Oral Steroid Treatment Research Articles

Comparison of mannitol, methacholine and exercise challenge test to evaluate bronchial hyperresponsiveness in asthmatic children

To compare the effect of hydrofluoroalkane-134a (HFA) beclomethasone dipropionate (BDP; 400μ g/d) with that of chlorofluorocarbon (CFC) BDP (800 μg/d) on asthma health-related quality of life in a 12-week, parallel-group, multicenter study.HFA-BDP is a new CFC-free preparation of BDP, which was developed as a result of CFCs being phased out from metered dose inhalers.Following 7 to 12 days of prednisone, 30 mg/d, 347 adults with moderate asthma were randomized to receive either 400μ g/d HFA-BDP, 800 μg/d CFC-BDP, or HFA placebo for 12 weeks (all other oral and inhaled steroids were withdrawn). Patients completed the Asthma Quality of Life Questionnaire (AQLQ), and clinical asthma status was measured at the end of a run-in period, at randomization (after oral steroid treatment), and at the end of the study treatment.Sixty-one patients withdrew, 43 due to worsening asthma (33 placebo; 5 HFA-BDP; 5 CFC-BDP). There was a deterioration in the AQLQ score (− 0.81) in the placebo group, and the difference between this and the stability observed in both the HFA-BDP group (+ 0.13) and the CFC-BDP group (− 0.03) was statistically significant (p ≤ 0.003). The difference between the two active treatments was not significant (p = 0.290). The calculated number of patients who needed to be treated in order to see a benefit in one patient (with the placebo as the standard treatment) was 2.4 for HFA-BDP and 3.0 for CFC-BDP. Only weak to moderate correlations were observed between changes in AQLQ scores and between asthma clinical status measures.HFA-BDP (400μ g/d) was as effective as CFC-BDP (800 μg/d) in sustaining improvements in asthma quality of life following withdrawal of 7 to 12 days of prednisone treatment in moderate asthma.

Oral vs Intratympanic Corticosteroid Therapy for Idiopathic Sudden Sensorineural Hearing Loss

Idiopathic sudden sensorineural hearing loss has been treated with oral corticosteroids for more than 30 years. Recently, many patients' symptoms have been managed with intratympanic steroid therapy. No satisfactory comparative effectiveness study to support this practice exists. To compare the effectiveness of oral vs intratympanic steroid to treat sudden sensorineural hearing loss. Prospective, randomized, noninferiority trial involving 250 patients with unilateral sensorineural hearing loss presenting within 14 days of onset of 50 dB or higher of pure tone average (PTA) hearing threshold. The study was conducted from December 2004 through October 2009 at 16 academic community-based otology practices. Participants were followed up for 6 months. One hundred twenty-one patients received either 60 mg/d of oral prednisone for 14 days with a 5-day taper and 129 patients received 4 doses over 14 days of 40 mg/mL of methylprednisolone injected into the middle ear. Primary end point was change in hearing at 2 months after treatment. Noninferiority was defined as less than a 10-dB difference in hearing outcome between treatments. In the oral prednisone group, PTA improved by 30.7 dB compared with a 28.7-dB improvement in the intratympanic treatment group. Mean pure tone average at 2 months was 56.0 for the oral steroid treatment group and 57.6 dB for the intratympanic treatment group. Recovery of hearing on oral treatment at 2 months by intention-to-treat analysis was 2.0 dB greater than intratympanic treatment (95.21% upper confidence interval, 6.6 dB). Per-protocol analysis confirmed the intention-to-treat result. Thus, the hypothesis of inferiority of intratympanic methylprednisolone to oral prednisone for primary treatment of sudden sensorineural hearing loss was rejected. Among patients with idiopathic sudden sensorineural hearing loss, hearing level 2 months after treatment showed that intratympanic treatment was not inferior to oral prednisone treatment. clinicaltrials.gov Identifier: NCT00097448.

