Corticosteroids Research Articles

Cyclic neutropenia and concomitant IgA nephropathy: a case report

BackgroundIgA nephropathy (IgAN) is universally recognized as one of the most common primary glomerular diseases in all ages. Cyclic neutropenia (CN) is a rare haematologic disorder that is associated with mutations of the ELANE gene. The co-occurrence of IgAN and CN is extremely rare. This is the first case report of a patient with IgAN and genetically confirmed CN.Case presentationWe report a case of a 10-year-old boy who presented with recurrent viral upper respiratory tract infections accompanied by several episodes of febrile neutropenia, haematuria, proteinuria and acute kidney injury. Upon first admission, his physical examination was unremarkable. His kidney function was impaired, whereas his urine microscopy showed evidence of macroscopic haematuria and proteinuria. Further workup showed elevated IgA. The renal histology was consistent with mesangial and endocapillary hypercellularity with mild crescentic lesions, while immunofluorescence microscopy showed IgA-positive staining, which was characteristic of IgAN. Moreover, genetic testing confirmed the clinical diagnosis of CN, therefore Granulocyte colony-stimulating factor (G-CSF) was initiated to stabilize the neutrophil count. Regarding proteinuria control, the patient was initially treated with an Angiotensin-converting-enzyme inhibitor for approximately 28 months. However, due to progressive proteinuria (> 1 g/24 h), Corticosteroids (CS) were added for a period of 6 months according to the revised 2021 KDIGO guidelines with favorable outcome.ConclusionsPatients with CN are more susceptible to recurrent viral infections, which can trigger IgAN attacks. In our case CS induced remarkable proteinuria remission. The use of G-CSF contributed to the resolution of severe neutropenic episodes, viral infections and concomitant AKI episodes, contributing to better prognosis of IgAN. Further studies are mandatory to determine whether there is a genetical predisposition for IgAN in children with CN.

Comparison of shock wave therapy and corticosteroid injection in the treatment of greater trochanteric pain syndrome: A single-blind, randomized study.

The aim of this study was to compare the efficacy of the corticosteroid (CS) injection and shock wave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). Between 2020 September and 2021 October, a total of 60 patients with GTPS (12 males, 48 females; mean age: 50.8±8.5 years; range, 34 to 65 years) were included. The patients were randomly assigned to two groups as the SWT group (n=32) receiving one session of SWT per week for a total of three weeks and CS injection group (n=28) receiving CS and local anesthetic. Both groups were evaluated using the Short Form-36 (SF-36) at baseline and three months and using the Visual Analog Scale (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) at baseline, three weeks, and three months. The mean VAS, greater trochanter tenderness, and WOMAC scores of both groups were similar at baseline, while the third-week and three-month scores were significantly lower in both groups compared to baseline (p<0.05). There was no significant difference in the treatment efficacy between the groups (p>0.05). There was a similar improvement in SF-36 physical function, physical role difficulty, and pain subscales in both groups (p<0.05). Our study results show that both CS injection and SWT are effective modalities and none of the treatments is superior to each other.

Surface-anchored microbial enzyme-responsive solid lipid nanoparticles enabling colonic budesonide release for ulcerative colitis treatment

Colon-targeted oral drug delivery systems (CDDSs) are desirable for the treatment of ulcerative colitis (UC), which is a disease with high relapse and remission rates associated with immune system inflammation and dysregulation localized within the lining of the large bowel. However, the success of current available approaches used for colon-targeted therapy is limited. Budesonide (BUD) is a corticosteroid drug, and its rectal and oral formulations are used to treat UC, but the inconvenience of rectal administration and the systemic toxicity of oral administration restrict its long-term use. In this study, we designed and prepared colon-targeted solid lipid nanoparticles (SLNs) encapsulating BUD to treat UC by oral administration. A negatively charged surfactant (NaCS-C12) was synthesized to anchor cellulase-responsive layers consisting of polyelectrolyte complexes (PECs) formed by negatively charged NaCS and cationic chitosan onto the SLNs. The release rate and colon-specific release behavior of BUD could be easily modified by regulating the number of coated layers. We found that the two-layer BUD-loaded SLNs (SLN-BUD-2L) with a nanoscale particle size and negative zeta potential showed the designed colon-specific drug release profile in response to localized high cellulase activity. In addition, SLN-BUD-2L exhibited excellent anti-inflammatory activity in a dextran sulfate sodium (DSS)-induced colitis mouse model, suggesting its potential anti-UC applications.

