Weisman M H
University of California at San Diego, USA.
Curr Opin Rheumatol. 1995 May;7(3):183-90. doi: 10.1097/00002281-199505000-00005.
Over the past year, a number of important advances have been made in understanding the pathobiology and clinical utility of corticosteroid agents for rheumatic disease patients. Unfortunately, the new information did not always confirm our preconceived notions. Pulse or intermittent high-dose steroid administration for rheumatoid arthritis as yet does not have a clear role. Observational analyses of populations of rheumatoid arthritis subjects, although based on data from the most severely ill patients, turn us away from using prednisone as background therapy in rheumatoid arthritis. Bone loss may be rapid and profound in rheumatoid arthritis patients in spite of clinical improvement from what are believed to be "acceptable" low doses of prednisone, and high-dose corticosteroid treatment of giant cell arteritis may be worse than the disease itself. Several reviews point to thoughtful strategies for the prevention of corticosteroid side effects. It is clear that new dosing arrangements need to be created and studied.
在过去一年中，在理解皮质类固醇药物对风湿性疾病患者的病理生物学和临床应用方面取得了一些重要进展。不幸的是，新信息并不总是证实我们先前的观念。脉冲式或间歇性高剂量类固醇给药在类风湿性关节炎中尚未有明确作用。对类风湿性关节炎患者群体的观察性分析，尽管基于病情最严重患者的数据，但却使我们不再将泼尼松用作类风湿性关节炎的背景治疗药物。尽管低剂量泼尼松被认为是“可接受的”，且类风湿性关节炎患者临床症状有所改善，但骨质流失可能迅速且严重，而高剂量皮质类固醇治疗巨细胞动脉炎可能比疾病本身更糟糕。多项综述指出了预防皮质类固醇副作用的周全策略。显然，需要制定并研究新的给药方案。
