Steroids for What???

When corticosteroids (often shortened to ‘steroids’) were first made available around 1950, they were used for acute inflammatory disorders as well as for severe infections. Since then, however, as we’ve come to understand more about how they work, their use has been avoided inactive infections because of their known immunosuppressive effects and potential long-term complications. Maybe we’ve swung back too far. A review in the Archives of Internal Medicine has examined published clinical trials of steroids in treating infectious diseases, and determined where they work, and where they don’t.

Treatment with steroids was found to be effective, improving survival, in bacterial and tuberculous meningitis, tuberculous pericarditis, typhoid fever, tetanus, and pneumoncystis pneumonia.

They are effective, with log-term benefits, in bacterial arthritis.

And they are effective, improving symptoms, in herpes zoster (shingles), infectious mononucleosis (‘mono’), croup, pneumococcal pneumonia, pharyngitis, tonsillar abscess, cellulitis, chronic middle ear effusion, pulmonary tuberculosis, and pleural tuberculosis.

This is an impressive list of infections where the use of steroids would help, rather than hinder, recovery. Provided they are used for a limited period of time in non-immunocompromised patients, steroids obviously should be brought out of the closet, and prescribed optimistically in these infectious diseases. They have proved their value in chronic inflammatory processes like rheumatoid arthritis and asthma, and their potential side effects and risks are well known. It’s time their full potential in infections is recognized.

Another condition shown to respond well to a steroid is acute gout. In fact, it’s just as effective as an NSAID. Dutch researchers gave 120 patients with gout either naproxen or prednisolone for 5 days. After 90 hours' treatment, pain and general disability scores were reduced to a similar extent in both groups. This finding provides a strong argument to consider prednisolone as a first treatment option in patients with gout.