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Dermatol Online J 2020 Jan 15;26(1). Epub 2020 Jan 15.

University of Wisconsin Department of Dermatology, Madison, WI.

Intralesional corticosteroids are associated with various, uncommon, local adverse events [1]. Atrophy and hypopigmentation most commonlyremain localized to sites of injection. However, outward radiation in a linear, streaky pattern has been reported and is termed "perilesional/perilymphatic hypopigmentation or atrophy [2]. Read More

Minerva Med 2018 Aug;109(4):300-325

Division of Orthopedics and Traumatology, School of Medical and Pharmaceutical Science, DINOGMI Department, Section of Orthopedic Rehabilitation, University of Genoa, Genoa, Italy.

Introduction: Clodronic acid is a non-nitrogen-containing bisphosphonate largely used from some decades in the prevention and treatment of postmenopausal and secondary osteoporosis. In addition to antiresorptive activity, clodronate has shown anti-inflammatory and analgesic properties, and modulatory effects on bone and cartilage metabolism.

Evidence Acquisition: A literature review has been conducted to characterize the mechanism of action of clodronate and to retrieve available evidence about the use of clodronate in primary and secondary osteoporosis, and its potential role in other musculoskeletal conditions and orthopedic surgery. Read More

Cochrane Database Syst Rev 2017 01 24;1:CD010899. Epub 2017 Jan 24.

Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Room 02.041, 2nd Floor, Mulhouse, Grosvenor Road, Belfast, Northern Ireland, UK, BT12 6BJ.

Background: Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the risk of vertebral fragility fractures. Good practice in the care of those with DMD requires prevention of these adverse effects. Treatments to increase bone mineral density include bisphosphonates and vitamin D and calcium supplements, and in adolescents with pubertal delay, testosterone. Read More

J Neurol Sci 2014 Mar 17;338(1-2):96-101. Epub 2013 Dec 17.

Principle Clinical Military Hospital, Federal Security Service of the Russian Federation, Golitzyno, Petrovskoe shosse d.48, Odinzovskiy r-n, Moscow Region 143040, Russia.

Background: Corticosteroid-induced myopathy is a well known clinical entity, and experimental studies showed decreased rate of protein synthesis and increased rate of protein breakdown in muscles of chronically treated animals.

Objective: The present observational study was aimed to evaluate skeletal muscle functions in asthmatics and patients with other chronic respiratory diseases treated by inhaled or oral corticosteroids.

Methods: Thirty six patients with respiratory diseases were included into the study. Read More

BMC Musculoskelet Disord 2012 Nov 22;13:228. Epub 2012 Nov 22.

Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan.

Background: To investigate whether or not coadministration of tacrolimus (TAC) with prednisolone (PSL) can produce a beneficial effect in the treatment of polymyositis/ dermatomyositis (PM/DM).

Methods: We reviewed medical records of 32 PM/DM patients who had been admitted to our hospital, and abstracted those who had received TAC in addition to oral PSL for treatment. The clinical usefulness of TAC in PM/DM was objectively evaluated focusing upon the manual muscle strength test (MMT) score, serum creatine kinase (CK) and tapering of PSL. Read More

Orv Hetil 2012 Mar;153(12):467-74

Szent Borbála Kórház I. Belgyógyászat Tatabánya Dózsa György u.

Polymyositis-dermatomyositis is a rare systemic autoimmune disease which belongs to the class of idiopathic inflammatory myopathies. The disease exhibits high inter-individual variability, but chronic myositis is a common feature. As different manifestations often appear in atypical forms, establishing the precise diagnosis can be rather complicated. Read More

Integr Blood Press Control 2011 3;4:7-16. Epub 2011 Mar 3.

Endocrine Unit.

Corticosteroids constitute an ideal treatment for various inflammatory and autoimmune disorders due to their anti-inflammatory and immunomodulatory actions. However, corticosteroids have a considerable number of side effects, including hypertension, diabetes, lipid disorders, sleep apnea, osteoporosis, myopathy, and disorders of coagulation and fibrinolysis, which are components of Cushing's syndrome (CS). Corticosteroid-induced side effects are dependent on the formulation, route, dose, and time of exposure. Read More

Med Oncol 2010 Sep 4;27(3):753-5. Epub 2009 Aug 4.

Division of Respiratory Medicine, International Medical Center of Japan, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.