Systemic Cancer Immunostimulatory Therapies and Acute Viral Infection Induce Corticosteroid-Mediated Thymic Involution and Naïve T cell Output in Mice and Humans

Abstract Thymic involution (TI) occurs with aging and during stress responses, decreasing naïve T cell output. Thymic progenitor apoptosis can occur directly by corticosteroids (CS) leading to transient involution followed by recovery. The effects of systemic immunotherapies (IT) used in cancer or immune stimulation via acute viral infection on the thymus has not been well-characterized and was the primary goal of this study. IT treatment of mice with high dose IL-2 (HD IL-2) or models of acute viral infection (mouse cytomegalovirus, MCMV) all resulted in rapid TI due to apoptosis of CD4/CD8 double-positive progenitors followed with a reduction in naïve T cell content. Interestingly, cessation of therapy or resolution of viral infection resulted in greater thymic size compared to untreated recipients, indicating a rebound effect. In both models, increased CS levels in the serum of mice preceded TI. Clinically, patients receiving HD IL-2 for cancer had significantly reduced T cell receptor excision circles, a marker for naïve T cell output, also correlating with increased cortisol levels. Using a model of sub-lethal MCMV infection that did not increase systemic pro-inflammatory cytokines, we observed a similar correlation of TI and increased CS levels. To further analyze the effects of CS on TI, mice were adrenalectomized and then given HD IL-2, where significantly reduced CS levels correlated with partial protection from TI. These results indicate that strong systemic immunostimulation by either IT or acute viral infections markedly induce transient CS-mediated TI, leading to a decrease in naïve T cells. Therefore, targeting CS responses in preventing TI and, especially with the aged, allow for naïve T cell populations to be maintained.

Reduction of seizures and inflammatory markers by betamethasone in a kindling seizure model.

Epilepsy is a chronic disease characterized by an ongoing predisposition to seizures. Although inflammation has emerged as a crucial factor in the etiology of epilepsy, no approaches to anti-inflammatory treatment have been clinically proven to date. Betamethasone (a corticosteroid drug used in the clinic for its anti-inflammatory and immunosuppressive effects) has never been evaluated in attenuating the intensity of seizures in a kindling animal model of seizures. Using a kindling model in male wistar rats, this study evaluated the effect of betamethasone on the severity of seizures and levels of pro-inflammatory interleukins. Seizures were induced by pentylenetetrazole (30mg/kg) on alternate days for 15days. The animals were divided into four groups: a control group treated with saline, another control group treated with diazepam (2mg/kg), and two groups treated with betamethasone (0.125 and 0.250mg/kg, respectively). Open field test was conducted. Betamethasone treatments were effective in reducing the intensity of epileptic seizures. There were lower levels of Tumor Necrosis Factor-α and interleukin-1β in the cortex, compared to the saline group, on the other hand, levels in the hippocampus remained similar to the control groups. There was no change in the levels of interleukin-6 in the evaluated structures. Serum inflammatory mediators remained similar. Lower quantities of inflammatory mediators in the central nervous system may have been the key to the reduced severity of seizures on the Racine scale.

