Facts Of Corticosteroids

Corticosteroids or glucocorticoids, often just called "steroids", where once thought to be almost miraculous. In 1948, at the Mayo Clinic in Rochester, Minnesota a group of arthritis patients were given daily injections of a corticosteroid. The results were so striking and the improvement so dramatic that it was thought that the "cure" for arthritis had been discovered. However, as the use of corticosteroids expanded over the years, side effects emerged and it was realized that high doses given over prolonged periods of time turned steroids into "scare-oids". Patients were warned of the potential problems, the use of corticosteroids became more conservative, and some patients were so frightened of them they even declined treatment.

Corticosteroids are powerful drugs that can have valuable effect if administered within proper guidelines. Understanding how they work and how they can be safely taken is very important.

Corticosteroids are drugs closely related to cortisol, a hormone which is naturally produced in the adrenal cortex (the outer layer of the adrenal gland).

Corticosteroid Drugs Include:

Cortisol plays an important part in controlling salt and water balance in the body, and regulating carbohydrate, fat, and protein metabolism. When the body becomes stressed, the pituitary gland at the base of the brain releases ACTH, adrenocorticotropic hormone, which stimulates adrenals to produce cortisol. The extra cortisol allows the body to cope with the stress such as infection, trauma, surgery, or emotional problems. When the stressful situation ends, adrenal hormone production returns to normal.

The adrenal glands usually produce about 20 milligrams of cortisol per day, mostly in the morning, but can produce five times that much when needed.

Corticosteroids act on the immune system by blocking the production of substances that trigger allergic and inflammatory actions, such as prostaglandins. However, they also impede the function of white blood cells which destroy foreign bodies and help keep the immune system functioning properly. The interference with white blood cell function yields a side effect of increased susceptibility to infection.

Corticosteroids are widely used for many conditions. They are also used to control inflammation of the joints and organs in diseases such as:

Corticosteroids are not used systemically for osteoarthritis, though they are sometimes used as a local injection into an affected joint.

Corticosteroids are versatile in their mode of application. They can be given:

orallyinjected into the vein or muscleapplied locally to the skininjected directly into inflamed joints

Corticosteroid drugs can also be used as ingredients contained in:

eye products (to treat various eye conditions)inhalers (to treat asthma or bronchial disease)nasal drops and sprays (to treat various nasal problems)topical creams, ointments, etc. (to treat various skin problems)

Corticosteroids can be used in conjunction with other drugs, and are prescribed for short-term and long-term use.

Prednisone (brand names include: Cortan, Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M and Sterapred) is the most commonly prescribed synthetic corticosteroid for arthritis. Prednisone is four to five times as potent as cortisol. Therefore, five milligrams of prednisone is the equivalent of the body's daily output of cortisol. There are other synthetic corticosteroids available which differ in potency and half-life.

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Neither Executive adopts Arthritis Care goals

Northern Ireland Executive’s Draft Programme for Government was revealed on November 17, and it included two important commitments which will make a difference for people with arthritis and for which Arthritis Care has been campaigning hard.

The two commitments are to provide better access to anti-TNF (biologic) treatments for people with severe rheumatoid arthritis and to ensure that people with long term conditions have access to self management training and other education, information and support programmes to help them manage their conditions effectively.

Arthritis Care has campaigned long and hard, with the active participation of members and others with arthritis, for better access to anti-TNF’s, which can be life transforming for people with severe RA, and which are much more readily available in other parts of the UK than in NI. The Programme for Government now pledges to ‘enhance access to life-enhancing drugs for conditions such as rheumatoid arthritis, cancer, inflammatory bowel disease and psoriasis…’. Minister for Health Edwin Poots MLA has said that he hopes to reduce the waiting time for access to anti TNF’s from 9 months to 3 months.

