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 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
|
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 |
Web:
Glucocorticoide in der Rheumatologie - medmix (German)