P074 Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for the symptomatic management of knee osteoarthritis: a systematic review and meta-analysis

Abstract Background/Aims Osteoarthritis (OA) is the commonest reason for orthopaedic referral in the UK, with the burden of knee OA affecting 10-25% of patients over 60 and 6% of those over 30. Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee OA, particularly in the UK. IA platelet-rich-plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA. Methods All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool and overall was deemed low. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC, VAS and KOOS scores (or subscores), comparing IA PRP to CS injections across studies at different time points of follow-up. Where studies used different outcome measures, these were combined using the standardised mean difference (SMD). Results 8 studies and 648 patients were included. 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. OA was diagnosed radiologically using the Kellgren-Lawrence scale. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3-, 6- and 9-months post-intervention (P &amp;lt; 0.01). The greatest effect was observed at 6 and 9 months (-0.78 (-1.34 to -0.23) SD and -1.63 (-2.14 to -1.12) SD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. On WOMAC pain and stiffness subscales, there were significant additional reductions in the PRP group for pain and stiffness (-2.66 (-4.73 to -0.60), P &amp;lt; 0.01 and 1.95 (-2.30 to -1.59), P &amp;lt; 0.01 respectively), but not functionality at 6 months. At 6 months PRP allowed greater return to sporting activities than CS injections, as measured by the KOOS subscale for sporting activity, of magnitude 9.7 (-0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months of follow-up (P &amp;lt; 0.001). Considerable heterogeneity in the preparation of PRP was observed. Conclusion IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than one IA-PRP injection. IA corticosteroid injections should no longer be routinely used for symptomatic management of knee OA. Disclosure M.E.D. McLarnon: None. N. Heron: None.

Prevalence of Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients Treated with Antiresorptive Drugs at Pranangklao Tertiary Care Hospital in Nonthaburi Province, Thailand

Background: Medication-related osteonecrosis of the jaw (MRONJ) could disturb the quality of life of the patients. In Thailand, published data reporting the prevalence of MRONJ is scarce. Objective: To analyze the current situation regarding the occurrence of osteonecrosis of the jaw in osteoporotic patients taking antiresorptive drugs at Pranangklao Hospital in Nonthaburi Province, Thailand. Materials and Methods: Data regarding osteoporotic patients received antiresorptive drugs were collected retrospectively from the electronic medical records between January 2014 and June 2020. Data were analyzed using descriptive statistics. Results: The hospital database revealed that there were 1,188 patients that received antiresorptive drugs during the specified period. One thousand twenty-nine (86.62%) were prescribed with only one antiresorptive drug. Alendronate was the main drug among the four medications prescribed, which was used by 592 patients (49.83%). Mean antiresorptive drug exposure time was 1.52 years (SD 1.54) and median was 0.85 years. Among 49 patients who had tooth extraction after receiving oral bisphosphonate, two MRONJ cases were reported. Therefore, the prevalence of MRONJ among the 1,188 patients receiving antiresorptive drugs in the present study was 0.17%, and the prevalence of MRONJ among the 677 obtaining oral bisphosphonates was 0.295%. About 89% had comorbid diseases. The most common comorbid diseases were hypertension, followed by dyslipidemia, and diabetes mellitus. Furthermore, 17% had a history of corticosteroid drug administration. Conclusion: MRONJ cases were found in osteoporotic patients receiving oral bisphosphonates. The prevalence of MRONJ and contributing factors gave information essential for managing this unwanted condition. Keywords: Medication related osteonecrosis of the jaw; Prevalence; Osteoporosis; Comorbidity; Corticosteroid

Comparison of the Effect of Intralesional Injection of Corticosteroid and Platelet-rich Plasma in Patients with de Quervain’s Tenosynovitis

