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Glucocorticoid withdrawal

Authors
Daniel E Furst, MD
Kenneth G Saag, MD, MSc
Section Editor
Eric L Matteson, MD, MPH
Deputy Editor
Monica Ramirez Curtis, MD, MPH

INTRODUCTION

Chronic glucocorticoid therapy is used in the treatment of a variety of disorders because of its potent antiinflammatory effects and, occasionally, because it is thought to have immunosuppressive activity [1]. Among the rheumatic diseases in which glucocorticoids are often used are rheumatoid arthritis, large- and small-vessel vasculitis, systemic lupus erythematosus, polymyalgia rheumatica, and, in some cases, the arthritis associated with inflammatory bowel disease [1].

Despite its efficacy, steroid-induced side effects generally require tapering of the drug as soon as the disease being treated is under control. Tapering must be done carefully to avoid both recurrent activity of the underlying disease and possible cortisol deficiency resulting from hypothalamic-pituitary-adrenal axis (HPA) suppression during the period of steroid therapy. (See "Pharmacologic use of glucocorticoids", section on 'HPA axis suppression'.)

This topic discusses the major issues related to tapering, the regimen(s) we use in most patients, and other glucocorticoid tapering regimens that have been reported in the literature.

The clinical manifestations, diagnosis, and treatment of adrenal insufficiency are presented separately. (See "Clinical manifestations of adrenal insufficiency in adults" and "Treatment of adrenal insufficiency in adults".)

INDICATIONS FOR WITHDRAWING GLUCOCORTICOIDS

It is helpful to briefly review the indications for glucocorticoid withdrawal before discussing the different glucocorticoid withdrawal regimens. These indications include the following:

                

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Literature review current through: Nov 2016. | This topic last updated: Tue May 31 00:00:00 GMT 2016.
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