Problems related to systemic glucocorticoid therapy in children.

Glucocorticoids (GC) are among the most potent antiinflammatory agents that can be used in the treatment of rheumatic diseases. Their mechanisms of action are multiple and complex. As would be expected of any drug with a wide range of actions, systemic GC have many side effects, some severe and some of which like growth suppression, are specific to childhood. To prescribe GC with an acceptable incidence of side effects, the following recommendations should be heeded: use only in well established indications, use at the lowest possible dose, as a single, daily administration, or as an alternate day regimen whenever possible, use concomitantly with steroid sparing agents (e.g., NSAID, disease modifying agents in rheumatic diseases (DMARD), antiepileptics) and choose the GC with the fewest side effects.