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Autoimmune conditions
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
According to the National Institute for Health and Care Excellence guidelines, oral or intravenous corticosteroid therapy is indicated in the treatment of optic neuritis. Steroids help to reduce inflammation and thus increase recovery, although it is recommended to limit corticosteroid treatment to more severe symptoms (where the relapse is painful or disabling) in order to avoid the side effects of steroid therapy. The other drugs are disease-modifying agents and are only indicated in MS patients with relapsing episodes and after full discussion and consideration of all the risks.9
An Overview of Drug-Induced Nephropathies *
Published in Robin S. Goldstein, Mechanisms of Injury in Renal Disease and Toxicity, 2020
Jean Paul Fillastre, Michel Godin
The outcome is favorable after withdrawal of the drug, and about 90% of patients recover. A favorable effect of steroid therapy is suggested in some cases reported. Penicillin G is rarely involved. Less than 20 cases of interstitial nephritis have been reported, including only a few cases in the past 5 years. Clinical and pathologic features are similar to those of methicillin-induced renal disease.
Steroids and Infection
Published in Herman Friedman, Thomas W. Klein, Andrea L. Friedman, Psychoneuroimmunology, Stress, and Infection, 2020
Yoshimasa Yamamoto, Herman Friedman
Development of steroid therapy has had revolutionary therapeutic effects for many diseases, and it is widely recognized that this therapy constitutes a major success for modern medicine. However, such therapy with steroids is associated with serious side effects, since they have both beneficial and non-beneficial features which may be inseparable. The anti-inflammatory and immunosuppressive activity of steroids are considered essential for therapy, but also may result in an increased susceptibility of a patient to infections, especially if treatment is inappropriate. The spectrum of microorganisms causing infection during steroid therapy is not clear, although experimental animal studies have shown that steroid treatment is associated with infections caused by certain groups of microorganisms. An understanding of which microorganisms are mainly responsible for infection of steroid treated patients is essential, since infections caused by different microorganisms are often handled differently by the host defense system, which consists of cell types with different susceptibilities to steroids.
The Role of Steroids for Pediatric Orbital Cellulitis – Review of the Controversy
Published in Seminars in Ophthalmology, 2023
Jonathan E. Lu, Michael K. Yoon
General risks of steroid therapy include fluid/electrolyte disturbances, gastrointestinal irritation/peptic ulcer, nausea/vomiting, hyperglycemia, hypercortisolism, menstrual changes, hypertension, coagulopathy, cataract, bone and muscle atrophy, insomnia, mood changes, acne, and others, although significant and long-term sequelae are usually with extended use of steroids.23–25 Shorter courses may still pose some risks. In the asthma literature, there is evidence of dose-dependent reduction in bone density and increased risk of osteopenia for males even in the cohort treated with 1–4 doses of oral steroids per year.26 In the study, the initial steroid dosages were 2 mg/kg/day up to 60 mg prednisone for 2 days followed by 1 mg/kg/day up to 30 mg a day for 2 days with option of further taper. This is a dose comparable to the steroids for orbital cellulitis literature, and thus, caution may be necessary, especially in male patients who have had steroids for other reasons recently.
Effect of omalizumab on bronchoalveolar lavage matrix metalloproteinases in severe allergic asthma
Published in Journal of Asthma, 2022
Weronika Zastrzeżyńska, Stanisława Bazan-Socha, Marek Przybyszowski, Agnieszka Gawlewicz-Mroczka, Bogdan Jakieła, Hanna Plutecka, Lech Zaręba, Jacek Musiał, Krzysztof Okoń, Krzysztof Sładek, Jerzy Soja
The final issue which deserves comment is the impact of steroid doses on MMPs response to anti-IgE therapy. Interestingly, lower doses of inhaled and systemic steroids were related to the higher MMPs in BAL at enrollment and, surprisingly, a better response to omalizumab therapy. That observation suggests that more aggressive steroid therapy might reduce MMPs production in the lungs. Alternatively, in some asthma patients, steroid therapy could still be suboptimal to control airway inflammation and MMPs responses, despite satisfactory disease symptoms management. These patients likely may benefit best from the biological treatment. Indeed, MMP-9 has been shown to increase in severe asthma (30) and during disease exacerbations (31,32). However, data presented by other investigators do not mirror our outcomes. Mattos et al. (31) showed no impact of increased budesonide on blood MMP-9 in mild asthmatics. Likewise, MMP-9 in exhaled breath condensates of patients with allergic asthma did not change after a substantial ICS increase. However, the study mentioned above (31) included newly exacerbated patients, which might influence the study results. In turn, Russel et al. (33) showed that dexamethasone might prevent in vitro the release of MMP-9 in the alveolar macrophage culture. Discrepancies between our results and the cited publications require additional research on a larger number of patients.
The Effect of Soluble TREM-1 in Idiopathic Granulomatous Mastitis
Published in Immunological Investigations, 2022
Dervis Ates, Hulusi Cem Doner, Sevil Kurban, Hande Koksal
Currently, steroid therapy is the preferred approach in the treatment of IGM. Steroid therapy is applied systemically or locally (intralesional or topical). Again, in recently, especially considering the possible side effects of systemic steroid treatment, local steroid treatment is more preferred (Akın et al., 2017; Cetin et al. 2019; Toktas et al. 2020). Also, the wait-and-watch approach may also be an option, especially in IGM patients with small lesions (Çetinkaya et al., 2020). Although the wait and watch approach and steroid therapy are sufficient in many patients, there are some IGM patients in whom methotreaxate, azathiopurine or even etanercept, a tumor necrosis factor inhibitor, is used for resistant diseases (Haddad et al. 2020; Kehribar et al. 2020; Tekgöz et al. 2020; Wang et al. 2019).