Background: De Querveins’ tenosynovitis affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of the wrist. Corticosteroid injection is the mainstay of treatment for those patients who do not respond to conservative management. Platelet-rich plasma (PRP) is a currently used strategy in the clinical practice to provide a regenerative stimulus for tendon healing. Objective: To evaluate the effects of Platelet-rich plasma in the treatment of DQVD in comparison with corticosteroid (CS) injection. Materials and Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. A total of 100 patients with pain and swelling over the radial aspect of the wrist with positive Finkelstein test were randomly allocated into three groups: group A (received platelet-rich plasma injection), group B (received corticosteroid injection) and group C (received conservative management). The severity of pain and functional status of the wrist joint were recorded according to VAS and Mayo’s wrist score both pre-procedurally on day 0 and post-procedurally at the end of 1st, 3rd and 6th month. Results: The mean age of the participants in group A, B and C were 45.6 (±10.4), 46.9 (±11.3) and 42.4 (±6.3) years respectively. In all groups, majority of the study participants were female and housewives. No significant statistical difference was observed among the groups regarding VAS scores and Mayo’s Wrist Scores at baseline. At the end of 6 months, the reduction of pain in group A was significantly lower than group B (p&lt;0.001). Again, at the end of 6 months, the improvement of Mayo’s Wrist Scores in group A group was significantly higher than group B (p&lt;0.001). In group A, 77.8% reduction of pain score was achieved while in group B, 68.4%reduction of pain score was achieved after 6 month of treatment (p&lt;0.001). Conclusions: Platelet-rich plasma provides better functional outcome than corticosteroid in the treatment of de Quervain tenosynovitis. Bangladesh Medical Res Counc Bull 2023; 49(1): 32-38

Recurrence of Idiopathic Orbital Inflammation: An 11-year Retrospective Study.

The high recurrence rate of idiopathic orbital inflammation (IOI) has been reported. This study aims to determine existing predictive factors for the recurrence of IOI. This was an 11-year retrospective study with at least a 12-month follow-up. Fifty patients with biopsy-proven IOI admitted between 2006 and 2017 at our tertiary hospital were observed. We compared the clinical characteristics, histopathological profile, and biomarker expressions (mast cell, immunoglobulin G4, tumor necrosis factor-alpha, and transforming growth factor-beta) of 16 patients with recurrence (Group I) and 34 patients with no recurrence (Group II). Statistical comparison and multivariate analysis were performed to establish the predictive factors. We discovered five recurrence predictive factors: presentation of proptosis (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.36-18.03), visual impairment (OR 15, 95% CI 1.58-142.72), extraocular muscle (EOM) restriction (OR 3.86, 95% CI 1.07-13.94), nonanterior involvement (OR 7.94, 95% CI 1.88-33.5), and corticosteroid (CS) alone treatment (OR 7.20, 95% CI 1.87-27.8). On multivariate analysis, nonanterior involvement and CS alone treatment were validated as predictive factors (area under the curve = 0.807 [95% CI 0.69-0.92]). Histopathological profile and biomarker expressions were not associated with recurrence. However, there was a 22-fold higher recurrence risk for granulomatous-type patients given CS alone treatment. Unlike the five clinical characteristics mentioned, both histopathology and biomarker variables were not associated with recurrence. CS alone treatment for patients with nonanterior involvement or granulomatous type is proven to increase the risk of recurrence. Therefore, we suggest not giving CS without any combination treatment with other modalities for this group of patients.

Noni simplistic effect with Chicken Shank Gelatin Film on White Rat Spleen Exposed to Dexamethasone

Dexamethasone is a corticosteroid drug belong to glucocorticoid group. Dexamethasone is immunosuppressant and anti-inflammatory in various inflammatory conditions. Side effects of its use can cause cell apoptosis in various organs such as the spleen. The immunosuppressant effect of dexamethasone can reduce and inhibit peripheral lymphocytes and macrophages until the death of lymphoid cells in the white pulps of the spleen. The simultaneous effect of administering chicken shank gelatin and noni has the potential to improve the structure of the spleen. This study was aimed to prove and obtain effective and safe dose of chicken shank gelatin and noni on the spleens of rats exposed to dexamethasone. The research was carried out experimentally in the laboratory with a completely randomized design (CRD). A total of 25 heads male rats were grouped into five treatments and each treatment consist of five repetitions. There was a treatment group P1 as a negative control, P2 as a positive control (dexamethasone 5 mg/kg BW), P3-P5 (dexamethasone 5 mg/kg + gelatin 1.585 mg/kg + noni simplicia 50; 112; 250 mg/kg BW). The results of the study showed an increase in the area of white pulps and a decrease in the percentage of necrotic cells in the spleen, however, it did not increase the relative weight of the spleen and serum albumin levels (P&gt;0.05). In conclusion, the effective and safe dose for the spleen organs of rats exposed to dexamethasone is 250 mg/kg BW.

