Corticosteroids

Nowhere is there more controversy in rheumatic diseases than the role of corticosteroids, and that is the reason for the development of this issue. Marcy Bolster has done a magnificent job in creating a list of topics and expert reviews that address the individual pieces of the controversy, including the much maligned role of steroids in rheumatoid arthritis to the important role they play in the management of diseases where other options are few, such as vasculitis and myositis. Their acute versus chronic use is emphasized in articles on toxicity and mechanism of action, and we now have information about steroids on the molecular level that informs us about the variations we see clinically regarding risks and benefits. The history of corticosteroid discovery and its relationship to the war effort is a fascinating story that needed to be brought forward in this issue since many of our colleagues forget the influences of societal factors on discovery. With the almost explosive use of injectable steroids for localized conditions come the risks and dangers that are carefully laid out in this issue. As Dr Bolster indicates, it is time to acknowledge and reassess our use of these powerful tools.

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