Only the modification of natural
steroids in the middle of the last century gave insights into the structural requirements for the
biological activity of the
glucocorticoids (GC). While the delta-4,3-keto-11-beta, 17-alpha,21-trihydroxyl configuration is needed for the GC-activity, an artificial additional double binding in position 1 and 2 lead to a four fold increase of the GC-activity. Of the artificial GC,
prednisolone is the most frequently used compound and essential in the
therapy of
vasculitis today. Dosage, duration and way of application depend on the diagnosis, disease stage, -extend as well as -activity. Considering the use and side-effects of the GC, experiences from cohort-studies of the late 80-ties help at clinical decision making. For
giant cell arteritis (GCA) it was shown, that doses of less then 60 mg/day are needed for the
induction of remission. Concerning the visual loss in GCA, time of initiating GC-
therapy seems more important than the dosage. In the treatment of
ANCA-associated vasculitis therapy with GC, later in combination with
cyclophosphamide, lead to a significant reduction of mortality. Due to the fact of an increasing survival rate,
therapy-related morbidity becomes a more and more important issue. There is a proven correlation between the dosage respectively duration of the GC-
therapy and the risk of GC-associated side-effects, especially the incidence of severe
infections. This article gives a short review of the present data of the role of GC in the treatment of
vasculitis.