We all know that Corticosteroid Therapy can be very efficient in the treatment of inflammation and disease activity in Still’s Disease and Rheumatoid Arthritis; in fact I’m not sure I know of anything that gets symptoms under control quite as quickly. But of course, they come with a long list of worrying side effects that makes their use debateable:
In much of the literature I have come across, it seems to be a popular view that steroid treatment is riskier than I have sometimes been led to believe. One article in particular, from the Journal of Rheumatology suggests that ‘even exposures of less than 5 mg a day may be associated with potentially severe outcomes’; as for exposure to long-term treatment or higher doses… well I’ll let you read that for yourself.
The article doesn’t deny that sometimes drugs like Prednisolone need to be used, especially in ‘the most afflicted’ patients, (and I wonder if Still’s Disease, with its many systemic symptoms and organ involvement, automatically applies here), but what it does suggest is that doctors and patients need to be better informed when weighing the risks and the benefits and that perhaps more research into this is needed.
However, this is only one article and one perspective. It is more difficult to find information supporting the benefits of steroid treatment but maybe these are just taken as gospel. I did find an article on a website called Arthritistoday from December 2010 that suggests there could be a turnabout in such opinions, citing two current studies. The main points that are raised here are that:
1) Corticosteroids are less toxic than many of the DMARD alternatives, which can also have both acute and long-term side effects, including organ damage.
2) They do modify disease activity and slow down the progress of joint damage.
3) There is a chance that corticosteroids protect against large B-cell Lymphomas, of which there is an increased risk of in patients with Rheumatoid Arthritis.
The article goes on to conclude that steroids ‘are still some of the most powerful and essential drugs in use today, with side effects that need to be managed’.
So I guess what this means is that we shouldn’t disregard the use of Steroid treatment altogether, but should stay as informed as possible, so as to be in the position to weigh up the risks and benefits, by discussing any concerns with our consultants. Hopefully, they too will be weighing up the right factors in making their treatment decisions (it is their job after all). We also need to make sure that they are never the first line in treatment, in order to keep the dosage/usage to a minimum, and to manage any potential side effects as an when they are experienced.
I think I will need to look into this further at some point.