Abstract
Glucocorticoids (GCs), one of the principal drug classes used in rheumatology, are known for their fast onset and powerful action, but also for their multiple adverse effects, the most feared ones being osteoporosis, steroidinduced diabetes (SID), cardiovascular diseases and, in children, the decrease of linear growth rate. Due to data scarcity, most SID treatment recommendations are not evidence-based. Using the minimum dose and shortest possible treatment are preventive measures generally recommended, which are frequently not followed, due to fear of GC-sparing immunosuppressive agents’ side effects (DMARDs). Physiologic dose splitting, whenever possible, can be efficient in preventing at least some of the GCs’ adverse effects, mainly the suppression of the hypothalamic-pituitary axis and SID. These are depicted by a case presentation, of a 12-year-old female patient with SID caused by high dose GC treatment for juvenile dermatomyositis (JDM), in whom this method was sufficient to control glycaemia.
Highlights
Glucocorticoids (GCs), synthetic analogues of adrenal glands’ hormones, are one of the most frequently used drugs in rheumatology
At least in rheumatoid/juvenile idiopathic arthritis, physiologic splitting of doses conveniently overlaps with symptoms flaring in the morning
Steroid-induced diabetes mellitus represents hyperglycemia occurring in a patient previously unknown to have diabetes
Summary
Glucocorticoids (GCs), synthetic analogues of adrenal glands’ hormones, are one of the most frequently used drugs in rheumatology. While using GCs (as with any other treatment), the goal is to obtain the highest benefit with the mildest (or no) adverse effects. As far as daily repartition of doses is concerned, this should fulfil two conditions: to efficiently control the disease activity and to simulate the endogenous synthesis of GCs (in order to minimize side effects).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
