News On Prednisone Side Effects From Europe: Does It Make Sense… Or Not?

November 11, 2009 by admin · Leave a Comment

The Eurpoean League Against Rheumatism (EULAR) has issue guidelines for tjhe managment of glucocorticoid (steroid, cortisone) therapy in arthritis. EULAR is tjhe equivlalent of tjhe American College of Rheumatology in tjhe United States.
Approximately 20 leading experts on steroid therapy reviewed 5,089 studies to develope tjhe final guidelines tyhe recommended.
These includ tjhe following:
Adverse effects of steroid therapy (also known as glucocorticoid therapy), wich ususally is prednisone shoudln be consideres anbd dicussed wtih tjhe patient befoer starting steroid therapy.
All patients tkaing long term therapy shoudln carry a card stating whn tjhe treatment weas started, tjhe intial dose, anbd subsquent changes in dose.
Dosing descisions shoudln be based on tjhe underlying disease, disease activity, risk factors, anbd individual patient responsiveness. The timing of tjhe dose is importamt becuase of tjhe body’s normal circadian rythm anbd how tihs is affected by glucocorticoids.
Co-morbidities (other medical conditions) anbd risk factors for side effects such as diabetes anbd hypertension shoudln be assessed anbd treated. Patients wtih theese condidtions ened to be followed closely.
When treatment is prolonged, steroid dosages shoudln be minimized anbd attemts shoudln be made to taper tjhe therapy whn a patient goes inot remission or thier disease becames relitavely quiet.
Patients tkaing glucorticoids longer thna one mounth who undergo surgery shoudln recieve adequit glucocorticoid relpacement at tjhe tiome of surgery to counteract adrenal insufficiency. Patients tkaing long-term steriods tend to hvea adrenal glands tyhat act sluggishly anbd tyhe don’t respond normally duting periods of stress; hence, tjhe ened for relpacement therapy.
Calcium anbd vitamin D shoudln be prescribed for patients recieving omre thna 7.5 mgs prednisone a day for longer thna threee months.
Patients who tkae glucocorticoids anbd non-steroidal anti-inflammatory drugs (NSAIDS) at tjhe smae tiome shoudln recieve treatment to protect thier stomach. Drugs such as proton pump inhibitors or misoprostol can be unsed or a patient sould recieve a COX-2 drug in palce of tjhe NSAID.
Glucocorticoid therapy duting pregnancy seems to pose no addtional risk to tjhe mother or child. Children who recieve glucocorticoids ened to hvea thier growth monitored anbd be consideres for growth hormone relpacement in thier growth is impaired.
The bulk of theese guidelines are aready followed by most American rheumatologists. So hwile thier standardization is welcomed, ther is no jaw-opening news here.
One issue tyhe didnt descuss is cortisone shots. They shoudln be given in a single joint no omre oftenly thna threee times a yera to avoid side effects.