The Future of Steroid Therapy in Inflammatory Disease

Submit Manuscript | http://medcraveonline.com billion/year and considerable patient awareness [1,2]. GCs were first discovered as the adrenal hormone capable of fully reversing the pathology of Addison’s disease [3]. It was Philip Hench (1948) however who first noticed that female patients with rheumatoid disease showed clinical improvements when pregnant, this led to the search for some adrenal factor responsible and the ensuing discovery of the primary endogenous glucocorticoid, cortisone (inactive)/ cortisol (active). Upon introduction of synthetic formulation of cortisone to women with arthritis significant pain relief and mobility was obtained within 3 days of treatment and was heralded as a miracle [4]. Since these humble beginnings several synthetic steroid preparations have been approved including dexamethasone and betamethasone which are particularly potent with dramatically less mineralocorticoid activity versus cortisone [4]. Endogenous Glucocorticoids like cortisol are produced and controlled by the hypothalamic-pituitary-adrenal (HPA) axis. This is a key axis which regulates steroid hormone production in the body. Upon stimulation of the hypothalamus by some biological stressor (e.g. illness, fever, hypoglycaemia) as well as neural and cytokine inputs the periventricular nuclei of the hypothalamus of the brain releases Corticotrophin Releasing Hormone (CRH) which stimulates the anterior pituitary gland to release ACTH (adrenocorticotrophic hormone) which in turn stimulates the adrenal cortex to release glucocorticoids which through negative feedback reduce and inhibit the production of the aforementioned factors which stimulated its secretion(5).