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Estos son los efectos adversos de la prednisona y otros corticoides.¿Son efectivos los corticoides intraarticulares en artrosis de rodilla? - Medwave |
Para que es el prednisone. Prednisone
There are significant differences at onset of CVF and the honeycomb pattern between both groups, where the high dose group was at a disadvantage. At the end of treatment the low dose group achieved improvement of radiologic lesions and the Warrick index, unlike the high dose group.
The remaining variables experienced improvement in both groups without marked inequality. Similarly, slight adverse reactions were present in both groups. Two patients dropped out of the study.. A combination of low dose steroids with cyclophosphamide is effective in interstitial lung disease treatment especially in active disease, and results did not show differences regarding the high dose group but the sample size and the evolutionary severity of high dose patients oblige other studies to verify these data..
Evaluar si el uso de prednisona en altas o bajas dosis combinado con ciclofosfamida intravenosa iv resulta igualmente eficaz en el tratamiento de la NI en la ES.. Se presentaron de forma similar reacciones adversas ligeras. Systemic sclerosis SS is a multisystem disease of unknown etiology, characterized by inflammatory, vascular and fibrotic changes primarily affecting the skin and other internal organs, especially lungs, kidneys, heart and gastrointestinal 1 apparatus.
Once interstitial fibrosis occurs, it is resistant to current treatment modalities, so it is very likely that aggressive therapy with immunosuppressive agents may be very effective at the beginning of the process.
Several agents have been evaluated as treatment, but only oral or intravenous cyclophosphamide has proven effective. The results indicate that cyclophosphamide has modifying effects on lung function and response measures, such as dyspnea, quality of life, functional capacity and thickness of the skin.
Pakas et al. We performed an exploratory, experimental and clinical study, randomized, single blind at the Ameijeiras Brothers Hospital during the period from September until December Patients were randomized to two treatments. Each patient was enrolled consecutively, after assessing the above criteria, and was included in the study and was assigned to the corresponding treatment, with the help of a list of random numbers previously obtained by a computer using Asal.
Two groups of patients were formed with different treatment regimens: — Group A, high doses 13 patients were administered intravenous cyclophosphamide at a rate of 0. Group B, low doses 10 patients were administered the same cyclophosphamide dose and similarly to the first group, received combined oral prednisone 10 mg daily. For prevention of nausea and vomiting, ondansetron was administered 8 mg plus intake of 3—4 l of water to prevent hemorrhagic cystitis.
Complete clinical examination was performed, including measurement of the dyspnea index and the index of skin thickness modified Rodnan. Patients were classified as diffuse and limited clinical skin forms using the LeRoy 12 extension. Dyspnea was assessed using a Likert scale Table 1 0—4 points grading from low to high degree of dyspnea: 0: none, 1: dyspnea on exertion after two flights of stairs, 2 dyspnea on exertion after a flight of stairs, 3 for dyspnea less than one flight of stairs or on the plain at their own pace, 4: dyspnea at rest.
Skin Thickness Index Modified Rodnan. By performing spirometry, inspiratory and expiratory forced inspiratory volume were measured. This study revealed the presence of two patterns, abnormal and the normal pattern. The presence of ground-glass opacities in the posterior basal subpleural courts was searched for in the prone position to exclude the possibility of gravitational effects that cause increased parenchymal density.
The second pattern that looks like a honeycomb lattice medium was defined as subpleural lines, thickened septal or subpleural parenchymal borders and air space having a diameter between 3 and 10 mm. Readings and semiquantitative assessment of pulmonary radiological deterioration were made using the Warrick 16 index and performed by two radiologists; any difference in interpretation was resolved by consensus.
Elemental lesions were considered when the scores from one to 5 according to the severity were 1, ground glass opacities; 2, pleural irregularities in the edges; 3, lines by septal thickening and subpleural interlobular septa 1 thickening linear cm of the pleura , 4, honeycomb, and 5, subpleural cystic areas of wall thickening. Also, Warrick's score assigns values between 1 and 3 according to the number of segments affected by the type of injury.
A score of 1 indicates that the lesion is present in 1—3 segments; a score of 2 is present in 4—9 segments, and score 3 lesions are present in more than 9 segments. The scores for severity and extent of injury were added to provide a total CT score ranging from 0 to Clinical evaluation was performed and a blood count with differential was performed each month before administering cyclophosphamide.
Final assessment: at the end of treatment we performed a thorough clinical examination, including measurement of the levels of dyspnea and skin thickness, hematological tests, echocardiogram, chest radiograph, RFT, CT, bronchoscopy and cytological lavage.
Two patients were not evaluated after they dropped out. To determine the homogeneous distribution of the two groups in baseline conditions, we used a homogeneity test statistic such as the chi-square, and the use of nonparametric Mann—Whitney test was used to calculate the average difference between the two groups for the duration of the disease. We also used the Wilcoxon test for related samples to evaluate the change in lung expansion obtained after treatment by Warrick index.
