Deoxycortone With Ascorbic Acid Versus Adrenocorticotropic Hormone in Rheumatoid Arthritis

Spies, Tom D.; Maeyer, Edouard De; Stone, RobertE.; Niedermeier, William

doi:10.1016/s0140-6736(49)91919-4

Cited by 24 publications

(4 citation statements)

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“…Glucocorticoids have entered the clinics more than 50 years ago; indeed the first patient to be treated was a patient suffering from rheumatoid arthritis [56]. The immunosuppressive qualities of glucocorticoids are multifold and among others, they modulate HLA expression.…”

Section: Pharmaceutical Intervention In Hla Class II Expression I) Glmentioning

confidence: 99%

The Role of HLA Promoters in Autoimmunity

Müller‐Hilke¹,

Mitchison²

2006

CPD

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Population studies reveal HLA class I and class II gene polymorphisms associated with all the common chronic autoimmune diseases, notably spondylarthropathies, rheumatoid arthritis, multiple sclerosis and type I diabetes. We here discuss the exceptionally high levels of nucleotide diversity in the MHC region likely to reflect not only balancing selection acting on the epitope binding sites but also natural selection operating on the promoter region. The latter possibility is supported by functional studies with promoters, higher levels of diversity in the promoters of class II than class I genes and the relatively high frequency of single nucleotide polymorphisms around transcription factor binding sites. This, we argue, reflects the need for an appropriate level of signalling at the immunological synapse. We here summarise our knowledge of HLA promoter polymorphisms and how these translate into differential expression, T cell polarisation and inflammation. We discuss current strategies for pharmaceutical intervention in HLA expression.

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Section: Pharmaceutical Intervention In Hla Class II Expression I) Glmentioning

confidence: 99%

The Role of HLA Promoters in Autoimmunity

Müller‐Hilke¹,

Mitchison²

2006

CPD

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“…Corticosteroids are powerful anti-inflammatory drugs that have been used to treat a variety of diseases for over seven decades, dating back to their introduction for rheumatoid arthritis in 1949. 1 2 3 4 5 A strong driver of corticosteroid use is the potent symptomatic relief they give many patients. Yet long term use of corticosteroids is generally avoided, given the risks of serious acute complications such as infection, venous thromboembolism, avascular necrosis, and fracture, as well as chronic diseases such as diabetes mellitus, hypertension, osteoporosis, and other features of iatrogenic Cushing’s syndrome.…”

Section: Introductionmentioning

confidence: 99%

Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study

Waljee

Rogers

Lin

et al. 2017

BMJ

594

479

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ObjeCtiveTo determine the frequency of prescriptions for short term use of oral corticosteroids, and adverse events (sepsis, venous thromboembolism, fractures) associated with their use. DesignRetrospective cohort study and self controlled case series.setting Nationwide dataset of private insurance claims. PartiCiPantsAdults aged 18 to 64 years who were continuously enrolled from 2012 to 2014. Main OutCOMe MeasuresRates of short term use of oral corticosteroids defined as less than 30 days duration. Incidence rates of adverse events in corticosteroid users and non-users. Incidence rate ratios for adverse events within 30 day and 31-90 day risk periods after drug initiation. resultsOf 1 548 945 adults, 327 452 (21.1%) received at least one outpatient prescription for short term use of oral corticosteroids over the three year period. Use was more frequent among older patients, women, and white adults, with significant regional variation (all P<0.001). The most common indications for use were upper respiratory tract infections, spinal conditions, and allergies. Prescriptions were provided by a diverse range of specialties. Within 30 days of drug initiation, there was an increase in rates of sepsis (incidence rate ratio 5.30, 95% confidence interval 3.80 to 7.41), venous thromboembolism (3.33, 2.78 to 3.99), and fracture (1.87, 1.69 to 2.07), which diminished over the subsequent 31-90 days. The increased risk persisted at prednisone equivalent doses of less than 20 mg/day (incidence rate ratio 4.02 for sepsis, 3.61 for venous thromboembolism, and 1.83 for fracture; all P<0.001). COnClusiOnOne in five American adults in a commercially insured plan were given prescriptions for short term use of oral corticosteroids during a three year period, with an associated increased risk of adverse events. IntroductionCorticosteroids are powerful anti-inflammatory drugs that have been used to treat a variety of diseases for over seven decades, dating back to their introduction for rheumatoid arthritis in 1949. [1][2][3][4][5] A strong driver of corticosteroid use is the potent symptomatic relief they give many patients. Yet long term use of corticosteroids is generally avoided, given the risks of serious acute complications such as infection, venous thromboembolism, avascular necrosis, and fracture, as well as chronic diseases such as diabetes mellitus, hypertension, osteoporosis, and other features of iatrogenic Cushing's syndrome. [6][7][8][9][10][11][12][13][14][15][16][17][18] Indeed, corticosteroids are one of the most common reasons for admission to hospital for drug related adverse events, 19 and optimizing their long term use has been a major focus for clinical guidelines across diverse specialties for many years. [20][21][22][23][24][25][26] In contrast with long term use, however, the risk of complications from short term use is much less understood, and evidence is generally insufficient to guide clinicians. In the outpatient setting, brief courses of oral corticosteroids are often used to treat conditions wit...