Arthritis Care has also pressed hard, though the Long Term Conditions Alliance Northern Ireland, for recognition of the value of the self management training and information work which the organisation and other groups in the Alliance carry out. The programme for Government now makes the commitment to make such training and information available for those who want it, and to work with stakeholders to secure appropriate support programmes to help people manage their long term condition effectively.

Steve McBride, Arthritis Care’s Policy Adviser for Scotland and Northern Ireland, said ‘These proposals are a big step forward, and will have real benefits for many people with arthritis. There is still work to be done in ensuring the full and effective implementation of these policies, but the Programme for Government pledges are a real success and everyone who has taken part in helping to bring them about can take real satisfaction in this very positive outcome.'

The full Programme for Govenment document can be read at:
http://www.northernireland.gov.uk/draft-pfg-2011-2015.pdf
The draft document is now open for consultation until February 22, 2012.

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2011 quality of rheumatoid arthritis services in the NHS survey

The consultation, launched on World Arthritis Day is aimed at patients, clinicians and commissioners and seeks to assess the progress that has been made in improving services for patients with rheumatoid arthritis since the publication of the 2009 National Audit Office report Services for people with rheumatoid arthritis which outlined a number of concerns about the provision and quality of services for patients.

The consultation asks participants for feedback on the state of services in their area, the information and support available to patients and whether patients are getting access to the treatment and care they need to manage their condition.

Upon launching the consultation Federico Moscogiuri, Head of Policy and Public Affairs for Arthritis Care said: "Over two years since the National Audit Office published its findings into the state of services for people with rheumatoid arthritis, Arthritis Care remains concerned at the current quality of these services in England, particularly against the current backdrop of NHS 'efficiency savings'. That is why this World Arthritis Day we are launching this survey with clinicians, commissioners and people with rheumatoid arthritis across England, to determine how services have changed over the past two years and get an understanding of where further progress is needed to improve services for people with rheumatoid arthritis. This survey will feed into our newly-launched ArthritisWatch project, which will gather evidence of changes and cuts to services for all people with arthritis in England. For too long musculoskeletal conditions such as rheumatoid arthritis have not been a priority for the NHS: we hope this initiative can help to change that."

You are not obliged to answer any of the questions, but the more information you are able to provide, the stronger our evidence will be. We will not contact you and your answers will remain anonymous.

Survey for people with rheumatoid arthritis

Survey for doctors and comissioners

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Drugs Used to Treat Lupus

Medications are an important aspect of the management of many patients with systemic lupus erythematosus. An array of drug options are now available, which have increased the potential for effective treatment and excellent patient outcomes.

The goals for treating a patient with lupus include:

reducing inflammation caused by the diseasesuppressing immune system abnormalities that are responsible for tissue inflammationpreventing flares and treating them when they do occurminimizing complications

Lupus patients should work with their doctors to develop their own treatment plan. Once a person has been diagnosed with lupus, a drug treatment plan will be developed by their doctor based on a person’s:

It is important that patients thoroughly understand:

the reason for taking a drugits actiondoseadministration timesside effects

Pharmacists also can be a good resource for patients in helping them understand their medication treatment plan. If a patient experiences a problem believed to be related to a drug, the patient should notify her or his doctor immediately. It can be dangerous to suddenly stop taking some medications, and patients should not stop or change treatments without first talking to their doctor.

The array of medications and the complexity of treatment plans can be overwhelming and confusing. Most patients do well on lupus medications and experience few side effects. Those who do experience side effects or adverse events should not become discouraged, since alternative drugs are often available.

Lupus treatment should include as few medications for as short a time as possible. Some patients never require medications, and others take them only as needed or for short intervals, but many require constant therapy with variable doses. Despite their usefulness, no drugs are without risks. Medications frequently used to control lupus symptoms are:

Other medications may be necessary to control specific manifestations or to treat other conditions commonly seen with the disease. These include:

diureticsantihypertensivesanticonvulsantsantibiotics

Medications used to treat lupus should be reevaluated regularly and revised as necessary to ensure treatment is as effective as possible.

