Prevention and management of glucocorticoid-induced side effects: A comprehensive review

Caplan, Arthur; Fett, Nicole; Rosenbach, Misha; Werth, Victoria P.; Micheletti, Robert G.

doi:10.1016/j.jaad.2016.01.062

Cited by 132 publications

(83 citation statements)

References 45 publications

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“…Osteoporosis counselling should be provided if corticosteroid treatment is anticipated to last >3 months 148 . Pneumocystis prophylaxis and tuberculosis screening should be considered for patients who will receive high doses of corticosteroids together with another immunosuppressive drug for >1 month 149,150 .…”

Section: Managementmentioning

confidence: 99%

Pemphigus

Kasperkiewicz

Ellebrecht

Takahashi

et al. 2017

Nat Rev Dis Primers

422

429

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Pemphigus is a group of IgG-mediated autoimmune diseases of stratified squamous epithelia, such as the skin and oral mucosa, in which acantholysis (the loss of cell adhesion) causes blisters and erosions. Pemphigus has three major subtypes: pemphigus vulgaris, pemphigus foliaceus and paraneoplastic pemphigus. IgG autoantibodies are characteristically raised against desmoglein 1 and desmoglein 3, which are cell–cell adhesion molecules found in desmosomes. The sites of blister formation can be physiologically explained by the anti-desmoglein autoantibody profile and tissue-specific expression pattern of desmoglein isoforms. The pathophysiological roles of T cells and B cells have been characterized in mouse models of pemphigus and patients, revealing insights into the mechanisms of autoimmunity. Diagnosis is based on clinical manifestations and confirmed with histological and immunochemical testing. The current first-line treatment is systemic corticosteroids and adjuvant therapies, including immunosuppressive agents, intravenous immunoglobulin and plasmapheresis. Rituximab, a monoclonal antibody against CD20+ B cells, is a promising therapeutic option that may soon become first-line therapy. Pemphigus is one of the best-characterized human autoimmune diseases and provides an ideal paradigm for both basic and clinical research, especially towards the development of antigen-specific immune suppression treatments for autoimmune diseases.

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Section: Managementmentioning

confidence: 99%

Pemphigus

Kasperkiewicz

Ellebrecht

Takahashi

et al. 2017

Nat Rev Dis Primers

422

429

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“…[11] Furthermore, glucocorticoids use increases the risk of osteoporosis which is concerned with bone apoptosis, bone resorption, calcium balance, osteoblast function, and sex hormone. [12] Multiple endocrine and metabolic adverse effects of glucocorticoids, such as glucocorticoid-induced osteoporosis, steroid-related adrenal insufficiency, and cognitive and mood disorders, [7] brought about the need of new agents to substitute for glucocorticoids.…”

Section: Discussionmentioning

confidence: 99%

“…[1–4] Although injection of synthetic glucocorticoids is beneficial due to their antiinflammatory effects, [5] the use of glucocorticoids is limited as it may cause multiple adverse effects such as glucocorticoid-induced osteoporosis, [6] adrenal suppression, [7] and cognitive and mood disorders. [7] Glucose intolerance associated with decreased insulin sensitivity is a major concerns related to use of synthetic glucocorticoids, and it may worsen the condition of patients with type 2 diabetes mellitus (DM). [8] …”

Section: Introductionmentioning

confidence: 99%

Effect of transforaminal epidural polydeoxyribonucleotide injections on lumbosacral radiculopathy

et al. 2017

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Rationale:Transforaminal epidural glucocorticoids administration is widely performed for the management of lumbosacral radiculopathy. However, it may worsen the condition of patients with type 2 diabetes mellitus (DM). Polydeoxyribonucleotide (PDRN) was recently noted as a substitute for glucocorticoids.Patient concerns:A 44-year-old male patient was admitted to our pain clinic with symptoms of low back pain with severe pain and tingling sensation of left posterolateral leg. He had type 2 DM medicated with Glimepiride and Metformin. Blood glucose level was 367 mg/dL. He declined to use glucocorticoid.Diagnoses:He was diagnosed as left foraminal disc protrusion at L4–5, left subarticular disc protrusion at L5-S1.Interventions:Fluoroscopically guided transforaminal epidural PDRN injections were carried out.Outcomes:The patient was followed up for more than 6 months and demonstrated good improvement in lumbosacral radiculopathy without any complications.Lessons:This is the first successful report on epidural injection of PDRN.

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“…In general, when oral cortisol (hydrocortisone) is used as a baseline, prednisone and prednisolone have about four times the potency, while methylprednisolone and triamcinolone are about five times the potency, and dexamethasone and betamethasone are about twenty-five times the potency. Reference charts of glucocorticoid potencies can be easily obtained [17]. …”

Section: Pharmacologic Preparations Of Glucocorticoidsmentioning

confidence: 99%

Advances in treatment of glucocorticoid-induced osteoporosis

Hsu

Nanes

2017

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of Review To summarize monitoring, prevention, and treatment options of glucocorticoid-induced osteoporosis for patients on chronic glucocorticoid therapy. Recent Findings Recent meta-analyses highlight the efficacy of bisphosphonate use in improving bone mineral density and in reducing vertebral fractures in the setting of long term glucocorticoid use. A new study has now shown that alendronate also reduces the risk of hip fracture in glucocorticoid use. Emerging data indicate that teriparatide and denosumab also reduce the risk of osteoporotic fracture in glucocorticoid-induced osteoporosis. Summary Glucocorticoid use is a leading cause of secondary osteoporosis; however, patients at risk of glucocorticoid-induced osteoporosis are often not evaluated or treated in a timely manner. Patients on a dose equivalent of 2.5mg prednisone or greater for 3 months or longer duration should have their fracture risk assessed. Those at moderate or high risk should start bisphosphonate therapy, or if contraindicated, a second line agent such as teriparatide or denosumab.

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Prevention and management of glucocorticoid-induced side effects: A comprehensive review

Cited by 132 publications

References 45 publications

Pemphigus

Pemphigus

Effect of transforaminal epidural polydeoxyribonucleotide injections on lumbosacral radiculopathy

Advances in treatment of glucocorticoid-induced osteoporosis

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