Optimum management of glucocorticoid-treated patients

Glucocorticoids are taken by approximately 2% of the US adult population at any given time. The powerful anti-inflammatory and immunosuppressive benefits of these drugs must, however, be weighed against their multisystem effects. Clinicians should always prescribe the lowest possible dose for the shortest possible time. Patients should be informed of the short-term and long-term adverse effects to expect, particularly if the dose of glucocorticoids is expected to exceed the equivalent of approximately 7.5 mg prednisone daily for 2 months or more. At the commencement of glucocorticoid therapy, a patient's blood pressure, lipid profile, 25-hydroxyvitamin D-3 level and fasting glucose level should be measured and baseline bone densitometry performed. Bisphosphonate therapy should be initiated for postmenopausal women and men with a bone density T-score below-1 or for those with a history of fracture. Regular ophthalmic screening for cataracts and glaucoma is warranted, and patients at high-risk of gastric ulceration (especially patients simultaneously taking nonsteroidal anti-inflammatory drugs) should receive proton-pump inhibitors. Prophylaxis against opportunistic infections is appropriate for high-risk populations, such as organ-transplant recipients. Trimethoprim plus sulfamethoxazole can be given to high-risk populations, such as organ transplant recipients. The duration of weaning from glucocorticoid treatment should be proportionate to treatment duration. Appropriate preventive therapy can mitigate many of the adverse effects associated with glucocorticoid therapy.