Systemic Corticosteroids for Autoimmune/Inflammatory Disorders in Children: Introduction

Abstract

More than six decades have elapsed since the introduction of corticosteroids into the pharmacologic armamentarium of pediatricians. Despite the widespread clinical use of these agents for many years, several questions remain concerning their appropriate therapeutic role, indications, possible regimens, and adverse effects. The discovery of corticosteroids can be considered one of the most important therapeutic revolutions of the last century. Steroids became crucial for the treatment of several infl ammatory and rheumatic diseases, including diseases that occur during childhood. However, the great enthusiasm over the discovery of corticosteroids was hampered in later years by the identifi cation of important side effects that raised concerns regarding steroid therapy. Thus, in the past years, research focused on the development of new steroid compounds with lower toxicity and higher effi cacy as well as on novel therapeutic regimens. Now, 60 years later, treatment with corticosteroids has stood the test of time, and despite the well-known side effects they are still a keystone in the therapy of many disorders and can sometimes be life-saving [ 1 ].In 1930, for the fi rst time an extract of animal adrenocortical tissue was demonstrated to counter human adrenal failure. Subsequently, following chemical analyses of cortical extracts, it became clear that there was not one cortical hormone, but several steroid hormones. By 1940 two categories of corticosteroids were identifi ed: those that caused sodium and fl uid retention (mineralocorticoids) and those that opposed shock and infl ammation (glucocorticoids) [ 2 ]. Extractive chemistry, chemical synthesis, and clinical investigations were combined, resulting in the discovery of cortisone and a long series of related derivatives [ 3 ]. P. Hench postulated that an antirheumatic chemical, or "substance X," was produced in response to stress. In

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“…Generally, this was achieved through mild analgesia, NSAIDs such as salicylic acid (Aspirin), and if needed, corticosteroids [3,21,24]. Children were then closely monitored for side effects, such as gastrointestinal irritation and hepatotoxicity [24], osteopenia and growth retardation [25]. In addition, physiotherapy and splinting were keystone in preserving functional ability and preventing contracture [21].…”