Systemic Corticosteroid Therapy

Systemic corticosteroids are used when inflammation or immune activity is causing harm that outweighs the risks of suppressing it. Prednisone is a commonly used oral systemic corticosteroid. Prednisone enters cells and binds cytoplasmic glucocorticoid receptors. The receptor-drug complex moves into the nucleus and alters gene transcription, reducing cytokine production, leukocyte migration, and capillary permeability. Swollen, inflamed tissue becomes less reactive because the immune system’s signalling volume has been turned down. That broad effect explains both benefit and harm. The drug can reduce airway inflammation during an asthma exacerbation or control an inflammatory bowel disease flare, but it can also blunt the immune response to infection, raise glucose, affect mood, weaken bone, and suppress normal cortisol production. Prednisone may be used for adrenal insufficiency or congenital adrenal hyperplasia, severe allergic reactions, asthma exacerbations, rheumatic and collagen vascular diseases, inflammatory bowel disease, severe dermatologic disease, and selected oncologic indications. The treatment goal differs by indication: - Replacement therapy supplies glucocorticoid activity when the body cannot produce enough cortisol. - Anti-inflammatory or immunosuppressive therapy uses the lowest dose that controls harmful inflammation. A...