Infection Risk and Safety of Corticosteroid Use

Abstract

Synopsis Corticosteroids are frequently used to treat rheumatic diseases. Their use comes with a number of well-established risks including osteoporosis, avascular necrosis, glaucoma, and diabetes. The risk of infection is of utmost concern and is well-documented, although randomized controlled trials (RCTs) of short term and lower dose steroids have generally shown little or no increased risk. Observational studies from the “real world”, however, have consistently shown dose-dependent increases in risk for serious infections as well as certain opportunistic infections (e.g. herpes zoster, tuberculosis, and PJP). In patients who begin chronic steroid therapy, vaccination and screening strategies should be utilized in an attempt to mitigate this risk.

Risk of Herpes Zoster in Individuals on Biologics, Disease-Modifying Antirheumatic Drugs, and/or Corticosteroids for Autoimmune Diseases: A Systematic Review and Meta-Analysis

“…Most included studies did not examine the association between corticosteroid use and HZ as a primary hypothesis, and this could have contributed to the varying results. The dose-related increases in zoster risk reported by included studies is in keeping with guideline development reviews, which have identified that higher doses and longer treatment duration confer a greater risk of serious infection [90, 91]. …”

Current approach to diagnosis and management of retroperitoneal fibrosis

“…Vaccination for herpes zoster is desirable for antibody-negative patients. 41 Even in patients receiving PSL <10 mg/day, PJP can develop. 41 Therefore, prophylaxis with trimethoprim-sulfamethoxazole should be considered.…”

“…41 Even in patients receiving PSL <10 mg/day, PJP can develop. 41 Therefore, prophylaxis with trimethoprim-sulfamethoxazole should be considered. Furthermore, reactivation of HBV is also reported in patients with IgG4RD.…”

Opportunistic Oral Infections

“…19 Box 1 lists some of the at-risk populations or risk factors associated with oral OIs that have been reported in the literature. 20–24 Familiarity with comorbidities and factors linked to the development of oral OI proves useful for clinical risk assessment, diagnosis, treatment planning, and prevention. In certain cases of oral OI, treatment of the underlying comorbidity and elimination of risk factors is necessary to achieve clinical resolution of secondary infection.…”