A 77-year-old woman was diagnosed as having advanced non-small cell lung cancer, and was started on treatment with gefitinib. Fifty days after the start of treatment, the patient was admitted to the hospital with complaints of dry cough, fever, and shortness of breath. A diagnosis of gefitinib-induced interstitial lung disease was made, and administration of high-dose prednisolone (1 g/day of intravenous methylprednisolone for three consecutive days, followed by oral prednisolone at 50 mg/day) was started. Read More

J Drugs Dermatol 2009 May;8(5):492-3

Duke University Medical Center, Division of Dermatology, USA.

Intralesional and intra-articular corticosteroids are commonly used therapies in the fields of dermatology, orthopedic surgery and rheumatology. The authors present the case of a 32-year-old female who received intra-articular corticosteroids for de Quervain's tendonitis and developed bilateral hypopigmented patches near the areas of injection. Unilateral linear extension of the hypopigmentation was subsequently noted, presumably secondary to venous or lymphatic uptake of corticosteroid crystals. Read More

Foot Ankle Surg 2009 31;15(1):22-7. Epub 2008 Jul 31.

Dokuz Eylül University, School of Medicine, Department of Orthopaedics and Traumatology, Izmir, Turkey.

Background: To determine the effects of human amniotic fluid and membrane in the treatment of Achilles tendon ruptures, 72 tendons of 36 Wistar rats were injected with betamethasone sodium phosphate.

Methods: By the end of fourth week, both tendons were tenotomized and repaired, then the samples were divided into three groups. The first group was left untreated after suturing. Read More

Pain Physician 2008 Nov-Dec;11(6):917-20

Millennium Pain Center, Bloomington, IL 61701, USA.

Background: Synthetic corticosteroids are commonly utilized in interventional pain management procedures. These substances have potential side-effects including psychological adverse events.

Objective: We describe a case of substance-induced psychotic disorder resulting from corticosteroids administration. Read More

Ann Dermatol Venereol 2008 Oct 24;135(10):668-71. Epub 2008 Jul 24.

Service de dermatologie 1 hôpital Saint-Louis, AP-HP, université Paris-7, 1 avenue Claude-Vellefaux, Paris, France.

Background: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of gas-filled cysts within the wall of the digestive tract. Classically, it occurs in lung or colon diseases but rarely in patients with collagen disorders. We report a new case of PCI occurring during the course of paraneoplastic dermatomyositis. Read More

Ann Allergy Asthma Immunol 2007 Oct;99(4):371-4

Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Background: Therapy-resistant asthma is an important clinical problem. However, before considering asthma truly therapy resistant, it is essential to exclude diagnoses that may masquerade as therapy-resistant asthma, such as vocal cord dysfunction and recurrent aspiration, as well as factors related to loss of asthma control, including poor compliance, exposure to allergens, and sinusitis. Corticosteroid-induced myopathy may be an unrecognized but potentially important consideration in both settings. Read More

Drug Saf 2007 ;30(10):861-81

Department of Internal Medicine, Hôpital Saint Antoine, Paris, France.

Corticosteroids represent the most important and frequently used class of anti-inflammatory drugs and are the reference therapy for numerous neoplastic, immunological and allergic diseases. However, their substantial efficacy is often counter-balanced by multiple adverse events. These corticosteroid-induced adverse events represent a broad clinical and biological spectrum from mild irritability to severe and life-threatening adrenal insufficiency or cardiovascular events. Read More

Crit Care Med 2007 Feb;35(2):351-7

Département d'Anesthésie Réanimation, University Hospital of Brest, Brest, France.

Objective: Physiopathology of critical illness polyneuromyopathy was investigated in several animal-based models. Electrophysiologic approach was achieved in denervated and corticosteroid-induced myopathy; other models based on sepsis or inflammatory factors (zymosan, cytokines) were also used but did not consider voltage-gated sodium channel implication in neuromuscular weakness. We have studied electrophysiologic effects of chronic sepsis on an intact neuromuscular rat model with special consideration to the subtypes of sodium channels involved. Read More

Cesk Patol 2006 Oct;42(4):175-81

Ustav patologie a molekulární mediciny UK 2. LF a FN Motol, Praha.