Dose-Response Meta-Analysis of Corticosteroid Effects in SARS Outbreak: A Model for Risk Stratification and Screening Strategy for Osteonecrosis of Femoral Head Post-Corticosteroid Therapy for COVID-19.

Corticosteroids (CS) have been used in the management regimens for COVID-19 disease to mitigate the cytokine storm and ill effects of the pulmonary inflammatory cascade. With the rampant use of CS, clinicians started reporting the occurrence of osteonecrosis of the femoral head (OFH). In this systematic review, we aim to analyze the literature and identify the definitive cumulative dose and duration of CS needed for the development of OFH based on the SARS model and generate a risk-based screening recommendation for OFH in convalescent COVID-19 patients to facilitate early identification and management. An electronic database search was conducted until December 2022 in PubMed, Web of Science, Embase, and CNKI (China Knowledge Resource Integrated Database). Studies involving CS therapy and osteonecrosis data in SARS patients were included. Three authors independently extracted the data from the included studies and a dose-response meta-analysis was performed for various doses and duration of CS utilized in the included studies. We selected 12 articles with 1728 patients in the analysis. The mean age was 33.41 (±4.93) years. The mean dosage of CS administered was 4.64 (±4.7) g which was administered for a mean duration of 29.91 (±12.3) days. The risk of osteonecrosis increases at pooled OR of 1.16 (95% CI 1.09-1.23, p < 0.001) per 2.0 g increase in the cumulative dose of CS usage. Similarly, the risk increases at pooled OR of 1.02 (95% CI 1.01-1.03, p < 0.001) per 5 days of increase in the cumulative duration of CS usage. A cumulative dosage of 4 g and a duration of 15 days were determined as the critical cut-off for the non-linear dose-response relationship observed. Appropriate and frequent screening of these individuals at regular intervals would help in the identification of the disease at an early stage in order to treat them appropriately.

A comparative study of the efficacy of intra-articular injection of different drugs in the treatment of mild to moderate knee osteoarthritis: A network meta-analysis.

Knee osteoarthritis (KOA) has a high clinical prevalence and frequently interferes with patients normal lives. In KOA patients, evidence suggests that intra-articular (IA) injection improves joint function and decreases discomfort. Several IA injection treatments are used in daily practice to improve symptomatic control of knee osteoarthritis, but their efficacy is frequently disputed. This network meta-analysis compares the efficacy of different IA injections for mild to moderate knee osteoarthritis. Seven databases (PubMed, EMBASE, Web of Science, Cochrane Library, China Biology Medicine disc, WanFang, and China National Knowledge Infrastructure) were searched for randomized controlled trials published up to and including December 20, 2021, and final follow up indicators were used. Visual analogue scale (VAS) score and The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index (WOMAC) score change from baseline were the primary outcomes. We used the Cochrane risk of bias tool to assess the quality and risks of biases of papers. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for each outcome. State (Version 15.1, Texas, USA) and SPSS (Version 20, Chicago, USA) was used in all statistical analyses, and Review Manager (version 5.4) was used in assessing the risks of biases. Our study included 16 randomized controlled trials with a total of 1652 patients. platelet-rich plasma (PRP) IA injection therapy had the highest likelihood of being the best intervention in reducing WOMAC pain (surface under the cumulative ranking area [SUCRA] 84.7%), stiffness (SUCRA 95.1%), and function (SUCRA 98.5%) scores, according to the SUCRA. The best measures for lowering the WOMAC total and VAS scores were IA injection platelet-rich plasma-derived growth factor (SUCRA 84.9%) and hyaluronic acid and platelet-rich plasma (SUCRA 84.9%). In the VAS score group, PRP outperformed hyaluronic acid (HA) (WMD 1.3, 95% CI 0.55-2.55) and corticosteroids (CS) (WMD 4.85, 95% CI 4.02-5.08), according to the forest map results. PRP also outperformed CS (WMD 14.76, 95% CI 12.11-17.41), ozone (WMD 9.16, 95% CI 6.89-11.43), and PRP + HA (WMD 2.18, 95% CI 0.55-3.81) in the WOMAC total score group. Furthermore, PRP outperforms other drugs in terms of reducing WOMAC function, stiffness, and function score. In patients with mild to moderate KOA, IA injection PRP outperformed IA injection ozone, HA, CS, platelet-rich plasma-derived growth factor, and hyaluronic acid and platelet-rich plasma in terms of pain, stiffness, and dysfunction.

