Corticosteroids: Friends and Foes

Marcy B. Bolster, MD, Editor
Corticosteroids have been a mainstay of treatment employed by rheumatologists since the Nobel Prize–winning discovery of cortisone in 1950 by Drs Hench, Kendall, and Reichstein. The history of cortisone discovery is eloquently described in the first article of this issue, as written by Christopher Burns, MD, and sets the stage for recognition of value in efficacy offered by this pharmacologic innovation as well as the quickly appreciated potential for toxicities. In the past 65 years, many of our patients have benefited from the rapid anti-inflammatory and immune-suppressing effects of these potent medications. Much continues to be learned about the varying biologic effects at the tissue level as mediated by the glucocorticoid receptor and its multiple isoforms. The mechanism of action is elegantly described by Drs Ramamoorthy and Cidlowski, distinguishing the recognized heterogeneity of glucocorticoid responsiveness among individuals. The other articles in this issue comprehensively address the impressive role played by corticosteroids in autoimmune and inflammatory diseases, such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory myopathy, systemic sclerosis, polymyalgia rheumatica, giant cell arteritis, other systemic vasculitides, and sarcoidosis. In addition to these inflammatory conditions, Dr Markman reports on the utility of corticosteroid injections for spinal pain conditions. In contrast to the valued efficacy of corticosteroids for this multitude of conditions, it is essential that we acknowledge the inherent risks with particular emphasis placed on bone health and infection associated with corticosteroid use, as discussed by Drs Whittier and Saag and Drs Youssef, Novosad, and Winthrop, respectively. A fine balance exists between the good and the evil played by these powerful medications while tempering the immune response in rheumatic disease. We, as physicians, as well as our patients, must appreciate the “friendship” of corticosteroids in providing healing. It is essential that we, however, also acknowledge the intercalation of potential toxicities with the prospect of this therapeutic advantage.

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Sep 28, 2017 | Posted by in RHEUMATOLOGY | Comments Off on Corticosteroids: Friends and Foes
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