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Posts Tagged ‘Debate’

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:

List of Side Effects.

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.

L

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Home from my Rheumy visit and feeling a bit tender; ended up needing my shoulder injected too as there was quite a bit of fluid there.  Steroids always seem to do the trick for me and it usually only takes a few days for things to settle down after having a joint injected so I’m confident I will see some improvement soon.  If only there weren’t so many side effects, treatment would really be that simple. 

I was prompted to discuss this with my rheumy earlier, when a certain conversation got me thinking about the pros and cons of steroid therapy as it stands.  I hate the stuff, but I have to say it works when I need it to and when things get tough, a temporary increase is usually the first thing we try to settle things down.  I have been on various doses over the past fifteen years and that is with just one break, which happens to coincide with my most serious flare up. When I am well I tend to hover around the 2.5mg – 5mg dose and the highest I’ve been on is 80mg when I was very first diagnosed; the rest of the time I’m somewhere in between. 

I hadn’t been overly concerned about this until recently, taking the view that it was important to feel as well as possible and to reduce symptoms and any possible joint damage.  Then I happened to see my consultant’s registrar in clinic and he said that one day I/we would regret all the steroids I have had to have over the years in various forms (Oral, IV, Joint Injections).  Of course this worried me; I have already experienced a lot of effects already, including an increased susceptibility to infection, and persistant tachycardia. Then there are things like heartburn, stretchmarks (ugh) and weight gain (double ugh), which aren’t pleasant but are bearable in comparison to the pain of a flare or joint damage.

The most worrying ones for me are those that are possible in the future, such as adrenal failure, Glaucoma, Diabetes and Osteoporosis.  I know that my bone density is already below the normal range and I am at risk of developing diabetes anyway since it runs it my family.  As for adrenal failure, the possibility of this was already mentioned when I last tried to wean myself off Prednisolone altogether four or five years ago; I could never get past the 2.5mg mark without showing some signs of this.  Perhaps it’s about time that I do start to think about how these and other possible contraindications could effect me in the long-run. 

I guess what surprised me was that two rheumatology practitioners, working together, could have such different opinions on my treatment with steroids: The consultant, who increased my Prednisolone dose and gave me two cortisone shots to ease the flare and the registrar, who was extremely reluctant and in fact wanted me to reduce the dose, despite the flare.  I know one has more experience than the other and perhaps that is the best factor to base a decision on… but how do you know for sure which approach is right?

On top of weighing the risks with the benefits it also becomes a matter of weighing the present with the future; we are always being told to live for the moment and of course we all want to feel as well as possible now.  And is it really worth putting present health on hold to protect the health of a future, in which anything could happen – for better or for worse?

Perhaps it’s simply trying to find a balance between the two? Weighing the risks and benefits of all sorts of things becomes part of life with Still’s Disease after all.

Food for thought.

L

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