The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS ). Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism , peptic ulcers, cataracts, and osteoporosis. Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. This negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of HPA axis suppression (ie, cosyntropin stimulation and basal cortisol plasma levels). Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function. The linear growth of pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of treatment alternatives. In order to minimize the potential growth effects of corticosteroids, pediatric patients should be titrated to the lowest effective dose.
Early trials of intra-articular corticosteroids showed equal systemic absorption of methylprednisolone in patients with rheumatic and osteoarthritic hands 42 and knees. 43 This suggests that steroid pharmacokinetics, rather than disease-related factors, should guide steroid selection. A recent review by the National Health Service of the United Kingdom 44 recommends triamcino-lone and methylprednisolone as preferred agents for injection of large joints (., knee). For smaller joints (., finger), either hydrocortisone or methylprednisolone (Hydeltrasol, brand no longer available in the United States) is recommended. Tables 5 and 6 45 compare commonly available steroid preparations.