Nonsteroidal anti-inflammatory drugs (NSAIDs) comprise a large and chemically diverse group of drugs that possess analgesic, anti-inflammatory, and antipyretic properties. Pain and inflammation are common problems in patients with lupus, and NSAIDs are usually the drugs of choice for patients with mild lupus with little or no organ involvement. Patients with serious organ involvement may require more potent anti-inflammatory and immunosuppressive drugs.

There are many NSAIDs on the market, and new ones are constantly becoming available. Some NSAIDs can be purchased as over-the-counter drugs, whereas larger doses are available only by prescription.

The Facts of NSAIDs

The therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating:

An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.

Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. In addition, patients may do well on one NSAID for a period of time, then, for some unknown reason, derive no benefit from it. Switching to a different NSAID may produce the desired effects. Patients should use only one NSAID at any given time.

Antimalarials were first developed during World War II because quinine, the standard treatment for malaria, was in short supply. Investigators found antimalarials could also be used to treat the joint pain that occurs with rheumatoid arthritis. Subsequent use has shown that these drugs are effective in controlling:

lupus arthritisskin rashesmouth ulcersfatiguefever

Antimalarials are not used to manage more serious, systemic forms of lupus that affect the organs. It may be weeks or months before the patient notices that these drugs are controlling disease symptoms.

Antimalarials include:

Although chloroquine is still used, due to better safety, hydroxychloroquine is usually preferred. The anti-inflammatory action of these drugs is not well understood. In some patients who take antimalarials, the total daily dose of corticosteroids can be reduced. Antimalarials also affect platelets to reduce the risk of blood clots and lower plasma lipid levels.

Related Resources - Lupus ErythematosusRelated Resources - Lupus MedicationsRelated Resources - Lupus Medications

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Paracetamol warning

People taking paracetamol for chronic pain on to regular basis should be careful to avoid accidental overdose of the drug.

Researchers at Edinburgh University have suggested that people who regularly take paracetamol as a painkiller may be at risk from a 'staggered overdose'. This can happen when a person takes just one or two more tablets than recommended a day over a period of time, said the researchers in the British Journal of Clinical Pharmacology. They looked at the medical records of 663 people who were referred to hospital. When a staggered overdose continues, it can cause liver problems and other medical complications.

' People are advised not to exceed 8 tablets of 500 mg per day. This has been the recommendation for some time,' said Dr Richard Hull, chair of Arthritis Care's clinical and medical advisory board. ' You should also be aware that other drugs, such as co-codamol and co-dydramol, also contain paracetamol and this should be kept in mind when taking them.' Over-the-counter medications, such as Lemsip or decongestants, can contain paracetamol as well.

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Guide to Raynaud's Phenomenon

Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks, called vasospastic attacks, that cause the blood vessels in the digits (fingers and toes) to constrict (narrow). Raynaud's phenomenon can occur on its own, or it can be secondary to other conditions.

Although estimates vary, recent surveys show that Raynaud's phenomenon may affect 5 to 10 percent of the general population in the United States. Women are more likely than men to have the disorder. Raynaud's phenomenon appears to be more common in people who live in colder climates. However, people with the disorder who live in milder climates may have more attacks during periods of colder weather.

For most people, an attack is usually triggered by exposure to cold or emotional stress. In general, attacks affect the fingers or toes but may affect the nose, lips, or ear lobes.

When a person is exposed to cold, the body's normal response is to slow the loss of heat and preserve its core temperature. To maintain this temperature, the blood vessels that control blood flow to the skin surface move blood from arteries near the surface to veins deeper in the body.

For people who have Raynaud's phenomenon, this normal body response is intensified by the sudden spasmodic contractions of the small blood vessels that supply blood to the fingers and toes. The arteries of the fingers and toes may also collapse. As a result, the blood supply to the extremities is greatly decreased, causing a reaction that includes skin discoloration and other changes.

