Corticosteroids for rheumatic disease. 1. Physiology, pharmacology, and therapeutic strategies.

Of the corticosteroid preparations available, the intermediate-acting agents are the preparations most commonly used in the rheumatic diseases. Careful tailoring of dosage is important to avoid adrenal atrophy and signs of adrenocortical hypofunction. The best regimen in a given patient depends on the amount of antiinflammatory and immunosuppressive activity required. The therapeutic strategies in use include pulse therapy, daily high-dose therapy, daily low-dose therapy, and alternate-day dosing. The latter two methods are preferable because of the decreased likelihood of adverse reactions, yet are not sufficient in cases of fulminant systemic inflammatory processes.