How may a general clinical baseline be established for potential complications before instituting Glucocorticoids therapy?
• Some chronic infections, that is, opportunistic, may not be immediately apparent on the initial physical examination and may progress rapidly when corticosteroid therapy is implemented. For a baseline, obtain a chest x-ray, tuberculin skin test (or interferon gamma-release assay), and screen for hepatitis B and C.
• For glucose intolerance, a baseline fasting glucose is sufficient before the implementation of therapy, with periodic monitoring, especially with longer courses of therapy.
• To assess one’s risk for osteoporosis -related problems, a bone mineral densitometry should be performed within the first few months if GC therapy will be prolonged.
• The activity of gastrointestinal erosive disease may be further aggravated by corticosteroid medications. A complete blood count with mean cell volume should be performed prior to therapy. In selected patients a stool guaiac should be done.
• Cardiovascular disease and hypertension may be aggravated by corticosteroid medications. Attention should be given toward blood pressure determination as well as the presence of peripheral edema on physical examination, with periodic reevaluation.
• Performing a mini-mental status examination, especially in those with a history of mental disturbance, to provide an objective baseline for future comparison may be useful.