Corticosteroids BT - Neurorheumatology: A Comprehenisve Guide to Immune Mediated Disorders of the Nervous System

Abstract

In this chapter, we discuss important concepts that are useful to the neurologist using corticosteroids in disease management. Corticosteroids are one of the most common medications used to treat many inflammatory, autoimmune, and allergic conditions. Corticosteroids have genomic and non-genomic effects on cells. The two main genomic effects of corticosteroids are transactivation and transrepression. Many of the side effects of corticosteroids are mediated via transactivation, while the beneficial anti-inflammatory effects are mediated via transrepression. Low-dose corticosteroids are used as maintenance therapy for chronic autoimmune and inflammatory conditions. Higher doses of corticosteroids (including pulse therapy for organ- or life-threatening disease) are used for initial treatment and are tapered once the disease process is controlled. Major side effects of corticosteroids include lipodystrophy, weight gain, metabolic disorders, neuropsychiatric alterations, glucocorticoid-induced osteoporosis, increased infection risk, cataracts, and skin atrophy. The dose and duration of corticosteroids should be minimized to reduce the occurrence of these side effects. Optimizing therapeutic response and steps to minimize side effects are discussed in the text of this chapter.