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Infections such as tuberculosis can spread extensively before they are discovered. Prolonged use of anti-inflammatory corticosteroids can also impair the function of fibroblasts, which reduces the ability of wounds to heal. In addition, changes in the synthesis of collagen occur resulting in thinning and loss of the mechanical resistance in the skin. On cessation of corticosteroid use, the structure of the skin may recover to a degree but there may be permanent damage in the form of striae particularly at sites of fat accumulation or oedema. There are other metabolic affects associated with chronic corticosteroid use including: redistribution of fat giving the typical moon face and buffalo hump; hyperglycaemia and possible diabetes; protein loss from skeletal muscles with wasting and weakness; increased bone metabolism leading to osteoporosis; and growth inhibition in children due to early closure of the epiphyseal plates in long bones.
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Indeed, use of DMARDs early on in the disease process is now recommended. The British Society for Rheumatology produces clinical guidelines for treatment of rheumatic diseases. Many of the same types of drugs are used to treat different rheumatic diseases. NSAIDs are used in the treatment of chronic inflammation because they have a lasting analgesic action and an anti-inflammatory effect. Both of these effects are due to the inhibition of an enzyme, cyclo-oxygenase.
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Tyrosine kinase then activates cellular enzymes, which in turn stimulate transcription of particular genes. This brings about the cellular response to the original hormone, for example growth. These are receptors for steroid hormones and thyroid hormone.
In moderate to severe rheumatoid arthritis of less than two years duration, low dose prednisolone may reduce the rate of joint destruction. Nevertheless, it is recommended that maintenance therapy should be for two to four years only and then gradually reduced to avoid possible long-term adverse effects. In some cases where there is involvement of only a few joints, corticosteroids (usually triamcinolone or hydrocortisone) can be administered locally by intra-articular injection to relieve pain, increase mobility and reduce deformity. Methylprednisolone has recently been added to the list of drugs that registered podiatrists can administer by injection into soft tissue injury.
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Quite often, this is due to genetic differences in enzyme activity. This can lead to differences in the rate at which a drug is metabolized and therefore after a given period of time, plasma levels will be different in different individuals.
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- Activation of effector mechanisms results in a product being produced.
- Initially, episodes of inflammation last only a week or so with no symptoms in between.
- This led to the suggestion that idiopathic Parkinsons disease may be caused by some, as yet, unidentified neurotoxin.
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This prevents the formation of certain prostaglandins that would otherwise cause inflammation and pain. Other drugs act as false substrates for the enzyme so that an abnormal product is made instead of the normal one.
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Side effects of amantadine and oseltamivir are gastrointestinal disturbances, insomnia and dizziness. Zanamivir should be used with caution in asthma and COPD because of the risk of bronchospasm.
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