We considered a group of key variables after treatment analyzed in each group and compared to each other using the nonparametric Mann—Whitney tests. In all statistical tests employed we considered a significance level of 0. In Table 2 , shows the baseline characteristics of both groups: group A was composed of 10 patients, all women, with a duration of disease of We obtained a 3.
This group had a lower mean value of FVC, more patients with a honeycomb pattern and a higher Warrick score compared with group B. Total patients with positive ANA were 7. In group B, 13 patients, all women, and a time of disease progression of One patient in each group did not complete the study.
In group A one patient died due to pulmonary thromboembolism after completing one month of treatment, and in group B one patient was discontinued because she developed hemolytic anemia after the third month of treatment. None of the causes of abandonment was attributed to treatment. In the low dose group we evidenced an improvement in the radiological lesions and the Warrick index, with the high dose group differing, with a slight worsening of Warrick performance and no changes in radiological lesions Table 3.
One patient in group A ground glass pattern and a patient in group B honeycomb pattern did not finish the study.
The clinical variables, the dyspnea index and improvement in skin thickness changes were seen in both groups, just as bronchoalveolar lavage and forced vital capacity. None of them showed significant differences between groups Table 4. Main Variables Measured After Treatment. Mann—Whitney's non-parametric test was employed. Both groups had similar minor adverse reactions nausea and vomiting that were resolved with the administration of antiemetics.
We determined the effectiveness of high or low dose of cyclophosphamide associated with prednisone in the treatment of ILD in the course of SS. A search of the literature provides very few studies specifically performed to review this association. There are many papers which evaluate the efficacy of cyclophosphamide and, to a lesser extent, the use of cyclophosphamide and steroids, rarely comparing the efficacy of cyclophosphamide with high or low dose of prednisone, as performed by Pakas et al.
The limited form usually has an indolent course with a predominance of vascular involvement, but in patients with prolonged illness and dyspnea can lead to lung disease, 19 which is evident in the group of low-dose prednisone. Of the 13 patients included, there are only 4 with the limited clinical form, but have dyspnea as the main symptom and a longer history of disease. CT patterns in group A showed no regression and motivated primarily because this group included more patients with a honeycomb pattern corresponding to established lung fibrosis, where the response to treatment is lower.
With these elements, group A shows a greater severity, yet, when we tried to strike a balance between groups by random assignment of patients, it was seen as weak and foreign to our purpose. The course of systemic sclerosis is characterized by parenchymal lung injury followed by inflammation and subsequent fibrosis.
In the high dose patients there was a higher percentage of mean reticular involvement that corresponds to the fibrosis seen on histological examination, which is considered the reason for the worsening of the Warrick index. Patients with this impairment have a greater restriction of lung function, however, both groups showed improvement in FVC in the same range. Although not directly related to the study variables and FVC Warrick index, it was found that patients in group A have a higher average value in the Warrick index and small FVC relative to group B.
This inverse relationship is due to the predominance of honeycomb pattern in group A, which increases the index score by greater severity and extent of lung injury , with the consequent decrease in the mean value of FVC and development of restrictive lung disease.
In group B, a lower index value associated with the presence of a ground glass pattern, mainly on the lung bases and periphery, provides a lower score for the severity and extent of injuries, and expresses a lower impairment of FVC. A restrictive pattern is associated with severe dyspnea, anti-SCL and the development of lung fibrosis. Clinical improvement was found in both groups to assess dyspnea and showed similar results to those obtained by Pakas et al.
In the Scleroderma Lung Study, a placebo-controlled, randomized double-blind trial that evaluated oral cyclophosphamide for a year, they found a similar beneficial effect on dyspnea in the group treated with cyclophosphamide. We consider this a weakness of the study.
Similar results were achieved Pakas et al. Although it was not the objective of this study, we evaluated the rate of skin thickness, which shows significant improvement in both groups. A similar result was obtained by Pakas et al. This decrease in skin thickness has been found in other studies, where the indication of cyclophosphamide was not directly related to skin involvement. However, a study by Andrade Macedo 29 in Brazil, showed that the clinical form in patients with diffuse and severe skin thickening without visceral involvement had a satisfactory response to cyclophosphamide.
Unlike the results obtained by Pakas et al. We concluded that a combination of low doses of steroids with cyclophosphamide is effective in treating ILD especially in active forms. The results show no differences from the high dose group, but the sample size and the more severe progression of patients with high doses require further studies to confirm this data.
Reumatol Clin. ISSN: X. DOI: Descargar PDF. Table 1. European evidenced-based consensus on reproduction in inflammatory bowel disease. J Crohns Colitis. Inflammatory bowel disease and pregnancy: report of two cases treated with infliximab and a review of the literature.
Eur J Gastroenterol Hepatol. Effect of preterm birth and antenatal corticosteroid treatment on lactogenesis II in women.
Managing asthma in expectant mothers. Treat RespirMed. Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to prednisone. If you are having any skin tests such as allergy tests or tuberculosis tests, tell the doctor or technician that you are taking prednisone. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.
You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Generic alternatives may be available. Prednisone pronounced as pred' ni sone. Why is this medication prescribed? How should this medicine be used?
Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow? What should I do if I forget a dose? What side effects can this medication cause?
What should I know about storage and disposal of this medication? Brand names. Swallow the delayed-release tablet whole; do not chew or crush it. Other uses for this medicine. What special precautions should I follow? Before taking prednisone, tell your doctor and pharmacist if you are allergic to prednisone, any other medications, or any of the inactive ingredients in prednisone tablets or solutions.
Ask your doctor or pharmacist for a list of the inactive ingredients. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. John's wort. If you become pregnant while taking prednisone, call your doctor.
You should carry a card or wear a bracelet with this information in case you are unable to speak in a medical emergency. Stay away from people who are sick and wash your hands often while you are taking this medication. Be sure to avoid people who have chicken pox or measles.
❿Para que es el prednisone.Prednisona
Mezclar medicamentos y suplementos dietéticos puede poner en peligro su salud | FDA.Prednisone: MedlinePlus Drug Information
Do not take a double dose to make up for a missed dose. Prednisone may slow growth and development in children. Your child's doctor will watch his or her growth carefully. Talk to your child's doctor about the risks of giving prednisone to your child. Prednisone may increase the risk that you will develop osteoporosis. Talk to your doctor about the risks of taking prednisone and about things that you can do to decrease the chance that you will develop osteoporosis.
Some patients who took prednisone or similar medications developed a type of cancer called Kaposi's sarcoma. Talk to your doctor about the risks of taking prednisone. Prednisone may cause other side effects.
Call your doctor if you have any unusual problems while you are taking this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture not in the bathroom. It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily.
To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Keep all appointments with your doctor and the laboratory.
Your doctor will order certain lab tests to check your body's response to prednisone. If you are having any skin tests such as allergy tests or tuberculosis tests, tell the doctor or technician that you are taking prednisone. Do not let anyone else take your medication.
Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.
You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Generic alternatives may be available.
Prednisone pronounced as pred' ni sone. Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow? What should I do if I forget a dose? What side effects can this medication cause? What should I know about storage and disposal of this medication?
Brand names. Swallow the delayed-release tablet whole; do not chew or crush it. Other uses for this medicine. What special precautions should I follow? Before taking prednisone, tell your doctor and pharmacist if you are allergic to prednisone, any other medications, or any of the inactive ingredients in prednisone tablets or solutions.
Ask your doctor or pharmacist for a list of the inactive ingredients. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. John's wort. We performed an exploratory, experimental and clinical study, randomized, single blind at the Ameijeiras Brothers Hospital during the period from September until December Patients were randomized to two treatments.
Each patient was enrolled consecutively, after assessing the above criteria, and was included in the study and was assigned to the corresponding treatment, with the help of a list of random numbers previously obtained by a computer using Asal. Two groups of patients were formed with different treatment regimens: — Group A, high doses 13 patients were administered intravenous cyclophosphamide at a rate of 0.
Group B, low doses 10 patients were administered the same cyclophosphamide dose and similarly to the first group, received combined oral prednisone 10 mg daily. For prevention of nausea and vomiting, ondansetron was administered 8 mg plus intake of 3—4 l of water to prevent hemorrhagic cystitis.
Complete clinical examination was performed, including measurement of the dyspnea index and the index of skin thickness modified Rodnan. Patients were classified as diffuse and limited clinical skin forms using the LeRoy 12 extension. Dyspnea was assessed using a Likert scale Table 1 0—4 points grading from low to high degree of dyspnea: 0: none, 1: dyspnea on exertion after two flights of stairs, 2 dyspnea on exertion after a flight of stairs, 3 for dyspnea less than one flight of stairs or on the plain at their own pace, 4: dyspnea at rest.
Skin Thickness Index Modified Rodnan. By performing spirometry, inspiratory and expiratory forced inspiratory volume were measured.
This study revealed the presence of two patterns, abnormal and the normal pattern. The presence of ground-glass opacities in the posterior basal subpleural courts was searched for in the prone position to exclude the possibility of gravitational effects that cause increased parenchymal density. The second pattern that looks like a honeycomb lattice medium was defined as subpleural lines, thickened septal or subpleural parenchymal borders and air space having a diameter between 3 and 10 mm.
Readings and semiquantitative assessment of pulmonary radiological deterioration were made using the Warrick 16 index and performed by two radiologists; any difference in interpretation was resolved by consensus. Elemental lesions were considered when the scores from one to 5 according to the severity were 1, ground glass opacities; 2, pleural irregularities in the edges; 3, lines by septal thickening and subpleural interlobular septa 1 thickening linear cm of the pleura , 4, honeycomb, and 5, subpleural cystic areas of wall thickening.
Also, Warrick's score assigns values between 1 and 3 according to the number of segments affected by the type of injury. A score of 1 indicates that the lesion is present in 1—3 segments; a score of 2 is present in 4—9 segments, and score 3 lesions are present in more than 9 segments. The scores for severity and extent of injury were added to provide a total CT score ranging from 0 to Clinical evaluation was performed and a blood count with differential was performed each month before administering cyclophosphamide.