Long-term outcomes of corticosteroid graft versus host disease prophylaxis in peripheral blood allogeneic haemopoietic stem cell transplant: a comparative cohort analysis.

Corticosteroids (CSs) have previously been incorporated into graft versus host disease (GVHD) prophylaxis regimens for bone marrow (BM) and haemopoietic stem cell transplant (HSCT). To assess the impact of prophylactic CS in HSCT using peripheral blood (PB) stem cells. Patients were identified from three HSCT centres receiving a first PB-HSCT between January 2011 and December 2015 from a fully human leukocyte antigen (HLA)-matched sibling or unrelated donor for acute myeloid leukaemia or acute lymphoblastic leukaemia. To enable meaningful comparison, patients were divided into two cohorts. Cohort 1 included only myeloablative-matched sibling HSCT, where the only variation in GVHD prophylaxis was the addition of CS. In these 48 patients, there were no differences in GVHD, relapse, non-relapse mortality, overall survival or GVHD-relapse-free-survival (GRFS) at 4 years after transplant. Cohort 2 included the remaining HSCT recipients, where one group received CS-prophylaxis and the non-CS group received an antimetabolite, ciclosporin and anti-T-lymphocyte globulin. In these 147 patients, those receiving CS-prophylaxis experienced higher rates of chronic GVHD (71% vs 18.1%, P < 0.001) and lower rates of relapse (14.9% vs 33.9%, P = 0.02). Those receiving CS-prophylaxis had a lower 4-year GRFS (15.7% vs 40.3%, P = 0.002). There does not appear to be a role for adding CS to standard GVHD prophylaxis regimens in PB-HSCT.

Discussion on the Car-t therapy’s benefits and side effects by using and analyzing the Therapeutic application of Carvykti in multiple myeloma (MM)

MM, multiple myeloma the cancer of bone is becoming a serious medical problem that more than a hundred thousand people suffer from it nowadays. Recently, it surpassed leukemia and become the top 2 blood system cancer in America. In the US, the lifetime risk of getting multiple myeloma is 1 in 132. And until now, there haven’t a proven way to cure this disease completely. In common treatment, corticosteroid drugs and the medicines like Dexamethasone Selinexor and Bortezomib that we use to treat this disease are only proven to control the process of the MM and decrease the pain of the patients. Expect using these drugs or the combination of drugs to interfere with the development of the MM we also have the stem cell transplantation treatment to control the patient’s conditions. Of course, there is a common treatment for most cancer is chemotherapy but as we all know this treatment usually has serious side effects. Under such a circumstance, Legend Biotech developed Carvykti, the drug which uses Car-t therapy for treating patients who cannot be cured or even won’t going better by using the common therapy. The paper reviews this kind of drug by using its data according to the results of the clinical trials and the FDA reports. Then the paper compares it to the common therapy to overview car-t therapy’s possible advantages and disadvantages directly and than try to provide another version to optimize the Car-t therapy in curing MM. This paper also summarizes car-t therapy’s development. At last, according to these results to review some possible optimization for car-t therapy.