Levetiracetam‐Induced Acute Generalized Exanthematous Pustulosis

Antiepileptic drugs have been associated with many adverse effects, including different types of rashes; however, the frequency of rash varies among the drugs. The most common adverse effects associated with levetiracetam include somnolence, asthenia, headache, dizziness, and behavioral abnormalities. Until recently, rash had not been reported as an adverse effect of levetiracetam in adults. We describe a 45‐year‐old, African‐American woman who developed a desquamating rash after starting levetiracetam for a witnessed seizure. The rash improved after the drug was discontinued, but on rechallenge, the desquamating rash reappeared. The patient was hospitalized, levetiracetam was discontinued, and supportive care and treatment with triamcinolone 0.1% cream and oral prednisone were started. Her rash was biopsied, and she was diagnosed with drug‐induced acute generalized exanthematous pustulosis (AGEP). With topical and oral steroid treatment the patient's rash improved, and she was discharged on hospital day 4. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6) between the patient's development of AGEP and levetiracetam exposure. To our knowledge, this is the first case report of levetiracetam‐induced AGEP. Although levetiracetam is usually well tolerated, clinicians should be aware of this potential adverse drug reaction in patients who develop severe skin reactions while receiving this drug.

Neonatal pulmonary interstitial glycogenosis in a patient with Hunter syndrome

In 2004, we reported on a neonate with pulmonary interstitial glycogenosis (PIG), with favorable outcome at the age of 19 months when the case report was published [8]. However, at the age of 3 years, hepatosplenomegaly and a mild limitation in joint mobility was detected by clinical examination. Hunter syndrome (mucopolysaccharidosis (MPS) type II) was diagnosed. In the following years, the patient presented with frequent upper respiratory infections, moderate hearing loss, and umbilical hernia, common findings in patients with MPS II. At the age of 8 years, the patient’s lung function tests show a severe combined obstructive/restrictive pattern with a forced vital capacity of 70% predicted and a FEV1 of 30% predicted. Infectious exacerbations usually necessitate oral steroid treatment (median of 3 periods annually). The patient receives enzymtherapy (Elaprase® = idursulfase), which stabilized his neurodevelopmental status but not his respiratory problems. It is unclear whether neonatal PIG accompanies MPS II or not. Classically, in MPS II, pulmonary dysfunction manifests primarily by progressive airway disease, frequent upper respiratory tract infections being one of the earliest findings [6]. Clinical features appear between 2 and 4 years of age, newborn infants usually being normal. The biochemical cause is a deficiency in the activity of the lysosomal enzyme, iduronate-2-sulfatase, resulting in reduced degradation of dermatan sulfate and heparan sulfate. Accumulation of these glycosaminoglycans in the soft tissues of the respiratory system leads to narrowing of the trachea, eventually leading to progressive obstructive airway disease, gradually involving the lower airways [5]. Atelectasis and tracheobronchomalacia have also been reported to be associated with MPS II [7]. Glycogen is required to support epidermal mitosis in embryonic respiratory epithelium and other tissues with

In vitro steroid resistance correlates with outcome in severe alcoholic hepatitis

Steroids improve the outcome in alcoholic hepatitis (AH), but up to 40% of patients fail to respond adequately. Interleukin-2 (IL-2) exacerbates steroid resistance in vitro. We performed a prospective study to determine if intrinsic steroid sensitivity correlates with response to steroids in individuals with severe AH and if IL-2 receptor blockade can reverse this. Peripheral blood mononuclear cells (PBMCs) were isolated from 20 patients with AH and a Maddrey's score >32. Patients were treated with oral prednisolone plus full supportive measures. Clinical resistance to oral steroid treatment was defined as a drop in serum bilirubin of <25% within 7 days or death within 6 months. In vitro steroid resistance was measured in PBMC using the dexamethasone suppression of lymphocyte proliferation assay and repeated after the addition of the anti-IL-2 receptor (anti-CD25) monoclonal antibody, basiliximab. Suppression of lymphocyte proliferation <60% was considered to indicate steroid resistance. In all, 82% (9/11) of in vitro steroid-resistant patients were dead at 6 months as compared to 21% (2/9) of steroid-sensitive patients (P = 0.03). Similarly, 91% (10/11) of in vitro steroid-resistant patients failed to show a significant fall in bilirubin at day 7 as compared to 44% (4/9) of steroid-sensitive patients (P < 0.05). Basiliximab improved the maximal proliferation count in 91% (10/11) of in vitro steroid-resistant patients (P = 0.003). Clinical outcome of steroid therapy in this patient cohort correlated with in vitro steroid resistance. IL-2 blockade improved in vitro steroid sensitivity. This suggests that intrinsic lack of steroid sensitivity may contribute to poor clinical response to steroids in severe AH. IL-2 receptor blockade represents a possible mechanism to overcome this.

