Steroid sparing

30 mg/kg/dose (Max: 1 gram/dose) IV or IM once daily for 1 to 3 days. High-dose pulse steroids may be considered as an alternative to a second infusion of IVIG or for retreatment of patients who have had recurrent or recrudescent fever after additional IVIG, but should not be used as routine primary therapy with IVIG in patients with Kawasaki disease. Corticosteroid treatment has been shown to shorten the duration of fever in patients with IVIG-refractory Kawasaki disease or patients at high risk for IVIG-refractory disease. A reduction in the frequency and severity of coronary artery lesions has also been reported with pulse dose methylprednisolone treatment.

American Academy of Achievement
American Association of Genito-Urinary Surgeons
American Surgical Association
American Urological Association
American Urological Association, Mid-Atlantic Section
American Fertility Society
American Society of Andrology
Baltimore Monthly Medical Society
Clinical Society of Genito-Urinary Surgeons
Comite Internacional de Andrologia (CIDA)
Endocrine Society
Fellow, American College of Surgeons, 1976-1980
Irish Society of Urology
Peripatetic Club
Society of University Surgeons
Society of Urologic Oncology
Urological Investigators Forum
. Section, Societe Internationale d'Urologie
Honorary member, Urological Society of Australasia
Honorary member, German Society of Urology
British Association of Urologic Surgeons, Honorary Member, 1998
Paul Harris Fellow, International Rotary Foundation, 1999
Honorary Royal College of Surgeons of Ireland, 2004
Honorary Royal College of Surgeons of England, 2004

The course of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) is variable: some patients receive glucocorticoids (GCs) for a period of 1–2 years, whereas others require treatment for several years, suffering frequent relapses and high cumulative GC doses. The prevalence of GC-induced adverse events is high, therefore GC-sparing agents are needed, at least for those patients with the highest risk for GC side effects. This chapter discusses methotrexate (MTX), non-MTX conventional disease-modifying anti-rheumatic drugs (DMARDs), and biological agents in the treatment of PMR and GCA. MTX has been shown to be effective as a steroid-sparing agent in randomized controlled trials in PMR and GCA. Data on second-line DMARDs are scarce, leflunomide and azathioprine may be effective. The value of biological agents for the treatment of PMR and GCA is unclear. Tumour necrosis factor-alpha antagonists were not effective in randomized controlled trials, but case series on tocilizumab are promising.

Somatostatin signaling is known to modulate pain pathways. Somatostatin receptors are expressed at multiple neuronal sites including peripheral nerve terminals, DRG neurons, and in the dorsal horn of the spinal cord. Clinical studies demonstrate that administration of peptide somatostatin analogs reduce pain in patients with advanced gastrointestinal cancer, and are opioid sparing in patients following abdominal surgery. These analogs are only available as injectables and so are poorly suited for patients dealing with chronic pain every day.

Steroid sparing

steroid sparing

Somatostatin signaling is known to modulate pain pathways. Somatostatin receptors are expressed at multiple neuronal sites including peripheral nerve terminals, DRG neurons, and in the dorsal horn of the spinal cord. Clinical studies demonstrate that administration of peptide somatostatin analogs reduce pain in patients with advanced gastrointestinal cancer, and are opioid sparing in patients following abdominal surgery. These analogs are only available as injectables and so are poorly suited for patients dealing with chronic pain every day.

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