Risk and benefit of steroid therapy - ekjm.org

1 : 77 3 2009. - (Current Clinical Practice). ( ) ( ).. Risk and benefit of steroid therapy Ji Min Kim, , and Sung Hwan Park, Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea (sex hormone), (mineral- ocorticoid), (glucocorticoid) , . (glucocorticoid, GC, ) (adre- nal cortex) .. , .. , .. , .. ( 1).. 1.. , .. (sex hor- , , . mone) .. (hexane ring) (pentane ring). sterol .. - 298 - Ji Min Kim, et al. Risk and benefit of steroid therapy . Table 1. Commonly used glucocorticoids Relative Relative Glucocorticoid Equivalent dose (mg) Plasma half-life (hour). anti-inflammatory effect mineralocorticoid activity Short-acting Cortisone 25 Cortisol 20 1 1 ~2. Intermediate-acting Prednisone 5 4 ~ Prednisolone 5 4 ~ Methylprednisolone 4 5 > Triamcinolone 4 5 0 2~>5.

2 Long-acting Dexamethasone 20~30 0 3~ Betamethasone 20~30 0 3~5.. T chaperones cochaperones . , , , .. 3) membrane-bound GCR (mGCR)-mediated non- genomic mechanism 2.. (membrane glucocorticoid receptor). , .. 1) Cytosolic GC receptor (cGCR)-mediated genomic (cell lysis) . mechanism 4) nonspecific nongenomic mechanism (genomic action) .. (cytosolic glucocorticoid receptor) . NF- B activator protein 1 (AP-1) . (transcription) IL-1, IL-6, . TNF- . 1.. 2) cGCR-mediated nongenomic mechanism , . mg , mg . 30 mg , 30 mg .. 100 mg , 100 mg . - 299 - : 77 3 589 2009 . , 250 mg .. 15 mg . , .. 100. 2.. mg 3 6 . 24 100 mg , . (diurnal rhythm) .. 100 mg . 2~3 25~50 mg 8 .. 1~3 .. 15 mg . 7 30 2 .. 5.. ( mg/day) . 8 , 1 , 11 . , .. , .. - .. 10:1 .. 3.. 1:1 . , - - .. , , .. , . 40 mg/day . 1~2 5~10 .. mg/day 20~40 mg/day 1~2.

3 5 mg/day , 20 mg/day 2~3 , . 1~ mg/day . 3 1~2 mg/kg ( ) . 30 mg/day 1~2 5~10 mg . 10~20 mg/day 2~4 ~5 . mg/day 10 mg/day 1 . ~5 mg/day 7 .. mg/day .. , . 4.. 4 .. - 300 - 1 . ( ) ( ) . 60 mg/day 6 .. 1.. 2 .. 5 .. 5 mg mg 2 . , .. TNF . 1.. , .. 1) .. 2.. mg/day . , . , mg/day 20 .. (trabecular bone) . - , , .. , , .. , , . 1 mg/kg/day D .. 250 mg/day 1,000 mg/day . 3 .. 3.. , . 2) .. , .. 30 mg/day . 15 mg/day 20 mg/day , .. - 301 - The Korean Journal of Medicine: Vol. 77, No. 3, 2009 .. 4.. 1) .. , , .. 3) , , . 10 mg/day .. 30 mg/day . , .. 2) .. 2 . , .. , .. 2.. , . 1) .. 5.. 1) .. 2) . , , .. , .. 2) . 3.. TNF 3) .. - 302 - Ji Min Kim, et al. Risk and benefit of steroid therapy . , , , .. , , . 4) - - (Hypothalamic-Pituitary- , . Adrenal axis, HPA axis) , , , , . HPA axis .. HPA axis , .. 6.. , .. 10 mg/day REFERENCES.

4 10% 1) Firestein GS, Kelley WN. Kelley's textbook of rheumatology. 8th 15 mg/day 1 ed. p. 863-881, Philadelphia, PA, Saunders/Elsevier, 2009.. 2) Boers M. Glucocorticoids in rheumatoid arthritis: a senescent re- search agenda on the brink of rejuvenation? Best Pract Res Clin 7. Rheumatol 18:21-29, 2004. 3) Boers M. Studying the benefit /risk ratio of glucocorticoids in , , , rheumatoid arthritis. J Rheumatol 34:661-663, 2007. , , , , 4) Buttgereit F, Burmester GR, Lipworth BJ. Inflammation, gluco- corticoids and risk of cardiovascular disease. Nat Clin Pract .. Rheumatol 5:18-19, 2009. 5) Rhen T, Cidlowski JA. Antiinflammatory action of glucocorti- . coids--new mechanisms for old drugs. N Engl J Med 353:1711- 1723, 2005. 8.. (psychosis) .. 2009 6 : . 2009 7 : . 60% 2 90% 6. 2009 8 : .. 2009 10.

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