Drug-free remission is an achievable target with immunosuppressive treatment in idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease, in which there is no clear established treatment algorithm. Several physicians keep away from using immunosuppressive(IS) treatments in routine clinical practice. This study aimed to evaluate the rates of drug-free remission of the patients with IGM in a period of 3-year follow-up. This retrospective study conducted with 55 biopsy-proven IGM patients, who were followed up between February, 2011, and November, 2021, in rheumatology outpatient clinic of Gulhane Training and Research Hospital. The demographic and clinical characteristics of the patients were obtained from patients' files. The 3-year follow-up data were assessed for long-term outcome analyses. There were 55 female patients with a mean age of 36.8 ± 6.3years. Fifty-four (98.1%) patients were in drug-free remission at the end of 3years. The median duration of drug-free remission in patients receiving methotrexate (MTX), only corticosteroid (CS), and azathioprine was 19.7, 32.9, and 14.7months, respectively. The drug-free remission duration for the patient who received cyclosporine A as IS was 28.3months. The median duration of IS treatment was 15.8months, and the median duration of treatment with CS and other IS combination was 6.7months. Recurrence was observed in 4 (80%) patients without IS therapy after surgery, of whom MTX was used in 3 (75%) patients and achieved remission. IS agents provide high rate of prolonged drug-free remission and should be considered a part of routine medical care of the patients with IGM.

Psychiatric manifestations of corticosteroid therapy

IntroductionChildren and adolescents treated with corticosteroids (CS) may experience psychiatric side effects, including psychotic symptoms. These can occur at any time during treatment, including withdrawal. There is evidence in the adult literature that higher doses of CS increase this risk. However, the dose-response relationship is not clearly identifiable. This is probably a reflection of the complexity of the effects of CS on the central nervous system and the body.Objectivesthe objective of this study is to discuss the psychiatric manifestations secondary to corticosteroid therapyMethodsThis is a descriptive study of 10 children with a history of somatic pathologies for which they were placed on oral, nasal, or intravenous corticosteroid therapy and who during the course of this corticosteroid therapy presented with various psychiatric manifestations.ResultsThe majority of the children studied were male, i.e., 7 boys to 3 girls, six children either 60%, were on nasal corticosteroids; 20% on intravenous corticosteroids, ., 20% orally.The psychiatric manifestations noted were represented by : depressive disorder in 8 childrens Anxiety in 7 childrens a psychotic disorder in one child ADHD in 3 childrens.ConclusionsA causal role of corticosteroid therapy in the development of mental disorders in children and adolescents has been widely discussed but the results are controversial with respect to the route of administration, the relationship with the dose and the chronology of the development of mental disorders.Disclosure of InterestNone Declared

Treat to target and tight control: Could be a new approach in the treatment of sarcoidosis?

Sarcoidosis is a chronic granulomatous disease with multisystemic involvement. Although it is accepted as a benign disease, it can sometimes cause life-threatening organ (heart, brain) involvement that determines the prognosis of the disease. There are conflicting opinions about the treatment of the disease. In the generally accepted treatment approach the "step-by-step" model has gained weight. According to this approach, corticosteroids (CS) drugs alone are preferred in the first step in patients who require treatment. In the second step, immunosuppressive drugs (IS) are used in patients who do not respond to CS and/or have contraindications to CS use, and biologics (TNF-alpha inhibitors) are used in the third step. This treatment approach may be valid in cases with mild sarcoidosis. However, although sarcoidosis is considered a benign and self-limiting disease in some major organ involvement, the "step-by-step" approach may be a treatment option that puts the patient's life in danger. In such selected patients, much more rigorous, early and combined treatment approaches that definitely include CS, IS or biologic drugs may be required. In selected sarcoidosis patients with high risk, early diagnosis, "treat-to-target" (T2T) and "tight control" follow-up of patients seems to be a rational approach. This article reviews the "step-down" treatment regimens in light of recent literature data and hypothesizes that the T2T model may be a probable new treatment approach in patients with sarcoidosis.

