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The discovery in the late 1940s of the very potent anti-inflammatory and immunosuppressive properties of glucocorticoids (GC)1 has dramatically improved the prognosis of severe systemic lupus erythematosus (SLE), with survival rates increasing markedly from 50% at 3 years in 19532 to 92% at 10 years in recent series.3 In particular, intravenous pulse methylprednisolone (MP) therapy, introduced as treatment for severe lupus manifestations in the 1970s,4 displays remarkable and prompt beneficial effects in acutely ill SLE patients suffering from renal impairment, central nervous system disease, arthritis, pleuropericarditis, fever or severe thrombocytopenia.5 ,6 Unfortunately, many patients, especially those taking >7.5 mg per day for long periods, experience the serious consequences of GC therapy, such as, increased risk of infection, avascular osteonecrosis, osteoporosis, myopathy, diabetes mellitus or Cushingoid features, as well as skin bruising and cataracts. Most of these side effects impact upon a patient's body image, being a huge source of emotional distress in young (sometimes teenaged) female patients, who are the principle victims of SLE.
Several longitudinal studies performed in SLE patients have revealed that GCs are the main cause of damage, as determined by the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (DI).7 Thus, the mean DI rose from 0.33 at baseline to 1.9 after 15 years of follow-up in an inception cohort, and damage was considered as …
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