Final assessment: at the end of treatment we performed a thorough clinical examination, including measurement of the levels of dyspnea and skin thickness, hematological tests, echocardiogram, chest radiograph, RFT, CT, bronchoscopy and cytological lavage. Two patients were not evaluated after they dropped out.
To determine the homogeneous distribution of the two groups in baseline conditions, we used a homogeneity test statistic such as the chi-square, and the use of nonparametric Mann—Whitney test was used to calculate the average difference between the two groups for the duration of the disease.
We also used the Wilcoxon test for related samples to evaluate the change in lung expansion obtained after treatment by Warrick index. We considered a group of key variables after treatment analyzed in each group and compared to each other using the nonparametric Mann—Whitney tests. In all statistical tests employed we considered a significance level of 0. In Table 2 , shows the baseline characteristics of both groups: group A was composed of 10 patients, all women, with a duration of disease of We obtained a 3.
This group had a lower mean value of FVC, more patients with a honeycomb pattern and a higher Warrick score compared with group B. Total patients with positive ANA were 7. In group B, 13 patients, all women, and a time of disease progression of One patient in each group did not complete the study.
In group A one patient died due to pulmonary thromboembolism after completing one month of treatment, and in group B one patient was discontinued because she developed hemolytic anemia after the third month of treatment. None of the causes of abandonment was attributed to treatment.
In the low dose group we evidenced an improvement in the radiological lesions and the Warrick index, with the high dose group differing, with a slight worsening of Warrick performance and no changes in radiological lesions Table 3. One patient in group A ground glass pattern and a patient in group B honeycomb pattern did not finish the study. The clinical variables, the dyspnea index and improvement in skin thickness changes were seen in both groups, just as bronchoalveolar lavage and forced vital capacity.
None of them showed significant differences between groups Table 4. Main Variables Measured After Treatment. Mann—Whitney's non-parametric test was employed. Both groups had similar minor adverse reactions nausea and vomiting that were resolved with the administration of antiemetics. We determined the effectiveness of high or low dose of cyclophosphamide associated with prednisone in the treatment of ILD in the course of SS.
A search of the literature provides very few studies specifically performed to review this association. There are many papers which evaluate the efficacy of cyclophosphamide and, to a lesser extent, the use of cyclophosphamide and steroids, rarely comparing the efficacy of cyclophosphamide with high or low dose of prednisone, as performed by Pakas et al.
The limited form usually has an indolent course with a predominance of vascular involvement, but in patients with prolonged illness and dyspnea can lead to lung disease, 19 which is evident in the group of low-dose prednisone. Of the 13 patients included, there are only 4 with the limited clinical form, but have dyspnea as the main symptom and a longer history of disease.
CT patterns in group A showed no regression and motivated primarily because this group included more patients with a honeycomb pattern corresponding to established lung fibrosis, where the response to treatment is lower. With these elements, group A shows a greater severity, yet, when we tried to strike a balance between groups by random assignment of patients, it was seen as weak and foreign to our purpose.
The course of systemic sclerosis is characterized by parenchymal lung injury followed by inflammation and subsequent fibrosis. In the high dose patients there was a higher percentage of mean reticular involvement that corresponds to the fibrosis seen on histological examination, which is considered the reason for the worsening of the Warrick index. Patients with this impairment have a greater restriction of lung function, however, both groups showed improvement in FVC in the same range.
Although not directly related to the study variables and FVC Warrick index, it was found that patients in group A have a higher average value in the Warrick index and small FVC relative to group B.
This inverse relationship is due to the predominance of honeycomb pattern in group A, which increases the index score by greater severity and extent of lung injury , with the consequent decrease in the mean value of FVC and development of restrictive lung disease.
In group B, a lower index value associated with the presence of a ground glass pattern, mainly on the lung bases and periphery, provides a lower score for the severity and extent of injuries, and expresses a lower impairment of FVC. A restrictive pattern is associated with severe dyspnea, anti-SCL and the development of lung fibrosis. Clinical improvement was found in both groups to assess dyspnea and showed similar results to those obtained by Pakas et al.
In the Scleroderma Lung Study, a placebo-controlled, randomized double-blind trial that evaluated oral cyclophosphamide for a year, they found a similar beneficial effect on dyspnea in the group treated with cyclophosphamide. We consider this a weakness of the study.
Similar results were achieved Pakas et al. Although it was not the objective of this study, we evaluated the rate of skin thickness, which shows significant improvement in both groups. A similar result was obtained by Pakas et al. This decrease in skin thickness has been found in other studies, where the indication of cyclophosphamide was not directly related to skin involvement. However, a study by Andrade Macedo 29 in Brazil, showed that the clinical form in patients with diffuse and severe skin thickening without visceral involvement had a satisfactory response to cyclophosphamide.
Unlike the results obtained by Pakas et al. We concluded that a combination of low doses of steroids with cyclophosphamide is effective in treating ILD especially in active forms. The results show no differences from the high dose group, but the sample size and the more severe progression of patients with high doses require further studies to confirm this data.