Corticosteroids Decrease the Incidence and Activity of Choroidal Neovascularization in Patients with Punctuate Inner Choroidopathy or Multifocal Choroiditis

ABSTRACT Purpose To assess the effect of corticosteroids (CS) on choroidal neovascularization (CNV) occurrence and recurrence of activity over 2 years in patients with punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC). Methods Retrospective longitudinal study. Previous use of CS was analyzed between group without CNV and group with CNV occurrence and recurrence. Results Thirty-six patients were included. Patients with CNV were less likely to have received CS in the 6 months following PIC or MFC diagnosis (17% versus 65%, p-value = 0.01). Patients with CNV who had a recurrence of neovascular activity were less likely to have received a previous CS therapy (20% versus 78%; odds ratio = 0.08, p-value = 0.005). Conclusions This study suggests that patients with PIC and MFC should be treated by CS to prevent CNV development and decrease CNV recurrences.

Treatment patterns in myasthenia gravis: A United States health claims analysis.

Limited knowledge exists on treatment patterns in clinical practice in patients with myasthenia gravis (MG). In this study we examined MG treatment patterns in the United States. Adult patients newly diagnosed with MG were identified from the IBM MarketScan insurance claims database. Patients with ≥2 MG International Classification of Disease diagnosis codes ≥3 months apart were retrospectively followed from the date of their first MG diagnosis record or start of treatment with acetylcholinesterase inhibitors (AChEI), intravenous (IV) or subcutaneous (SC) immunoglobulin (Ig), or plasma exchange (PLEx) therapy. Based on treatment received at any time during the follow-up period, patients were segmented into six main treatment cohorts. Exacerbations and use of IVIg, SCIg, or PLEx after the index date were identified. During 2010 to 2019, 7,194 patients were followed for up to 10 (median, 2.3) years. Of 6,539 treated patients, 6,462 (99%) were ever treated with AChEI and/or corticosteroids (CS); 95% were first treated with AChEI and/or CS only; 33% received ≥1 nonsteroid immunosuppressive treatment (IST) and 2% received a biologic. During treatment with first IST (n = 2,166), patients experienced 42% and 94% higher incidence rates of exacerbations and IVIg, respectively, compared with AChEI and/or CS (n = 6,242), and 33% and 23% higher, respectively, compared with a second IST (n = 353). Many patients experienced exacerbations and received rescue therapy despite treatment, suggesting current treatments may not provide adequate disease control for some patients and that additional treatment options should be explored.

Microbiota signatures and mucosal healing in the use of enteral nutrition therapy v. corticosteroids for the treatment of children with Crohn's disease: a systematic review and meta-analysis.

Corticosteroids (CS) and exclusive and partial enteral nutrition (EEN and PEN) are effective therapies in paediatric Crohn's disease (CD). This systematic review of randomised controlled trials (RCT) and cohort studies analyses the impact of EEN/PEN v. CS on intestinal microbiota, mucosal healing as well as other clinically important outcomes, including clinical remission, relapse, adherence, adverse events and health-related quality of life (HRQL) in paediatric CD. Three RCT (n 76) and sixteen cohort studies (n 1104) compared EEN v. CS. With limited available data (one RCT), the effect on intestinal microbiome indicated a trend towards EEN regarding Shannon diversity. Based on two RCT, EEN achieved higher mucosal healing than CS (risk ratio (RR) 2·36, 95 % CI (1·22, 4·57), low certainty). Compared with CS, patients on EEN were less likely to experience adverse events based on two RCT (RR 0·32, 95 % CI (0·13, 0·80), low certainty). For HRQL, there was a trend in favour of CS based on data from two published abstracts of cohort studies. Based on thirteen cohort studies, EEN achieved higher clinical remission than CS (RR 1·18, 95 % CI (1·02, 1·38), very low certainty). Studies also reported no important differences in relapse and adherence. Compared with CS, EEN may improve mucosal healing with fewer adverse events based on RCT data. While limited data indicate the need for further trials, this is the first systematic review to comprehensively summarise the data on intestinal microbiome, mucosal healing and HRQOL when comparing enteral nutrition and CS in paediatric CD.