Hydroxyproline levels in nasal polyps

The aim of this study was to evaluate hydroxyproline levels in nasal specimens from patients with nasal polyps, and to examine hydroxyproline levels after nasal steroid spray and oral steroid treatments. This study was performed on 41 patients. The subjects were divided into four groups: no medication group (group A, n 11), oral methylprednisolone group (group B, n 8), topical steroid spray group (group C, n 8) and control group (group D, n 14). Nasal polyp samples were collected endoscopically. Healthy subjects were studied as a control group, and their nasal samples were taken during turbine reduction surgery. All samples were analyzed using the immunocytochemistry method. Hydroxyproline levels were investigated and compared with the control group. Mean hydroxyproline levels in groups A-D were 98.48, 24.20, 8.97 and 4.52, respectively. The hydroxyproline levels were significantly higher in group A compared with that of group D. The treatment that revealed significant decreases in hydroxyproline levels was group C. Although there was also a noticeable reduction in group B, there were no statistically significant differences between group B and group A. Our study revealed a significant correlation between nasal polyp and hydroxyproline levels. The hydroxyproline levels were significantly higher in nasal polyps. Both oral and topical steroid treatments decrease hydroxyproline levels in nasal polyps. Thus, in theory, steroid treatment can directly decrease hydroxyproline levels by inhibiting proline hydroxylase and indirectly by lowering the inflammatory process.

A Case of Vogt-Koyanagi-Harada Disease Associated With Polycystic Ovary Syndrome

We report a female patient diagnosed as Vogt-Koyanagi-Harada (VKH) and polycystic ovary syndrome (PCOS). She has diagnosed as VKH with diminished vision, bilateral serous retinal detachment, the signs of fundus fluorescein angiography and the findings of optical coherence tomography. The patient was referred to the gynecology clinic for her complaints as weight gain, hirsutismus and amenorrhea. She has also been diagnosed with PCOS. With oral steroid treatment, visual acuity has improved and the detachments have resolved within a month. VKH disease may be associated with polycystic ovary syndrome. The two conditions may have a common autoimmune pathogenesis.KeywordsAutoimmune pathogenesis; Polycystic ovary syndrome; Vogt-Koyanagi-Harada

Steroid Responsive Pancreatic Mass-Forming Type 2 Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP) has two distinct subsets. Type 1 AIP or lymphoplasmacytic sclerosing pancreatitis is systemic disease with the elevation in serum levels of the IgG4. Type 2 AIP, also called duct-centric pancreatitis, features granulocyte epithelial lesions with duct obstruction in the pancreas without systemic involvement. Here, we report a case of type 2 AIP diagnosed by pathology, which is the first report in Korea. The case is a 56-year-old woman who presented with anorexia and vomiting. Computed tomography revealed mass-like lesion in the pancreatic head and the compression of the distal common bile duct and the head portion of the main pancreatic duct. Serum levels of the IgG4 were normal. Histologic examination revealed a dense neutrophil infiltration in the pancreatic parenchyme associated with extensive fibrosis, thereby confirming the diagnosis of type 2 AIP. The abnormalities in the clinical, laboratory, and radiological findings improved after oral steroid treatment.

