- Chronic inflammatory diseases
- Cortisone tablets
- Cushing’s threshold dose,
- Dexamethasone
- Low-dose therapy
- Neurodermatitis
- Prednisone
- Prednisolone
- Rheumatic illnesses
Today, cortisone preparations (glucocorticoids) are among the most important drugs in the treatment of many acute and chronic inflammatory diseases. They are very effective drugs, which are available today in various forms of application and enable targeted therapy. In the case of chronic inflammatory diseases, cortisone tablets in particular can have a positive influence on the course of the disease and give those affected a better quality of life.
Cortisone can be used in many different ways. Cortisone ointments and creams are available for local therapy of inflammatory skin diseases, for example. Applied to the diseased skin area, these effectively combat the inflammation and promote the healing process.
Cortisone can also be administered as an injection, e.g. for inflammatory joint diseases. Cortisone sprays for inhalation play an important role in the therapy of asthma and have a positive influence on the course of the disease. Cortisone can still be administered in tablet form.
These are often only used in severe disease progressions where therapy of the underlying disease and local administration of glucocorticoids have little effect. The main effect of cortisone is the suppression of inflammatory processes and exaggerated immune reactions. Inflammation is a component of many diseases and, depending on its severity, can severely restrict the quality of life of those affected.
Through targeted treatment with cortisone, inflammation is effectively combated and associated complaints are reduced. However, cortisone does not eliminate the cause of the disease! However, the healing process can be positively influenced by treating the accompanying symptoms.
For some inflammatory diseases with a chronic course, basic therapy and local application of cortisone are often not sufficient. For example, in skin diseases such as neurodermatitis, in which even deep-lying skin layers can be inflamed, the active substance from a cream cannot penetrate deep enough. Here the use of cortisone tablets can help.
The active ingredient enters the bloodstream via the gastrointestinal tract and is transported from there to diseased areas. One speaks of a systemic effect. On the one hand, cortisone tablets can be used as a short-term therapy to treat a relapse of the disease.
On the other hand, depending on the severity of the disease, regular intake as part of a long-term therapy may be necessary to prevent a relapse. Cortisone is also used as a form of therapy for children. Examples: Disease patterns in which cortisone is given systemically A systemic cortisone therapy can also be given via infusions.
Here, glucocorticoids are given directly into the bloodstream. This makes the active substance available even faster. – severe forms of neurodermatitis
- Lupus erythematosus
- Rapidly progressing, destructive rheumatoid arthritis
- Chronic polyarthritis
- Ulcerative colitis, Crohn’s disease
- Multiple sclerosis flare-up
- Substitution therapy for Addison’s disease
Cortisone is an endogenous hormone and regulates many processes in the body (see Cortisone).
Introduced into the body as a drug from outside, it enhances the effect of the body’s own cortisone. Inflammatory processes and the overreactivity of the immune system are inhibited, and associated complaints are reduced. As part of a short-term therapy (approx.
2 weeks) to treat a flare-up, a high dose is administered in the first few days, which is continually reduced over the course of the treatment days. This is also called a creeping dosage. In the context of long-term therapy, your doctor will choose the smallest possible but nevertheless most effective dosage with which your disease can be well controlled and causes as few side effects as possible (low-dose therapy).
The entire daily dose can either be taken at once at a certain time of day, usually in the morning between 6-8 o’clock (circadian rhythm). This is when the body’s own cortisone production is at its highest. However, the daily dose can also be divided into several daily profile-dependent units.
Please do not change your dosage automatically or stop the therapy abruptly! This could endanger the success of the treatment and cause undesirable side effects. If you have any questions about the dosage or if problems occur, please consult your treating physician!
Side effects of cortisone therapy (see Cortisone therapy for asthma) usually occur when the externally administered dose is many times higher than the body could tolerate over a long period of time. A uniquely high dose is not dangerous. Likewise, the risk of undesirable side effects occurring is low if the treatment period is 2 weeks.
Glucocorticoids are not fast-acting drugs. Because they control gene regulation, their effect is delayed, but all the more lasting. Side effects are closely related to the natural function of glucocorticoids.
A high dose taken over a long period of time has the desired therapeutic effect in particularly severe diseases. Inflammatory processes are inhibited, the immune system is prevented from overreacting and the patient is free of symptoms. But other metabolic processes can also be influenced, which can have undesirable consequences.
If a high dose of glucocorticoids is supplied to the body from outside over a longer period of time, the body’s own production is downregulated in the adrenal gland. However, this can also further impair metabolic processes that are controlled by hormones produced in the kidney. This can lead to high blood pressure.
Furthermore, an excess supply of cortisone in the body promotes the breakdown of body reserves to blood sugar. If this cannot be broken down quickly enough, diabetes develops. In this context, pay attention to an increased feeling of thirst and an increased urge to urinate.
Too much cortisone can also have a negative effect on fat metabolism. The result would be weight gain. You should therefore pay attention to a balanced diet.
Osteoporosis can develop in connection with long-term use of cortisone. The suppressive effect of glucocorticoids on the immune system reduces resistance to pathogens. Patients treated with cortisone often show an increased susceptibility to infections.
Occasionally there are psychological changes such as euphoria or depression. In the context of long-term therapy, as is often carried out in addition to basic therapy in the case of more serious chronic diseases, the benefits and risks must be weighed up against each other. Of all cortisone preparations, the use of cortisone tablets entails a higher risk of undesirable side effects in relative terms (systemic effect).
In the case of many serious illnesses, one must weigh up whether the possible side effects of cortisone therapy are more serious than the consequences of the (untreated) underlying illness. The cortisone side effects are often considered the “lesser evil” in comparison to the underlying disease, especially since the course of the disease can be influenced positively by cortisone therapy. The so-called Cushing’s threshold dose is regarded as the yardstick by which therapeutically used glucocorticoids can produce side effects.
This term is derived from a disease (Cushing’s syndrome). The symptoms of Cushing’s syndrome are the result of an excess supply of cortisone in the body. It is precisely these “cortisone-typical” side effects that can also occur with an excessively high dose of cortisone therapy.
The Cushing’s threshold dose indicates the amount of active substance which, when taken daily over a long period of time, causes “cortisone-typical” side effects such as those which occur in Cushing’s syndrome. However, this is only a rough guide value. It varies according to age, sex and type of disease. Active substance | Cushing’s threshold dose [mg/day] | Preparations Betamethasone | 1 | Celestamine® Dexamethasone | 1.5 | Dexa-CT®, Dexamethasone GALEN® Fluocortolone | 7.5 | Ultralan®-oral Hydrocortisone | 30 | Hydrocortisone Hoechst®, Hydrocutan® methylprednisolone | 6 | Urbason®, M-PredniHEXAL®, Metysolon® prednisolone | 7.5 | Decortin®, Dermosolon, PredniHEXAl® prednisone | 7.5 | Decortin®, PrednisolHEXAL® triamcinolone | 6 | Delphicort®, Volon®