Granulomatous myopathies are extremely rare. The finding of epithelioid granulomas in muscle biopsy indicates mostly an involvement of the skeletal muscle in systemic sarcoidosis. In this report we provide description of five patients with previously diagnosed sarcoidosis (pulmonary or cutaneous), in which a clinically significant muscle weakness developed. Read More

Appl Physiol Nutr Metab 2006 Oct;31(5):490-4

Medical School of Ribeirão Preto, University of São Paulo, Internal Medicine Department, Hospital das Clínicas de Ribeirão Preto, Avenida Bandeirantes 3900, CEP 14098-900, Brazil.

Myopathy is a well-known side effect of corticosteroid therapy. Creatine monohydrate (Cr) supplementation has been shown to increase fat-free mass and muscular function. This study aimed to investigate if Cr administration could offset the deleterious functional effects of high doses of steroids. Read More

J Appl Physiol (1985) 2007 Feb 19;102(2):698-703. Epub 2006 Oct 19.

Dept. of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.

The objective of the present study was to investigate whether creatine (Cr) could attenuate the deleterious effects of high doses of dexamethasone (Dexa) on body mass, exercise performance, and respiratory variables of rodents. Forty-four Wistar rats performed incremental maximal exercise tests. They were then assigned to four groups: G1: subcutaneous (s. Read More

J Rheumatol 2005 Oct;32(10):1986-91

Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.

Objective: Reports of eye involvement in juvenile dermatomyositis (JDM), including significant retinopathy with visual loss, have led some to recommend routine formal ophthalmologic assessments for all patients with JDM at diagnosis. Our objective was to document the frequency and spectrum of eye involvement in patients followed in a single clinic caring for children with JDM.

Methods: A chart review was conducted of formal ophthalmologic consultation notes for patients with JDM followed at the Hospital for Sick Children between 1981 and 2002. Read More

Spinal Cord 2006 Apr;44(4):263-4

Arch Phys Med Rehabil 2004 Sep;85(9):1470-4

Department of Orthopaedics and Traumatology, Dokuz Eylül University, School of Medicine, Izmir, Turkey.

Objective: To investigate the local effects of hylan G-F 20 on locally administered corticosteroid-induced experimental Achilles' tendonitis.

Design: Before-after trial.

Setting: Institutional practice. Read More

J Neurol 2002 Aug;249(8):1004-9

First Department of Internal Medicine, School of Medicine, The University of Tokushima, Kuramoto-3-18-15, Tokushima 770-8503, Japan.

Corticosteroid myopathy is a major clinical problem in patients undergoing chronic corticosteroid treatment and shows insidious and progressive muscle atrophy in proximal limbs. Although several mechanisms underlying the pathophysiology of muscle injury have been postulated, precise pathogenesis is still not clear. We evaluated the mitochondrial functions in patients receiving corticosteroids compared with those in healthy controls or patients not receiving corticosteroids. Read More

Knee Surg Sports Traumatol Arthrosc 2001 Jul;9(4):247-53

Dokuz Eylül University, School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey.

This study investigated the local effects of heparin on locally administered corticosteroid-induced experimental Achilles tendinitis. After performing Achilles degeneration, 28 rats were divided into two groups; one was treated with local heparin and the other with saline injections at 3 and 6-day intervals. The tendons and paratenons were excised after 60 or 75 days and evaluated histopathologically and statistically. Read More

J Jpn Phys Ther Assoc 2001 ;4(1):25-7

The First Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.

We studied the effect of treadmill exercise on muscle fibers in mice with experimental steroid myopathy. Frozen sections of the extensor digitorum longus (EDL) and soleus (SOL) muscles were stained with hematoxylin-eosin, and the muscle fiber diameters measured. In the EDL, muscle fiber diameters in the steroid groups decreased significantly compared with those in the control groups; moreover, muscle fiber diameters in the exercise groups increased significantly compared with those in the non-exercise groups, whereas the diameters in the SOL did not differ. Read More

Sports Med 2000 Sep;30(3):171-92

College of Health and Human Performance, and College of Medicine (Division of Cardiology), University of Florida, Gainesville 32611, USA.

During the past 2 decades, heart transplantation has evolved from an experimental procedure to an accepted life-extending therapy for patients with endstage heart failure. However, with dramatic improvements in organ preservation, surgery and immunosuppressive drug management, short term survival is no longer the pivotal issue for most heart transplant recipients (HTR). Rather, a return to functional lifestyle with good quality of life is now the desired procedural outcome. Read More

Rev Mal Respir 2000 Jun;17(2 Pt 2):591-6

Service de Pneumologie et Immuno-Allergologie, Hôpital Calmette, CHRU de Lille.