Intravitreal triamcinolone acetonide for rebound phenomenon after high-dose intravenous steroid treatment in Vogt-Koyanagi-Harada disease

The authors report two cases of rebound phenomenon treated with intravitreal triamcinolone acetonide in Vogt-Koyanagi-Harada (VKH) disease. Patients in the acute phase of VKH disease were treated with high-dose intravenous (IV) methylprednisolone (1 g/day) for 3 days. Serous retinal detachment decreased and visual acuity improved during IV steroid treatment. After switching to oral steroid treatment, choroiditis and visual acuity worsened. An injection of triamcinolone acetonide (4 mg) into the vitreous resulted in gradual resolution of subretinal fluid and improvement of visual acuity. Systemic steroids were tapered to discontinuation without a relapse of inflammation. Adjuvant intravitreal triamcinolone is useful in the management of the rebound phenomenon in VKH disease.

Influence of Age on the Risk of Severe Exacerbation and Asthma Control in Childhood

Background. Asthma is a heterogeneous disease but it is a common observation that children tend to “grow out of their asthma.” Objective. The aim was to specifically assess the influence of age on the occurrence of a severe exacerbation (at least 3 days use of systemic corticosteroid – international 2009 definition) and of the achievement of control (GINA guidelines) in children treated for asthma. Our study was controlled for amount of therapy and for season. Methods. Children under inhaled corticosteroid (ICS) were enrolled over two 2-month periods (autumn, spring). Duration of oral steroid treatment and of symptoms, dose of ICS and long-acting beta-agonist were recorded for the past 3 months. Results. Three hundred and fifty-nine children (110 girls) were included (48 [<2 years], 116 [2–6 years], 107 [6–10 years], 88 [>10 years]) during autumn (n = 175) and spring (n = 184), all treated by ICS (mean daily dose ± SD = 378 ± 250 μg). Among the 359 children, 133 (37%) experienced at least one severe exacerbation, and control was observed in 111 (31%) children. A multivariate logistic regression model demonstrated that age, season, and ICS dose are independent risk factors for exacerbation, whereas age is the only predictor of control. The odds ratio of exacerbation and control are 0.85 (95% CI, 0.78–0.92, p < .0001) and 0.85 (95% CI, 0.79–0.91, p < .0001) per year of increase in age, respectively. Conclusions. From infancy to adolescence, each year of life reduces per se the risk of a severe exacerbation by 15% and similarly increases the achievement of control in children treated for asthma.

Neurosarcoidosis Affecting the Spinal Cord

Sarcoidosis is a chronic inflammatory disease that involves multiple systems. Complications in the nervous system are rare, especially in Asia. This report describes an unusual case of neurosarcoidosis affecting the spinal cord and other systems in a 53-year-old Taiwanese women patient. The patient presented with subacute onset of right arm radicular pain followed by quadriparesis. Magnetic resonance imaging revealed a hyperintense lesion on T2WI in the cervical spinal cord. The patient also had a history of facial neuropathy, bilateral parotid enlargement, intrathoracic lymphadenopathy, hypercalcemia, nephrocalcinosis, and renal function impairment. Parotid gland biopsy showed granulomatous lesion with multinucleated giant cells. Sarcoidosis was diagnosed after other possibilities were excluded. Oral steroid treatment resulted in initial significant clinical improvement. Awareness of the systemic and neurological presentations of sarcoidosis can prompt the correct diagnosis and treatment.

Thiazolidinedione use and ulcerative colitis-related flares: An exploratory analysis of administrative data

