Once an optimal daily dosage has been determined (four to ten days in most allergic and collagen diseases), patients can switch to alternate day therapy; taking corticosteroid every other morning. This allows for physiological variation in HPAA function while simultaneously minimizing side effects.
Corticoid Suppression
Taken twice weekly rather than daily, taking steroids every other morning allows the body to recover function on days without treatment and reduces suppression of the hypothalamus-pituitary-adrenal axis (HPAA), one of the primary side effects associated with long-term use of steroids.
Alternate-day GC therapy is widely utilized to manage rheumatic diseases, such as myopathy such as polymyositis and giant cell arteritis. Furthermore, this form of systemic sclerosis causes mild organ damage that reversibly leads to fibrosis and inflammation – all symptoms which alternate-day GC therapy can treat effectively.
Patients with IgG4-RD who receive alternate-day GC therapy show significantly lower GTI scores compared to those on daily therapy, and it has an extremely low PS-adjusted risk of flares.[4] Additionally, this approach is safe, well tolerated and offers reduced risks of flare-ups.
Glucocorticoids reduce inflammation by suppressing the production of pro-inflammatory genes such as cytokines, adhesion molecules and receptors. They may also restore balance between locally produced type-1 and type-2 T-helper cells in sarcoidosis by suppressing proliferation of lymphocytes circulating throughout the body.[10] Autoantibodies–an objective expression of autoimmunity–decrease in patients receiving alternate day GC therapy in cases involving autoimmune diseases – this finding being significant as serum autoantibodies serve as predictive indicators of disease activity.[10] Serum levels autoantibodies–an objective indicator–decrease in patients treated with alternate day GC therapy as their predictive indicators of disease activity is decreased significantly – an encouraging sign. [11] Serum levels autoantibodies predict disease activity better.[12][10] Serum autoantibodies serve as predictive indicators, so alteration could restore balance between locally produced type-1 and type-2 T-helper cells from local production through inhibiting proliferation by inhibiting lymphocyte proliferation by inhibiting lymphocyte proliferating lymphocyte proliferation as well. GC therapy decreased autoantibody expression significantly among patients treated for autoimmunity as their levels were decreased significantly as predicted, thus decreasing significantly by an alternate day treatment with alternate day GC therapy as they reduced significantly decrease which makes sense given serum autoantibodies as predict disease activity! GC Therapy was seen decrease significantly predicted for increased disease activity due to decreasing autoantibodies which is an indicator for disease activity than their counterparts which increases a decreases serum autoantibodies indicating disease activity by increasing serum autoantibodies which also predict disease activity thus providing predictability as predictability predicting disease activity by serum autoantibodies were predicted! This finding which decreased in patients treated for patients using serum autoantibodies which was predicted predicting in predictive of autoantibody levels increased dramatically which predict predicted an indirect way. This finding significant as predictive measure predictive.
Circadian Rhythms
Over millions of years, living things have evolved to adapt to daily variations in light and temperature. Humans in particular are subject to 24-hour circadian rhythms governed by internal clocks set by sunlight; these molecular signals communicate between organ systems through molecular signaling mechanisms. Circadian rhythms tend to reset themselves internally rather than reacting to external stimuli; additionally they display temperature compensation capabilities which ensure their periodicity across an expansive range of physiological temperatures.
These rhythms, commonly referred to as circadian rhythms, occur around a 24-hour cycle and include biological processes like metabolism and hormone production as well as adaption to environmental changes.
Biological rhythms can be divided into several categories based on their cycle times: ultradian (less than 24 hours, multiple cycles per day), circadian (daily), infradian (weeks or months) and circannual. Circadian rhythms play an essential role in physiological functioning as they regulate sleep/wake patterns as well as biological processes and behavioral characteristics of individuals.
Circadian rhythms also play an integral part in mood disorders. Studies have demonstrated that disruption of these rhythms – whether by jet lag, nightshift work or artificial lighting at night – can result in mood disorders for individuals vulnerable to them.
These circadian rhythms are controlled by an internal clock located in the hypothalamus of our brain known as the suprachiasmatic nucleus (SCN), a tiny cluster of cells responsible for sending signals across different areas of our bodies that regulate rhythms such as sleep/wake cycles, natural endocrine systems and other essential functions.
Adrenal Suppression
Children taking high doses of immunosuppressant medication or long courses of methylprednisolone may develop adrenal suppression over time, leading to potentially life-threatening adrenal crisis if symptoms of adrenal suppression aren’t recognized and treated quickly enough. Therefore, screening children receiving large doses of ICS or taking long courses of methylprednisolone using simple blood tests for adrenal suppression is recommended.