Diaphragmatic strength, which can be roughly estimated by non invasive techniques such as maximal inspiratory pressure or sniff nasal pressure, is specifically assessed by the measurement of transdiaphragmatic pressure during electric or magnetic phrenic nerve stimulation. However, muscle endurance is probably a more relevant parameter in pulmonary disease. Recent progress in the field of diaphragm biology were mainly obtained in animal models. Read More

Ann Rheum Dis 1998 Dec;57(12):724-7

Instituut, Diepenbeek, Belgium.

Objective: To study the effect of cyclic etidronate in secondary prevention of corticosteroid induced osteoporosis.

Methods: A double blind, randomised placebo controlled study comparing cyclic etidronate and placebo during two years in 37 postmenopausal women receiving long term corticosteroid treatment, mainly for polymyalgia rheumatica (40% of the patients) and rheumatoid arthritis (30%). Bone density was measured in the lumbar spine, femoral neck, and femoral trochanter. Read More

Rev Mal Respir 1998 Feb;15(1):33-41

Unité de recherche sur les muscles respiratoires, Hôpital Universitaire, Leuven, Belgique.

Skeletal muscle myopathy is one of the main side-effects of systemically administered corticosteroids, and involves respiratory as well as peripheral muscles. After prolonged treatment with moderate doses of either fluorinated or non-fluorinated corticosteroids, chronic myopathy may occur. In patients, such myopathy is characterized by the gradual onset of proximal limb muscle weakness and a sudden increase in creatine excretion in 24h urine. Read More

Br J Rheumatol 1997 Feb;36(2):255-9

St Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.

The objectives were to determine the efficacy and safety of nasal salmon calcitonin 200 IU daily in the prevention of corticosteroid-induced osteoporosis. A minimized, double-blind, placebo-controlled trial was carried out in corticosteroid-treated patients with polymyalgia rheumatica. The setting was a tertiary care university-affiliated hospital and a total of 31 patients were enrolled. Read More

Calcif Tissue Int 1996 Feb;58(2):73-80

Cornell Multipurpose Arthritis and Musculoskeletal Disease Center, Hospital For Special Surgery, New York, New York 10021, USA.

Patients treated with high-dose or long-term corticosteroids are at risk of accelerated osteoporosis and spontaneous vertebral and traumatic fractures. To assess the efficacy of salmon calcitonin in preventing corticosteroid- induced osteoporosis, 48 patients with newly diagnosed polymyalgia rheumatica, temporal arteritis, and other vasculitides were enrolled in a 2-year, double-blind, randomized, controlled trial. Patients were randomized to receive subcutaneous injections t. Read More

Dermatology 1996 ;193(4):342-4

Service de dermatologie, CHU Trousseau, Tours, France.

Alternaria is a very common and saprophytic fungus. Cutaneous infection is rare and about 71 cases have been described, mainly in Europe in immunocompromised hosts. We report a case of dermal alternariosis occurring in a woman treated with corticosteroids for dermatomyositis. Read More

Neth J Med 1994 Sep;45(3):114-22

Department of Pulmonary Diseases, Universital Hospital, Nijmegen, Netherlands.

Corticosteroids may cause myopathy of both skeletal and respiratory muscles. This is of specific clinical importance in patients with chronic obstructive pulmonary disease (COPD), who already have impaired respiratory muscle function. After treatment with fluorinated steroids, side-effects occur more frequently and are worse compared to treatment with non-fluorinated steroids. Read More

J Cataract Refract Surg 1994 May;20(3):353-4

Department of Ophthalmology, UCLA School of Medicine.

A patient who could not recline from the seated position because of myotonic dystrophy and advanced interstitial lung disease presented to the UCLA Department of Ophthalmology Inpatient Consultation Service complaining of poor vision in both eyes as a result of corticosteroid-induced cataracts. We performed phacoemulsification and posterior chamber intraocular lens implantation in the standing position using magnifying loupes and fiber optic headlamp illumination. The excellent red reflex provided by the coaxial headlamp and the surgical control provided by bracing the operating hand against the cheek made this approach a viable option for this severely compromised patient. Read More

Am Rev Respir Dis 1992 Sep;146(3):800-2

Department of Medicine, Katholieke Universiteit Leuven, Belgium.

