Mechanism of anti-inflammatory action
The pharmacological effect of steroid agents is realized at several levels:
- Biochemical level: The main mechanism consists in inhibiting the activity of the enzyme phospholipase A2. As a result, the arachidonic acid cascade is blocked, leading to a decrease in the production of inflammatory mediators — prostaglandins and leukotrienes.
- Genetic and molecular level: The drugs suppress the synthesis of pro-inflammatory factors, such as interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-α), and cyclooxygenase-2 (COX-2), while simultaneously stimulating the synthesis of anti-inflammatory factors.
- Pathophysiological level: At the level of inflammatory stages, vascular wall permeability decreases, exudation and tissue infiltration are reduced, and phagocyte activity is suppressed.
Clinical application
The main profile for the use of these medicinal products is the therapy of various autoimmune pathologies.
In clinical practice, glucocorticoids are prescribed for:
- Rheumatoid arthritis.
- Systemic lupus erythematosus.
- Skin diseases, including neurodermatitis and eczema.
Safety profile and adverse effects
Adverse reactions develop predominantly with prolonged drug administration, which is necessary for the treatment of chronic autoimmune conditions.
- Systemic disorders: They cause immunosuppression (decreased immunity), hyperglycemia, redistribution of adipose tissue, as well as impaired mineral and protein metabolism. Physical and mental developmental delay is possible in children, and osteoporosis in adults.
- Organ damage: They exert an ulcerogenic effect, leading to ulceration of the gastric mucosa. Mental disorders of the central nervous system are possible, as well as the development of glaucoma and cataracts.
Briefly: answers to topical questions
What dosages of glucocorticoids are used in rheumatoid arthritis?
Low doses of glucocorticoids are used in rheumatoid arthritis. Exact numerical dosage values are not specified, but the general pharmacotherapy strategy is defined.
Glucocorticoids are used within the framework of the following approach:
- Combination regimen — drugs are prescribed together with disease-modifying antirheumatic drugs (DMARDs) and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Duration of therapy — the minimum duration of the treatment course is 3 months.
- Start of treatment — therapy with disease-modifying drugs must be started immediately after diagnosis.
The main goals of such treatment are the induction of remission and the prevention of joint destruction.
Class and exam questions
What is the main biochemical mechanism of action of glucocorticoids?
The main mechanism consists in inhibiting the activity of phospholipase A2. This leads to the blockage of the arachidonic acid cascade and a decrease in the synthesis of prostaglandins and leukotrienes.
In what diseases are steroidal anti-inflammatory drugs used?
They are used mainly for the treatment of autoimmune pathologies such as rheumatoid arthritis, systemic lupus erythematosus, and also for skin diseases (eczema, neurodermatitis).
What are the main side effects of these drugs associated with?
Side effects usually develop against the background of prolonged administration required to control chronic autoimmune processes, and affect metabolism, the gastrointestinal tract, the immune and bone systems.
What else to study on this topic
- Genetic and molecular level of regulation of cytokine synthesis
- The effect of steroids on exudation and vascular wall permeability
- Metabolic disorders and endocrine safety profile
- Organ damage of the gastrointestinal tract, visual organs, and central nervous system
- Features of use in rheumatoid arthritis and lupus erythematosus
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