Recent animal studies and clinical trials suggest that thiazolidinediones, a class of oral antidiabetic agents, are efficacious in reducing inflammation, yet no studies have evaluated their effectiveness in preventing flares. We examined the association between thiazolidinedione use and ulcerative colitis (UC)-related flares. We conducted a retrospective cohort study using administrative data from 87 health plans across 33 states. Individuals with both UC and diabetes were identified using administrative definitions. Exposure to thiazolidinediones or other oral antidiabetic agents was ascertained through outpatient pharmacy claims. The primary outcome was occurrence of a UC flare defined by: 1) a new prescription for oral steroids, infliximab, or oral/rectal salicylates, or 2) a claim for colectomy. Secondary analyses analyzed outcomes separately. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression after matching each thiazolidinedione user to a comparable oral antidiabetic user on propensity score. This study included 142 thiazolidinedione and 468 other oral antidiabetic users with a mean follow-up of 7.3 and 6.2 months, respectively. Thiazolidinedione use was not associated with UC-related flares as measured by the composite outcome (HR = 1.05, 95% CI: 0.66, 1.68). However, thiazolidinedione use was associated with a nonsignificant reduction in risk of oral steroid use when analyzed as a separate outcome (HR = 0.53, 95% CI: 0.20, 1.44). Thiazolidinediones do not provide any benefit over other oral antidiabetics in preventing UC-related flares as measured by our primary composite outcome. However, thiazolidinedione use may reduce the risk of more significant disease flares requiring oral steroid treatment.

Steroid treatment of posttraumatic anosmia

The objective of this study was to treat posttraumatic anosmia with oral steroid and evaluate its effect. One-hundred sixteen posttraumatic patients whose olfactory thresholds were -1.0 by the phenyl ethyl alcohol threshold test assembled in our department. They were treated with a course of high-dose steroid, and followed up for at least 3 months. During the latter period of this study, magnetic resonance imaging was performed to measure the volumes of olfactory bulbs and to detect subfrontal lobe damage. Among them, 19 (16.4%) patients' olfactory thresholds improved after steroid treatment, but the other 97 patients' thresholds did not change. The incidences of loss of consciousness and intracranial hemorrhage after head injury, the ratios of admission and craniotomy, the intervals between head injury and steroid treatment, the volumes of olfactory bulbs, and the incidences of subfrontal lobe damage were not significantly different between patients whose thresholds improved and those whose thresholds did not improve. However, patients with olfactory improvement were significantly younger than those who remained unchanged. Our study showed that oral steroid treatment might improve olfactory acuity in some patients with posttraumatic anosmia, but the possibility of spontaneous recovery cannot be ruled out.

Preemptive Use of High-Dose Fluticasone for Virus-Induced Wheezing in Young Children

Ducharme FM, Lemire C, Noya FJD, et al. N Engl J Med. 2009;360(4):339–353PURPOSE OF THE STUDY. To examine the efficacy and safety of preemptive, high-dose fluticasone treatment in reducing the severity of recurrent virus-induced wheezing in children.STUDY POPULATION. Children between 1 and 6 years of age (N = 129) with moderate-to-severe, virus-induced wheezing were included. The investigators tried to exclude subjects with sensitization to aeroallergens, but 7% of the randomly assigned children developed symptoms of persistent or atopic asthma during the study period.METHODS. The subjects received 750 μg of fluticasone propionate or placebo twice daily, beginning at the onset of an upper respiratory infection and continuing for a maximum of 10 days, over a period of 6 to 12 months. The primary outcome measured was the use of rescue oral steroid treatment. Secondary outcomes included symptoms, use of β2-adrenergic receptor agonists, acute care visits, hospitalizations, discontinuation of study drug administration, changes in growth and bone mineral density, basal cortisol level, and adverse events.RESULTS. Over a median period of 40 weeks, 8% of upper respiratory infections in the fluticasone group led to systemic steroid treatment, compared with 18% in the placebo group (odds ratio: 0.49). However, children treated with fluticasone, compared with the placebo group, had smaller gains in height (6.23 ± 2.62 vs 6.56 ± 2.90 cm) and weight (1.53 ± 1.17 vs 2.17 ± 1.79 kg). There were no significant differences between the groups in basal cortisol levels, bone mineral density, or adverse events.CONCLUSIONS. In preschool-aged children with moderate-to-severe, virus-induced wheezing, preemptive treatment with high-dose fluticasone, compared with placebo, reduced the use of rescue oral steroid treatment. High-dose fluticasone treatment, however, was associated with smaller gains in height and weight. Therefore, the authors concluded that this approach should not be adopted in clinical practice until long-term adverse effects are clarified.REVIEWER COMMENTS. The investigators showed, on one hand, improvement in the need for oral steroid treatment for children treated with high-dose fluticasone but, on the other hand, smaller gains in height and weight for these patients. The question for the rest of us is how to incorporate these new data into clinical practice. For example, the dose of fluticasone that was used was quite substantial for small children. Was this dose on the flat part of the dose-response curve for corticosteroids? Would a smaller dose give the same benefit without the detriment? Also, how do these data apply to children with clinical allergy or risk factors for allergy?

