Few therapeutic agents are as effective in such a variety of clinical situations as the glucocorticosteroids. Beginning with their first use over 30 years ago in the treatment of rheumatoid arthritis, they have proved to be a group of drugs with potent effects on many aspects of the immune system. Studies in the past 10 years have begun to shed light on the mechanisms of these effects, yet the precise means of benefit in individual immune disorders continues to elude us. This article describes our current understanding of the immunologic effects of glucocorticosteroids and uses this information in an attempt to place the therapeutic dosing of glucocorticosteroids on a more rational basis. The important topics of the side effects of glucocorticosteroids or their use in individual disease states will not be covered.
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