Reumatol Clin. ISSN: X. DOI: Descargar PDF. Table 1. Table 3. Introduction Interstitial lung disease ILD as part of systemic sclerosis SS is a leading cause of morbidity and mortality. Objectives To evaluate the use of intravenous pulse cyclophosphamide combined with low and high doses of prednisone in the treatment of ILD in SS is equally effective.
Group B: 10 patients with cyclophosphamide ev , oral prednisone 10 mg daily. Results There are significant differences at onset of CVF and the honeycomb pattern between both groups, where the high dose group was at a disadvantage.
Two patients dropped out of the study. Conclusions A combination of low dose steroids with cyclophosphamide is effective in interstitial lung disease treatment especially in active disease, and results did not show differences regarding the high dose group but the sample size and the evolutionary severity of high dose patients oblige other studies to verify these data.
Objetivos Evaluar si el uso de prednisona en altas o bajas dosis combinado con ciclofosfamida intravenosa iv resulta igualmente eficaz en el tratamiento de la NI en la ES. Palabras clave:. Texto completo. Introduction Systemic sclerosis SS is a multisystem disease of unknown etiology, characterized by inflammatory, vascular and fibrotic changes primarily affecting the skin and other internal organs, especially lungs, kidneys, heart and gastrointestinal 1 apparatus.
Methods We performed an exploratory, experimental and clinical study, randomized, single blind at the Ameijeiras Brothers Hospital during the period from September until December Initial Assessment Complete clinical examination was performed, including measurement of the dyspnea index and the index of skin thickness modified Rodnan.
Level 1: Thickened skin. Level 2: Skin thickening, no pinching possible. Level 3: Skin thickening with no movement.
Anatomical areas: 17 Central zones: face, anterior surface of the thorax and abdomen. Bilateral zones: fingers, back of the hands, forearms, arms, thighs, legs, back of the feet. Maximum score: 51 units. Table 2. General Initial Characteristics. Forced vital capacity.
Tomographic patterns. After one year of treatment. Table 4. Steen, C. Conte, G. Owens, T. Medsger Jr.. Severe restrictive lung disease in systemic sclerosis. Arthritis Rheum, 37 , pp. J Clin Rheumatol, 11 , pp. Ioannidis, P. Vlachoyannopoulos, A. Mortality in systemic sclerosis: an international meta-analysis of individual patient data. Am J Med, , pp. Rheum Dis Clin North Am, 22 , pp.
White, W. Moore, F. Wigley, H. Xiao, R. Cyclophosphamide is associated with pulmonary function and survival benefit in patients with scleroderma and alveolitis. Ann Intern Med, , pp. Rheum Dis Clin North Am, 29 , pp. Silver, J.
Warrick, M. Kinsella, L. Staudt, M. Baumann, C. Cyclophosphamide and low-dose prednisone therapy in patients with systemic sclerosis scleroderma with interstitial lung disease. J Rheumatol, 20 , pp. Pakas, J. Ioannidis, K. Malagari, F. Skopouli, H.
Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels lack of certain substances that are usually produced by the body and are needed for normal body functioning. Prednisone is also used to treat other conditions in patients with normal corticosteroid levels.
These conditions include certain types of arthritis; severe allergic reactions; multiple sclerosis a disease in which the nerves do not function properly ; lupus a disease in which the body attacks many of its own organs ; and certain conditions that affect the lungs, skin, eyes, kidneys blood, thyroid, stomach, and intestines. Prednisone is also sometimes used to treat the symptoms of certain types of cancer. Prednisone is in a class of medications called corticosteroids.
It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.
Prednisone comes as a tablet, delayed-release tablet, as a solution liquidand as a concentrated solution to take by mouth. Prednisone is usually taken with food one to four times a day or once every other day. Your doctor will probably tell you to take your dose s of prednisone at certain time s of day every day. Your personal dosing schedule will depend on your condition and on how you respond to treatment. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.
Take prednisone exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor. If you are taking the concentrated solution, use the specially marked dropper that comes with the medication to measure your dose.
You may mix the concentrated solution with juice, other flavored liquids, or soft foods such as applesauce.
Your doctor may change your dose of prednisone often during your treatment to be sure that you are always taking the lowest dose that works for you. Your doctor may also need to change your dose if you experience unusual stress on your body such as surgery, illness, infection, or a severe asthma attack.
Tell your doctor if your symptoms improve or get worse or if you get sick or have any changes in your health during your treatment. If you are taking prednisone to treat a long-lasting disease, the medication may help control your condition but will not cure it. Continue to take prednisone even if you feel well. Do not stop taking prednisone without talking to your doctor. If you suddenly stop taking prednisone, your body may not have enough natural steroids to function normally.
This may cause symptoms such as extreme tiredness, weakness, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, and craving for salt. Call your doctor if you experience these or other unusual symptoms while you are taking decreasing doses of prednisone or after you stop taking the medication.
Prednisone is also sometimes used with antibiotics to treat a certain type of pneumonia in patients with acquired immunodeficiency syndrome AIDS.
