PROBLEM SOLVING IN CLINICAL PRACTICE
A balancing act
Birmingham Children’s Hospital, Birmingham, UK
Correspondence to:
For correspondence:
Dr Mark Wood
Birmingham Children’s Hospital, Birmingham, UK; mark.wood10@tesco.net
Keywords: chicken pox; corticosteroids; osteoporosis; vaccination
| The first 150 words of the full text of this article appear below. |
Corticosteroids were first used in 1948 to successfully treat rheumatoid arthritis.1 They have proven to be very useful in the management of many childhood diseases. However, adverse effects of long-term corticosteroid use are significant, especially in the growing child.
Inevitable adverse effects have to be balanced against very valuable benefit. Reducing the chances of serious harm from long-term corticosteroid use involves careful planning, education and surveillance.
Two case histories are described to highlight some of the important concerns raised in the management of children treated long-term with corticosteroids. Many of these dilemmas commonly present to general paediatric services, especially out of hours. Generic issues are covered in this article, predominantly drawing on the authors’ experience in paediatric rheumatology.
John was diagnosed with systemic onset juvenile idiopathic arthritis (SOJIA) when 4 years old. His disease followed an active course with polyarthritis and frequent exacerbations of systemic features (characterised by fever, typical
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