Episodic Use of an Inhaled Corticosteroid or Leukotriene Receptor Antagonist in Preschool Children With Moderate-To-Severe Intermittent Wheezing

Bacharier LB, Phillips BR, Zeiger RS, et al. J Allergy Clin Immunol. 2008;122(6):1127–1135PURPOSE OF THE STUDY. To examine the effectiveness of episodic use of an inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA) in preschool-aged children with moderate-to-severe intermittent wheezing associated with respiratory tract illness (RTI).STUDY POPULATION. Children 12 to 59 months of age with ≥2 episodes of wheezing with RTI in the previous year and either 2 urgent care visits for wheezing, 2 wheezing episodes requiring oral steroid treatment (<6 courses), or 1 episode requiring urgent care and oral steroid treatment.METHODS. The study design was a randomized, double-blind, placebo-controlled trial, with children assigned randomly to 1 of 3 treatment groups with instructions to treat for 7 days at the onset of each RTI-associated symptom set during a 12-month period: (1) budesonide suspension (1 mg twice daily) plus LTRA placebo, (2) montelukast (4 mg daily) plus ICS placebo, or (3) ICS placebo plus LTRA placebo. All groups received albuterol 4 times per day for the first 48 hours of illness plus as-needed dosing. Orally administered steroids were available if needed, but other asthma medications were prohibited. Symptom/treatment diaries were maintained, and clinic/telephone follow-up evaluations were conducted. The primary outcome was the proportion of episode-free days (EFDs). Secondary outcomes included severity of lower respiratory tract symptoms in the 14-day period after initiation of treatment, time to initiation and number of orally administered steroids, number of wheezing episodes, days missed from day care and work, caregiver quality of life, unscheduled visits because of acute wheezing, and linear growth.RESULTS. Two hundred thirty-eight children were randomly assigned and were well matched with respect to baseline characteristics. Adherence to therapy was similar between the groups. EFDs did not differ among the 3 treatment groups (adjusted EFD mean: budesonide: 76%; montelukast: 73%; placebo: 74%). Relative to placebo, there were significant reductions in trouble breathing (budesonide: 37.5%; montelukast: 36.8%; P = .003) and interference with activity (budesonide: 31.9%; P = .01; montelukast: 39.6%; P = .001). Wheezing scores were reduced with montelukast (33.5%; P = .02) but not with budesonide (24.6%; P = .09). Overall, total symptom scores were reduced with montelukast (29.6%; P = .006) and budesonide (24.6%; P = .02). Among participants with positive asthma predictive index status, both budesonide and montelukast significantly reduced scores for trouble breathing (budesonide: 48.0%; P = .001; montelukast: 40.3%; P = .007) and activity interference (budesonide: 43.6%; montelukast: 53.7%; P < .001); only montelukast reduced wheezing (P = .049). Similar findings were seen for children with previous oral steroid therapy use.CONCLUSIONS. For preschool-aged children with moderate-to-severe intermittent wheezing, episodic use of either budesonide or montelukast early in RTIs did not increase the proportion of EFDs. However episodic use of an ICS or LTRA decreased symptom burden, particularly for those with risk factors for asthma or greater illness severity (use of oral corticosteroid therapy).REVIEWERS COMMENTS. This study was conducted to address an important clinical question: is the episodic use of an ICS or LTRA effective in decreasing the morbidity associated with severe intermittent wheezing in preschool-aged children? Using a unique study design, the authors demonstrated benefit for children with symptoms and treatment predictive of asthma, indicating consideration for the early use of antiinflammatory medications. Additional study is needed to address this important question fully.