Talk to your doctor about the risks of using this drug for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Your doctor may instruct you to follow a low-salt, high potassium, or high calcium diet.
Your doctor may also prescribe or recommend a calcium or potassium supplement. Follow these directions carefully. Talk to your doctor about eating grapefruit and drinking grapefruit juice while you are taking this medication. When you start to take prednisone, ask your doctor what to do if you forget to take a dose. Write down these instructions so that you can refer to them later. Call your doctor or pharmacist if you miss a dose and do not know what to do.
Do not take a double dose to make up for a missed dose. Prednisone may slow growth and development in children.
Your child's doctor will watch his or her growth carefully. Talk to your child's doctor about the risks of giving prednisone to your child. Prednisone may increase the risk that you will develop osteoporosis. Talk to your doctor about the risks of taking prednisone and about things that you can do to decrease the chance that you will develop osteoporosis.
Some patients who took prednisone or similar medications developed a type of cancer called Kaposi's sarcoma. Talk to your doctor about the risks of taking prednisone. Prednisone may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture not in the bathroom. It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at Keep all appointments with your doctor and the laboratory.
Your doctor will order certain lab tests to check your body's response to prednisone. If you are having any skin tests such as allergy tests or tuberculosis tests, tell the doctor or technician that you are taking prednisone. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital.
It is also important information to carry with you in case of emergencies. Generic alternatives may be available. Prednisone pronounced as pred' ni sone.
Why is this medication prescribed? How should this medicine be used? Other uses for this medicine What special precautions should I follow? What special dietary instructions should I follow? What should I do if I forget a dose? What side effects can this medication cause? What should I know about storage and disposal of this medication? Brand names. Swallow the delayed-release tablet whole; do not chew or crush it. Other uses for this medicine. What special precautions should I follow?
Before taking prednisone, tell your doctor and pharmacist if you are allergic to prednisone, any other medications, or any of the inactive ingredients in prednisone tablets or solutions.
Ask your doctor or pharmacist for a list of the inactive ingredients. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. John's wort. If you become pregnant while taking prednisone, call your doctor. You should carry a card or wear a bracelet with this information in case you are unable to speak in a medical emergency.
Stay away from people who are sick and wash your hands often while you are taking this medication. Be sure to avoid people who have chicken pox or measles. Call your doctor immediately if you think you may have been around someone who had chicken pox or measles.
Prednisone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache dizziness difficulty falling asleep or staying asleep inappropriate happiness extreme changes in mood changes in personality bulging eyes acne thin, fragile skin red or purple blotches or lines under the skin slowed healing of cuts and bruises increased hair growth changes in the way fat is spread around the body extreme tiredness weak muscles irregular or absent menstrual periods decreased sexual desire heartburn increased sweating Some side effects can be serious.
If you experience any of the following symptoms, call your doctor immediately: vision problems eye pain, redness, or tearing sore throat, fever, chills, cough, or other signs of infection seizures depression loss of contact with reality confusion muscle twitching or tightening shaking of the hands that you cannot control numbness, burning, or tingling in the face, arms, legs, feet, or hands upset stomach vomiting lightheadedness irregular heartbeat sudden weight gain shortness of breath, especially during the night dry, hacking cough swelling or pain in the stomach swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs difficulty breathing or swallowing rash hives itching Prednisone may slow growth and development in children.
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¿Qué es este medicamento? La PREDNISONA trata muchas afecciones tales como asma, reacciones alérgicas, artritis, enfermedades intestinales inflamatorias. Prednisolone se usa en el tratamiento de varias diferentes condiciones, como la artritis, lupus, psoriasis, colitis ulcerativa, trastornos de alergias. La evidencia contenida en este resumen es aplicable a pacientes con dolor de rodilla secundario. Su profesional de la salud puede pedirle que deje de tomar suplementos alimenticios dos o tres semanas antes del procedimiento para evitar. ¿Son necesarias las dosis elevadas de prednisona para el tratamiento de la neumopatía intersticial en la esclerosis sistémica?Are High Doses of Prednisone. Prednisone comes as a tablet, delayed-release tablet, as a solution liquidand as a concentrated solution to take by mouth. Prednisone is in a class of medications called corticosteroids. Of the 13 patients included, there are only 4 with the limited clinical form, but have dyspnea as the main symptom and a longer history of disease. Skopouli, H. Nicholson, et al.Interstitial lung disease ILD as part of systemic sclerosis SS is a leading cause of morbidity and mortality.. To evaluate the use of intravenous pulse cyclophosphamide combined with low and high doses of prednisone in the treatment of ILD in SS is equally effective..
Two treatment schedules were evaluated and randomly assigned. Group B: 10 patients with cyclophosphamide ev , oral prednisone 10 mg daily.. There are significant differences at onset of CVF and the honeycomb pattern between both groups, where the high dose group was at a disadvantage. At the end of treatment the low dose group achieved improvement of radiologic lesions and the Warrick index, unlike the high dose group. The remaining variables experienced improvement in both groups without marked inequality.
