Tapering systemic steroids

Methotrexate is given weekly as an intramuscular injection of 15 to 25 mg. Side effects are rare and include leukopenia and hypersensitivity interstitial pneumonitis. Hepatic fibrosis is the most severe potential sequela of long-term therapy. Patients with concomitant alcohol abuse and/or morbid obesity are more likely to develop hepatic fibrosis and therefore should not be treated with methotrexate. It is prudent to obtain a baseline chest radiograph and to monitor complete blood count, liver function and renal function every two weeks until the patient is receiving oral therapy, and every one to three months thereafter. Before methotrexate therapy is initiated, the risks of treatment and the possible need for a liver biopsy should be discussed with the patient.

Variability in cortisol assays creates an additional problem with setting criteria for a normal response to ACTH that apply to all centers. Two studies comparing cortisol results obtained with different assays showed a positive bias of radioimmunoassays and immunofluorometric enzyme assays of 10 to 50 percent compared with a reference value obtained using isotope dilution gas chromatography-mass spectrometry. As a result, in one study, depending on the combination of assay and criterion used, between 0 and 100 percent of healthy volunteers would be considered to have a normal response to ACTH. This illustrates the difficulty of interpreting cortisol responses that are close to the cutoff point. (3)

Treatment guidelines, based upon presence or absence of active systemic features, clinician global assessment, active joint count, and presence or absence of features concerning for macrophage activation syndrome (MAS), are outlined by the American College of Rheumatology (ACR) [ 2 ]. These guidelines emphasize the earlier use of biologics in children with sJIA, although specific information on appropriate dose is lacking. Another set of standardized treatment plans was developed through a consensus process by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) based upon the most commonly used treatment approaches for systemic JIA [ 3 ].

Fludrocortisone is rapidly and completely absorbed after oral administration. Man, dog, rat, monkey and guinea-pig were studied after . and intraduodenal administration. Depending on species, 50% or more of the steroid remained unchanged 30 minutes after administration. Fludrocortisone is hydrolysed to produce the non-esterified alcohol; after administration of the acetate, only the non-esterified alcohol is detectable in blood. The blood level reaches a peak between 4 and 8 hours. The highest blood level after . administration to human volunteers was hours.

Tapering systemic steroids

tapering systemic steroids

Fludrocortisone is rapidly and completely absorbed after oral administration. Man, dog, rat, monkey and guinea-pig were studied after . and intraduodenal administration. Depending on species, 50% or more of the steroid remained unchanged 30 minutes after administration. Fludrocortisone is hydrolysed to produce the non-esterified alcohol; after administration of the acetate, only the non-esterified alcohol is detectable in blood. The blood level reaches a peak between 4 and 8 hours. The highest blood level after . administration to human volunteers was hours.

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