Rheumatoid arthritis, treatment with corticosteroids and risk of malignant lymphomas: results from a case–control study

BackgroundBenefits and risks of corticosteroid treatment in rheumatoid arthritis (RA) are debated. Patients with RA are at increased risk of malignant lymphomas. In a large case–control study of risk factors...

SOLITARY IDIOPATHIC CHOROIDITIS WITH CHOROIDAL NEOVASCULARIZATION

To report a case of solitary idiopathic choroiditis associated with choroidal neovascularization. Case report of a 36-year-old healthy man who was referred for floaters in the left eye of 3 weeks' duration. Fundus examination of the left eye revealed a yellow-white subretinal lesion superior to the fovea. It was associated with a small subretinal hemorrhage and a macular detachment, which extended into the fovea. No vitreous cells were detected. The right eye was normal. The visual acuity was 20/20 in the right eye and 20/50 in the left eye. Laboratory evaluation for inflammatory or infectious diseases was nonrevealing. Fluorescein angiography showed Type 2 or so-called classic choroidal neovascularization associated with retinochoroidal anastomoses. After two laser treatments with poor outcomes, the lesion was effectively treated with oral steroids. A reactivation occurred 1.5 years later, and it was also successfully treated with oral steroids. Solitary idiopathic choroiditis can rarely be associated with choroidal neovascularization. Oral steroid treatment seems to be the preferred form of therapy rather than some form of interventional modality.

Increased blood glucose levels following intra-articular injection of methylprednisolone acetate in patients with controlled diabetes and symptomatic osteoarthritis of the knee

The effect of oral or intravenous steroid treatment on glucose metabolism is well known.1 Intra-articular steroid injection (IASI) at the knee joint is a common procedure,2 however there are no...

Steroid Treatment of Primary Progressive Aphasia

To learn if oral steroid treatment can alter the signs of primary progressive aphasia (PPA). Many patients with PPA have had a vasectomy and there is a possible link between vasectomy and autoimmune diseases. If PPA is, at least in part, an autoimmune disease, patients might improve with immunosuppressant treatment. Case report. Cognitive and memory clinic. A 68-year-old right-handed man with a 2.5-year history of progressive speech impairment who had a vasectomy 25 years prior. Examination revealed that he had a nonfluent aphasia with intact repetition and comprehension. Before and during oral prednisone treatment, he was assessed for speech fluency, naming, and episodic and working memory. All assessments except episodic memory showed a dramatic improvement. On reassessment 1 month after discontinuing treatment, the patient's performance on cognitive testing had regressed toward baseline. Although this patient's improvement with steroid treatment provides support for the postulate that PPA might be a treatable autoimmune disease, future placebo-controlled trials are needed before conclusions can be drawn.

The improvement of renal survival with steroid pulse therapy in IgA nephropathy

Background. The benefits of steroid therapy in immunoglobulin A nephropathy (IgAN) have not been established.Methods. The effect of steroids on kidney survival was retrospectively investigated in 702 patients with IgAN by multivariate analyses.Results. There were 295 men and 407 women. The median follow-up period was 62 months. One hundred and ninety-four patients were treated with oral steroids (oral steroid group). Thirty-four patients were treated with methylprednisolone (mPSL) pulse therapy (pulse steroid group) followed by oral prednisolone (PSL). In 474 patients, no steroid was used (no steroid group). The urinary protein-creatinine ratio and histological grade were significantly different among treatment groups and were highest in the pulse steroid group followed by the oral steroid group and lowest in the no steroid patients. Serum creatinine was significantly higher in the pulse steroid group than in other two groups. Eighty-five patients developed end-stage renal failure (ESRF) requiring haemodialysis. In multivariate analysis, steroid pulse therapy significantly decreased the risk of ESRF while oral steroid treatment did not improve renal survival in this cohort.Conclusion. We found that pulse steroid therapy improved kidney survivals in IgAN. Since the clinical findings and histological grade were the most severe in patients treated with mPSL pulse therapy, such therapy may prevent progression of IgAN.