Once the attack begins, a person may experience three phases of skin color changes (white, blue, and red) in the fingers or toes. The order of the changes of color is not the same for all people, and not everyone has all three colors.

Pallor (whiteness) may occur in response to spasm of the arterioles and the resulting collapse of the digital arteries.Cyanosis (blueness) may appear because the fingers or toes are not getting enough oxygen-rich blood.

The fingers or toes may also feel cold and numb. Finally, as the arterioles dilate and blood returns to the digits, redness may occur. As the attack ends, throbbing and tingling may occur in the fingers and toes. An attack can last from less than a minute to several hours.

Doctors classify Raynaud's phenomenon as either the primary or the secondary form. In medical literature, "primary Raynaud's phenomenon" may also be called:

Raynaud's diseaseidiopathic Raynaud's phenomenonprimary Raynaud's syndrome

The terms idiopathic and primary both mean that the cause is unknown.

Most people who have Raynaud's phenomenon have the primary form (the milder version). A person who has primary Raynaud's phenomenon has no underlying disease or associated medical problems. More women than men are affected, and approximately 75% of all cases are diagnosed in women who are between 15 and 40 years old.

Research shows that less than 10% of people who have only vasospastic attacks for several years, without involvement of other body systems or organs, rarely have or will develop a secondary disease later.

Although secondary Raynaud's phenomenon is less common than the primary form, it is often a more complex and serious disorder. Secondary means that patients have an underlying disease or condition that causes Raynaud's phenomenon. Connective tissue diseases are the most common cause of secondary Raynaud's phenomenon. Some of these diseases reduce blood flow to the digits by causing blood vessel walls to thicken and the vessels to constrict too easily. Raynaud's phenomenon is seen in patients with:

Raynaud's phenomenon also can occur in patients who have other connective tissue diseases, including:

Possible causes of secondary Raynaud's phenomenon, other than connective tissue diseases, are:

carpal tunnel syndromeobstructive arterial diseasesome drugs (such as beta-blockers, ergotamine preparations, certain chemotherapy agents)drugs that cause vasoconstriction (such as some over-the-counter cold medications and narcotics)people in certain occupations (such as workers exposed to vinyl chloride or workers who operate vibrating tools)

People with secondary Raynaud's phenomenon often experience associated medical problems. The more serious problems are skin ulcers or gangrene in the fingers or toes. Painful ulcers and gangrene are fairly common and can be difficult to treat. Weakness in the muscle of the esophagus may cause heartburn or difficulty in swallowing.

Related Resources - Raynaud's PhenomenonRelated Resources - Raynaud's PhenomenonRelated Resources - Raynaud's Phenomenon

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Rheumatoid arthritis in Quality Outcome Framework consultation

Rheumatoid arthritis (RA) could be included in England’s Quality Outcome Framework (QOF). Arthritis Care has long campaigned for arthritis to be covered by the QOF to ensure the condition is prioritised and those living with it get the best outcomes from their healthcare service.

There are 20 potential new QOF indicators across nine areas currently being consulted on – RA is one of the areas being proposed. NICE is now consulting on whether to include RA and the five indicators they have chosen for the condition.

‘This is potentially great news for those living with RA in England,’ said Federico Moscogiuri, head of policy and campaigns at Arthritis Care. ‘Arthritis Care will be responding to the consultation to ensure we push for the most appropriate indicators to be included.’

Dr Fergus Macbeth, director of the Centre for Clinical Practice at NICE, said: ‘This consultation on potential new indicators is an integral part of NICE's process for QOF. The final menu of indicators, to be published on the NICE website in August, will support healthcare professionals to deliver good quality patient care, based on the best available evidence.’

Introduced in 2004, the QOF is a voluntary incentive scheme for GP practices in England, rewarding them for how well they care for patients. Arthritis Care continues to campaign for osteoarthritis to be included in the QOF.

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