severe morbidity and mortality, and that corticosteroids (CS) might strongly increase the short-term risk of developing scleroderma renal crisis. These findings further support the crucial preventive role of avoiding corticosteroids in patients at risk for scleroderma renal crisis , as well as the persistent need for effective adjunctive or alternative agents to manage SRC. L. Teixeira. FRI0145 EULAR 2005. (Also see: What is Scleroderma and Scleroderma Renal Involvement) |
| A 60 year old male patient having systemic scleroderma and normotensive scleroderma renal crisis. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. PubMed. Medicina (B Aires) 2003;63(1):49-50. (Also see: Renal Involvement) |
| Additional Risks with Glucocorticoid, Steroids (Prednisone) |
| Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population-based cohort study. RF-positive but not RF-negative patients were at increased risk of cardiovascular events following exposure to glucocorticoids. (Wiley InterScience) Arthritis and Rheumatism Vol 56, Issue 3, Pages 820 - 830. (Also see: Rheumatoid Arthritis ) |
| Pulmonary-renal syndrome (PRS) in systemic sclerosis: a report of three cases and review of the literature. Clinical courses of the patients with PRS with thrombotic microangiopathy suggest that high-dose corticosteroid therapy is a trigger of diffuse alveolar hemorrhage in patients with diffuse SSc with signs of thrombotic microangiopathy. PubMed. Mod Rheumatol. 2007;17(1):37-44. (Also see: Renal Involvement, Pulmonary Involvement, and Clinical Trials: Negative Results ) |
| Studying the Benefit/Risk Ratio of Glucocorticoids (GC) in Rheumatoid Arthritis GC treatment is a dynamic process, with lots of patients stopping or starting these drugs each year. This shows that physicians constantly scrutinize the need for ongoing treatment, although the study also demonstrated that the indication-setting to start or stop GC was highly variable between individual practices. Editorial Journal of Rheumatology Vol 34: No. 4 April 2007. (Also see: Rheumatoid Arthritis ) |
| Prednisone associated with increased risk of Pneumonia. Pneumonia is among the major causes of mortality and morbidity in rheumatoid arthritis. According to a study conducted by the National data bank for Rheumatic diseases prednisone is associated with a 70 percent increased risk of developing pneumonia. arthritis.about.com. 03-16-06. (Also see: Rheumatoid Arthritis) |
| Steroids and brain atrophy in multiple sclerosis. It appears that chronic low-dose treatment with corticosteroids may contribute to irreversible loss of brain tissue in a variety of autoimmune diseases. Evidence is mounting that high-dose corticosteroids may induce reversible short-term brain volume changes. PubMed. J Neurol Sci. 2005 May 5. (Also see: Multiple Sclerosis and Brain Involvement) |
| Brain abscesses caused by Abiotrophia defectiva: complication of immunosuppressive therapy in a patient with connective-tissue disease. We report the case of a patient who developed brain abscesses caused by Abiotrophia defectiva. The patient was treated with prednisone and cyclophosphamide for connective-tissue disease (Lupus-Sjogren's overlap syndrome). PubMed. Scand J Infect Dis. 2004;36(6-7):497-9. (Also see: Lupus, Sjogren's Syndrome, Overlap Syndrome, and Brain Involvement) |
| Infections in systemic connective tissue diseases: systemic lupus erythematosus, scleroderma, and polymyositis/dermatomyositis. In SLE, scleroderma, and PM/DM, infections are important causes of morbidity and mortality. Thus, patients with these diseases, especially when receiving high doses of corticosteroids and immunosuppressive therapy, need to be monitored closely for these infections. PubMed. Rheum Dis Clin North Am 2003 Feb;29(1):163-84. |