Similarly, slight adverse reactions were present in both groups. Two patients dropped out of the study.. A combination of low dose steroids with cyclophosphamide is effective in interstitial lung disease treatment especially in active disease, and results did not show differences regarding the high dose group but the sample size and the evolutionary severity of high dose patients oblige other studies to verify these data..
Evaluar si el uso de prednisona en altas o bajas dosis combinado con ciclofosfamida intravenosa iv resulta igualmente eficaz en el tratamiento de la NI en la ES.. Se presentaron de forma similar reacciones adversas ligeras. Systemic sclerosis SS is a multisystem disease of unknown etiology, characterized by inflammatory, vascular and fibrotic changes primarily affecting the skin and other internal organs, especially lungs, kidneys, heart and gastrointestinal 1 apparatus.
Once interstitial fibrosis occurs, it is resistant to current treatment modalities, so it is very likely that aggressive therapy with immunosuppressive agents may be very effective at the beginning of the process. Several agents have been evaluated as treatment, but only oral or intravenous cyclophosphamide has proven effective. The results indicate that cyclophosphamide has modifying effects on lung function and response measures, such as dyspnea, quality of life, functional capacity and thickness of the skin.
Pakas et al. We performed an exploratory, experimental and clinical study, randomized, single blind at the Ameijeiras Brothers Hospital during the period from September until December Patients were randomized to two treatments.
Each patient was enrolled consecutively, after assessing the above criteria, and was included in the study and was assigned to the corresponding treatment, with the help of a list of random numbers previously obtained by a computer using Asal.
Two groups of patients were formed with different treatment regimens: — Group A, high doses 13 patients were administered intravenous cyclophosphamide at a rate of 0.
Group B, low doses 10 patients were administered the same cyclophosphamide dose and similarly to the first group, received combined oral prednisone 10 mg daily. For prevention of nausea and vomiting, ondansetron was administered 8 mg plus intake of 3—4 l of water to prevent hemorrhagic cystitis.
Complete clinical examination was performed, including measurement of the dyspnea index and the index of skin thickness modified Rodnan. Patients were classified as diffuse and limited clinical skin forms using the LeRoy 12 extension.
Dyspnea was assessed using a Likert scale Table 1 0—4 points grading from low to high degree of dyspnea: 0: none, 1: dyspnea on exertion after two flights of stairs, 2 dyspnea on exertion after a flight of stairs, 3 for dyspnea less than one flight of stairs or on the plain at their own pace, 4: dyspnea at rest.
Skin Thickness Index Modified Rodnan. By performing spirometry, inspiratory and expiratory forced inspiratory volume were measured. This study revealed the presence of two patterns, abnormal and the normal pattern. The presence of ground-glass opacities in the posterior basal subpleural courts was searched for in the prone position to exclude the possibility of gravitational effects that cause increased parenchymal density.
The second pattern that looks like a honeycomb lattice medium was defined as subpleural lines, thickened septal or subpleural parenchymal borders and air space having a diameter between 3 and 10 mm.
Readings and semiquantitative assessment of pulmonary radiological deterioration were made using the Warrick 16 index and performed by two radiologists; any difference in interpretation was resolved by consensus. Elemental lesions were considered when the scores from one to 5 according to the severity were 1, ground glass opacities; 2, pleural irregularities in the edges; 3, lines by septal thickening and subpleural interlobular septa 1 thickening linear cm of the pleura , 4, honeycomb, and 5, subpleural cystic areas of wall thickening.
Also, Warrick's score assigns values between 1 and 3 according to the number of segments affected by the type of injury. A score of 1 indicates that the lesion is present in 1—3 segments; a score of 2 is present in 4—9 segments, and score 3 lesions are present in more than 9 segments. The scores for severity and extent of injury were added to provide a total CT score ranging from 0 to Clinical evaluation was performed and a blood count with differential was performed each month before administering cyclophosphamide.
Final assessment: at the end of treatment we performed a thorough clinical examination, including measurement of the levels of dyspnea and skin thickness, hematological tests, echocardiogram, chest radiograph, RFT, CT, bronchoscopy and cytological lavage.
Two patients were not evaluated after they dropped out. To determine the homogeneous distribution of the two groups in baseline conditions, we used a homogeneity test statistic such as the chi-square, and the use of nonparametric Mann—Whitney test was used to calculate the average difference between the two groups for the duration of the disease. We also used the Wilcoxon test for related samples to evaluate the change in lung expansion obtained after treatment by Warrick index.
We considered a group of key variables after treatment analyzed in each group and compared to each other using the nonparametric Mann—Whitney tests. In all statistical tests employed we considered a significance level of 0.
In Table 2 , shows the baseline characteristics of both groups: group A was composed of 10 patients, all women, with a duration of disease of We obtained a 3. This group had a lower mean value of FVC, more patients with a honeycomb pattern and a higher Warrick score compared with group B.
Total patients with positive ANA were 7. In group B, 13 patients, all women, and a time of disease progression of One patient in each group did not complete the study. In group A one patient died due to pulmonary thromboembolism after completing one month of treatment, and in group B one patient was discontinued because she developed hemolytic anemia after the third month of treatment.