We made observations on two patients with asthma and one with COPD who developed steroid-induced myopathy during prolonged treatment with high doses of corticosteroids. On admission, quadriceps force was on the average reduced to 31% of predicted (range 16 to 46% of predicted, nondominant leg), and urinary excretion of creatine in 24 h averaged 687 mg (range 275 to 1,045 mg/24 hr). Respiratory muscle involvement was evidenced by reductions in PImax and PEmax, being 38% (range 36 to 39) and 48% of predicted (range 36 to 68), respectively. Read More

Intensive Care Med 1992 ;18(7):424-6

Service de Réanimation Polyvalente, Hôpital B, CHRU, Lille, France.

Objective: We report a case of corticosteroid-induced myopathy with involvement of respiratory muscles observed in a myasthenic patient.

Patient: A 37-years-old woman, under corticosteroid treatment for two years for typical myasthenia gravis was admitted to ICU for acute myasthenic respiratory failure. Weaning from mechanical ventilation remained impossible despite 4 plasma exchanges and azathioprine. Read More

Rev Med Interne 1991 Nov-Dec;12(6):458-9, 461-4

Service de Rhumatologie, CHRU Angers.

Corticosteroid-induced osteoporosis, the principal cause of "secondary" osteoporosis, is usually observed in patients under prolonged systemic corticosteroid therapy and results from the multiple effects exerted by these drugs on bone cell metabolism. Corticosteroids reduce the intestinal absorption of calcium and its tubular reabsorption, thereby negativating the calcium balance and inducing a parathyroid reaction. This reaction is responsible for an increase in bone cell remodelling, but the main manifestation of the direct effect of corticosteroids on bone is osteoblast depression, so that there is disparity between bone resorption and formation, which in turn is responsible for bone tissue deficit. Read More

Am J Med 1990 Apr;88(4):396-404

Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colorado.

Patients with idiopathic pulmonary fibrosis (IPF) inevitably experience declines in functional status that are most frequently due to progressive pulmonary fibrosis. However, the cause of the clinical deterioration is often uncertain, and disease progression is difficult to distinguish from disease-associated complications or adverse effects of therapy. In studies of the clinical course of IPF, mortality is most frequently due to respiratory failure (38. Read More

Chest 1989 May;95(5):1160-2

Respiratory Division, Katholieke Universiteit, Leuven, Belgium.

Two women with connective tissue disease developed a characteristic steroid-induced myopathy. Reduced maximal transrespiratory pressures indicated reduced respiratory muscle strength. Gradual steroid dosage tapering resulted in prompt clinical improvement and marked increases in respiratory muscle strength, maximal inspiratory pressure increasing by 33 percent in one patient and by 70 percent in the other. Read More

Wiad Lek 1989 Mar;42(5):273-7

In 274 outpatients with chronic spastic bronchitis long-term treatment with corticosteroids was used due to their clinical condition. In patients treated for 6 years with daily doses of 1-2 mg of prednisolone no corticosteroid-induced complications were observed. Transient ecchymoses occurred in patients treated for longer time periods with prednisolone 4 mg daily. Read More

Arch Dis Child 1986 Dec;61(12):1230-1

Severe osteoporosis with multiple vertebral fractures occurred in two girls receiving prolonged high dose corticosteroids for relapsing dermatomyositis. Sodium fluoride, supplemented with calcium and vitamin D, helped control secondary osteoporosis in one case and should be considered as part of the curative treatment of corticoid induced osteoporosis. Read More

Postgrad Med J 1982 May;58(679):297-8

Am J Med Sci 1977 May-Jun;273(3):273-7

The ultrastructural findings in a muscle biopsy of a patient with Cushing's disease associated with severe myopathy are described. They included pronounced mitochondrial damage, thickening and deep invaginations of the sarcolemmal basement membrane, and thickening of the basement membrane of the capillaries. In addition, the muscle fibers showed a marked degree of disarray and wide interfibrillar spaces, containing large numbers of vacuoles, which presented degenerated mitochondria. Read More

Teratology 1975 Feb;11(1):47-55

Since the discovery 25 years ago that cortisone can produce cleft palate in mouse embryos investigations into possible mechanisms of this corticosteroid-induced defect have been many and varied. However, the teratogenic mode of action remains not fully clarified. It is with this thought in mind that we have reflected upon what is known concerning corticosteroids and cleft palate. Read More

Mayo Clin Proc 1966 Nov;41(11):785-96

Arch Maragliano Patol Clin 1961 Dec;17:1271-90