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Glucocorticoids (GCs)

Glucocorticoids are potent medication used for a variety of medical indications. In the management of rheumatic disorders, there are two primary indications for their use:

  • Suppression of the inflammatory cascade

  • Modification of the immune response

Methods of GC administration effective in treatment of rheumatic disease:

  • Oral or alimentary therapy

  • Parenteral: intramuscular (IM) and intravenous (IV)

  • Intrasynovial therapy, generally used to control inflammatory reactions involving the synovial lining of articular surfaces

GCs are divided into three main groups according to their duration of biologic activity:

SHORT-ACTING

INTERMEDIATE-ACTING

LONG-ACTING

(Half-Life 12 hours)

(Half-Life 12 to 36 hours)

(Half-Life 48 hours)

Hydrocortisone

Prednisone

Paramethasone

Cortisone

Prednisolone

Betamethasone

Methylprednisolone

Dexamethasone

Triamcinolone

Examples of adverse consequences of GC therapy:

  • Osteonecrosis (risk at dose >20 mg/day for a month)
  • Osteoporosis (doses ≥5 to 7.5 mg/day for 3 months)
  • Posterior subcapsular cataract formation (risk even at 5 mg/day) and glaucoma (>10 mg/day)
  • Skin disorders (striae, delayed wound repair, hirsutism).
  • Peptic ulcer disease
  • Weight gain (>5 mg/day)
  • Infection (doses >20 to 25 mg/day)
  • Hypertension (doses >10 mg/day)
  • Abnormal menstruation
  • Mental disturbance (doses ≥20 to 30 mg/day)
  • Muscle weakness (doses >10 to 20 mg/day)

Corticosteroid Comparison Chart (see also Steroid Equivalence Converter)

Steroid

Generic Drug

Duration

of

Action

Potency

Equivalent Dose

Mineralocorticoid effect

Cortisol

Hydrocorton, Solucortef

Short Acting

1

30mg

Yes

Cortisone

Cortison CIBA

Short Acting

0.8

37.5mg

Yes

Prednisone

Prednison Streuli u.a.

Short Acting

4

7.5mg

No

Prednisolone

Prednisolon Streuli, Spiricort u.a.

Short Acting

4

7.5mg

No

Methyl

prednisolone

Urbason, Solu-Medrol

Short Acting

5

6mg

No

Triamcinolone

Kenacort

Intermediate Acting

5

6mg

No

Betamethasone

Diprophos, Celestone

Long Acting

25

1.2mg

No

Dexamethasone

Fortecortin, Decadron

Long Acting

30

1mg

No


Pubmed

UpToDate

Images


Video


Web:

Drugs.com

Glucocorticoide in der Rheumatologie - medmix (German)

WebMD

Amboss

Standford.edu

Glucocorticoid-induced Osteoperosis

ScienceDirect


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