Glucocorticoids are an essential therapeutic agent in the management of many inflammatory, autoimmune, and other rheumatic diseases. Perhaps because of their remarkable potency and widespread use, the literature on steroid treatment has tended to be rather anecdotal. Nonetheless, new information, both on the mechanism of action and on the clinical application, continues to become available. The complexity of the biology of steroid-receptor engagement and gene regulation is unraveling, and carefully designed clinical studies are helping to refine clinical application. However, for the clinician, the need for careful observation and sound judgment with glucocorticoid use remains critically important.
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