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Since 1948, hydrocortisone (cortisol), the principal glucocorticoid
(GC) of the human adrenal cortex has been successfully used at
phar- macological concentrations for the suppression of clinical
manifesta- tions of rheumatoid arthritis. Numerous compounds with
GC activity have also been developed and used. Fifty years after
their initial clinical use, GCs are still the most im- portant and
frequently prescribed class of anti-inflammatory drugs for various
inflammatory disorders. They are administered either orally,
parenterally (intravenous, intramuscular, intrathecal), or
topically (cu- taneous, intranasal, pulmonic, rectal). Despite the
many beneficial ef- fects of GCs, they also have their limitations
and disadvantages that occur with varying prevalence on different
organs and after different durations of therapy. These side-effects
can range in severity from cos- metic (e.g. telangiectasias,
hypertrichosis) to seriously disabling (e.g. induction of glaucoma,
diabetes, osteoporosis) or even life-threatening disorders (e.g.
gastric haemorrhage). These adverse effects of GCs se- riously
handicap their successful use as anti-inflammatory agents. There is
therefore a strong need for the development of substances with the
anti-inflammatory potency of classical GCs but with reduced
side-effects.
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