None of the causes of abandonment was attributed to treatment. In the low dose group we evidenced an improvement in the radiological lesions and the Warrick index, with the high dose group differing, with a slight worsening of Warrick performance and no changes in radiological lesions Table 3.
One patient in group A ground glass pattern and a patient in group B honeycomb pattern did not finish the study. The clinical variables, the dyspnea index and improvement in skin thickness changes were seen in both groups, just as bronchoalveolar lavage and forced vital capacity.
None of them showed significant differences between groups Table 4. Main Variables Measured After Treatment. Mann—Whitney's non-parametric test was employed. Both groups had similar minor adverse reactions nausea and vomiting that were resolved with the administration of antiemetics. We determined the effectiveness of high or low dose of cyclophosphamide associated with prednisone in the treatment of ILD in the course of SS.
A search of the literature provides very few studies specifically performed to review this association. There are many papers which evaluate the efficacy of cyclophosphamide and, to a lesser extent, the use of cyclophosphamide and steroids, rarely comparing the efficacy of cyclophosphamide with high or low dose of prednisone, as performed by Pakas et al.
The limited form usually has an indolent course with a predominance of vascular involvement, but in patients with prolonged illness and dyspnea can lead to lung disease, 19 which is evident in the group of low-dose prednisone. Of the 13 patients included, there are only 4 with the limited clinical form, but have dyspnea as the main symptom and a longer history of disease. CT patterns in group A showed no regression and motivated primarily because this group included more patients with a honeycomb pattern corresponding to established lung fibrosis, where the response to treatment is lower.
With these elements, group A shows a greater severity, yet, when we tried to strike a balance between groups by random assignment of patients, it was seen as weak and foreign to our purpose.
The course of systemic sclerosis is characterized by parenchymal lung injury followed by inflammation and subsequent fibrosis. In the high dose patients there was a higher percentage of mean reticular involvement that corresponds to the fibrosis seen on histological examination, which is considered the reason for the worsening of the Warrick index.
Patients with this impairment have a greater restriction of lung function, however, both groups showed improvement in FVC in the same range. Although not directly related to the study variables and FVC Warrick index, it was found that patients in group A have a higher average value in the Warrick index and small FVC relative to group B. This inverse relationship is due to the predominance of honeycomb pattern in group A, which increases the index score by greater severity and extent of lung injury , with the consequent decrease in the mean value of FVC and development of restrictive lung disease.
In group B, a lower index value associated with the presence of a ground glass pattern, mainly on the lung bases and periphery, provides a lower score for the severity and extent of injuries, and expresses a lower impairment of FVC. A restrictive pattern is associated with severe dyspnea, anti-SCL and the development of lung fibrosis.
Clinical improvement was found in both groups to assess dyspnea and showed similar results to those obtained by Pakas et al. In the Scleroderma Lung Study, a placebo-controlled, randomized double-blind trial that evaluated oral cyclophosphamide for a year, they found a similar beneficial effect on dyspnea in the group treated with cyclophosphamide.
We consider this a weakness of the study. Similar results were achieved Pakas et al. Although it was not the objective of this study, we evaluated the rate of skin thickness, which shows significant improvement in both groups. A similar result was obtained by Pakas et al. This decrease in skin thickness has been found in other studies, where the indication of cyclophosphamide was not directly related to skin involvement. However, a study by Andrade Macedo 29 in Brazil, showed that the clinical form in patients with diffuse and severe skin thickening without visceral involvement had a satisfactory response to cyclophosphamide.
Unlike the results obtained by Pakas et al. We concluded that a combination of low doses of steroids with cyclophosphamide is effective in treating ILD especially in active forms.
The results show no differences from the high dose group, but the sample size and the more severe progression of patients with high doses require further studies to confirm this data.
Reumatol Clin. ISSN: X. DOI: Descargar PDF. Table 1. Table 3. Introduction Interstitial lung disease ILD as part of systemic sclerosis SS is a leading cause of morbidity and mortality.
Objectives To evaluate the use of intravenous pulse cyclophosphamide combined with low and high doses of prednisone in the treatment of ILD in SS is equally effective. Group B: 10 patients with cyclophosphamide ev , oral prednisone 10 mg daily. Results There are significant differences at onset of CVF and the honeycomb pattern between both groups, where the high dose group was at a disadvantage.
Two patients dropped out of the study. Conclusions A combination of low dose steroids with cyclophosphamide is effective in interstitial lung disease treatment especially in active disease, and results did not show differences regarding the high dose group but the sample size and the evolutionary severity of high dose patients oblige other studies to verify these data. Objetivos Evaluar si el uso de prednisona en altas o bajas dosis combinado con ciclofosfamida intravenosa iv resulta igualmente eficaz en el tratamiento de la NI en la ES.
Palabras clave:. Texto completo. Introduction Systemic sclerosis SS is a multisystem disease of unknown etiology, characterized by inflammatory, vascular and fibrotic changes primarily affecting the skin and other internal organs, especially lungs, kidneys, heart and gastrointestinal 1 apparatus.
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