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“…Corticosteroids have both anti‐inflammatory and immunosuppressive therapeutic effects. Since their introduction in 1949, they have been widely used for the treatment of inflammatory and autoimmune disorders, hematological and oncological conditions, and as part of immunosuppressive treatment following organ transplantation 1–3 . They affect virtually all immune cells; their precise effects depend upon the differentiation and activation state of the cell 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Since their introduction in 1949, they have been widely used for the treatment of inflammatory and autoimmune disorders, hematological and oncological conditions, and as part of immunosuppressive treatment following organ transplantation. [1][2][3] They affect virtually all immune cells; their precise effects depend upon the differentiation and activation state of the cell. 4 Long-term use of corticosteroids is associated with serious adverse effects, among them impaired immune response, accelerated osteoporosis, cardiovascular disease, metabolic disorders and psychiatric disturbances.…”

Section: Introductionmentioning

confidence: 99%

Intra‐articular and soft‐tissue corticosteroid injections and risk of infections: Population‐based self‐controlled‐risk‐interval design

Zacay

Heymann

2023

Pharmacoepidemiology and Drug

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Purpose Chronic and short‐term treatment with oral corticosteroids is associated with an increased risk of infection. However, the potential risk of infection that may be associated with intra‐articular and soft‐tissue injections of corticosteroids has not been reported. The aim of this study was to assess the risk for infection following intra‐articular or soft‐tissue corticosteroid injections. Methods Self‐controlled‐risk‐interval study with 15 732 adults who were treated with intra‐articular or soft‐tissue corticosteroid injections during 2015–2018. The study was conducted in a large Israeli Health Maintenance Organization. We self‐matched the participants and analyzed the incidence of infection over three periods: an exposure‐period of 90 days following the injection, and two 90‐day control periods. We identified the occurrence of several common infections in the patient's electronic medical record and analyzed the incidence rates of all infections (composite end‐point) as well as each infection separately. Results The incidence of any infection was higher during postexposure period compared with the control periods (46.5 vs. 42.1 events per 1000 persons), number needed to harm was 227 persons. Self‐matching analysis showed increased incidence‐rate‐ratio (IRR) for the combined incidence of infections in the post‐exposure period compared with the control periods (IRR = 1.10, 95% confidence interval [CI] 1.01–1.21). A sensitivity analysis showed that the highest IRR was during the first 30 days (IRR = 1.19, 95% CI 1.03–1.38), with higher IRR for patients aged 65 years and older (IRR = 1.37, 95% CI 1.08–1.73). Conclusions Intra‐articular and soft‐tissue corticosteroids injections may be associated with an increased risk of infections; however, the absolute risk increase is low.

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Deoxycortone With Ascorbic Acid Versus Adrenocorticotropic Hormone in Rheumatoid Arthritis

Cited by 24 publications

References 0 publications

The Role of HLA Promoters in Autoimmunity

The Role of HLA Promoters in Autoimmunity

Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study

Intra‐articular and soft‐tissue corticosteroid injections and risk of infections: Population‐based self‐controlled‐risk‐interval design

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