Corticosteroids

What are the corticosteroids?

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. Corticosteroids are often referred to by the shortened term steroids. Corticosteroids are different from the male hormone-related steroid compounds that some athletes abuse.

What are some types of steroids?

Some corticosteroid medicines include cortisone, prednisone, and methylprednisolone. Prednisone is the most commonly used type of steroid to treat certain rheumatologic diseases.

How are steroids given?

Steroid medications are available in several forms that vary in how easily they dissolve or how long they stay in the body.

Steroids might be given locally, to the precise place where a problem exists, or systemically, which means throughout the system or body.

Examples of local steroid treatments include joint injections, eye drops, ear drops, and skin creams. Systemic steroid treatments include oral medicines (given by mouth) or medicine that is delivered directly into a vein (intravenously or IV) or muscle (intramuscularly). Systemic steroids circulate through the bloodstream to various body sites.

When possible, local steroid treatments are prescribed instead of systemic steroids to reduce the risk of side effects.

How do steroids work?

Steroids work by decreasing inflammation and reducing the activity of the immune system. Inflammation is a process in which the body's white blood cells and chemicals can protect against infection and foreign substances such as bacteria and viruses. In certain diseases, however, the body's defense system (immune system) doesn't function properly. This might cause inflammation to work against the body's tissues and cause damage. Signs of inflammation include redness, warmth, swelling, and pain.

Steroids reduce the production of chemicals that cause inflammation. This helps keep tissue damage as low as possible. Steroids also reduce the activity of the immune system by affecting the way white blood cells work.

When are steroids given?

Steroids are used to treat many conditions in which the body's defense system doesn't work properly and causes tissue damage. Steroids may be the main therapy for certain diseases. For other conditions, steroids might only be used sparingly or when other measures have not been successful.

Steroids are used in the treatment for certain rheumatologic inflammatory conditions, such as:

• Systemic vasculitis (inflammation of blood vessels)
• Myositis (inflammation of muscle)
• Rheumatoid arthritis (chronic inflammatory arthritis)
• Systemic lupus erythematosus (a generalized disease caused by abnormal immune system function)

How are steroids beneficial?

When inflammation threatens to damage critical body organs, steroids can be organ-saving and in many instances, life-saving.

For example, steroids may prevent the worsening of kidney inflammation, which could lead to kidney failure in people who have lupus or vasculitis. For these patients, steroid therapy might eliminate the need for kidney dialysis or transplantation.

Low doses of steroids might provide significant relief from pain and stiffness for people with rheumatoid arthritis. Short-term use of higher doses of steroids might help a person recover from a severe flare-up of arthritis.

How will my doctor decide if steroids are the right treatment?

The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, physical activity, and other medicines you are taking. Your doctor will also make sure you understand the potential benefits and risks of steroids before you start taking them.

The potential benefits and risks of steroids vary with:

• The nature and severity of the disease being treated.
• The presence or absence of other treatment alternatives.
• The presence or absence of other significant medical problems.

What are the possible side effects of steroids?

The chance of side effects depends on the dose, type of steroid, and length of treatment. Some side effects are more serious than others. Common side effects of systemic steroids include:

• Increased appetite, weight gain
• Sudden mood swings
• Muscle weakness
• Blurred vision
• Increased growth of body hair
• Easy bruising
• Lower resistance to infection
• Swollen, "puffy" face
• Acne
• Osteoporosis (bone weakening disease)
• Worsening of diabetes
• High blood pressure
• Stomach irritation
• Nervousness, restlessness
• Having difficulty sleeping
• Cataracts or glaucoma
• Water retention, swelling

Please note: These side effects are the most common side effects. All possible side effects are not included. Always contact your doctor if you have questions about your personal situation.

Does everyone have side effects?

Not all patients will develop side effects. How often any side effect occurs varies from patient to patient.

If steroid use is brief (from a few days to a few weeks), it is possible that none of the listed side effects will occur. The side effects listed here generally do not occur when occasional steroid injections are given for arthritis, tendonitis, or bursitis. However, if steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects might occur. The prolonged use of high dose steroids is justified only for severe illnesses that represent serious risks to the patient.

How can the side effects of steroids be minimized?

To minimize the side effects of steroids, doctors follow several guidelines:

• Use steroids only when necessary.
• Watch the patient closely to detect early signs of serious side effects.
• If possible, use local steroids for local problems.
• Use the smallest dose needed to control the disease.
• Reduce the dose gradually as long as the disease remains under control.
• Monitor blood pressure often and treat if necessary.
• Monitor bone density and prescribe medications and supplements to help bone health.

There are other ways to prevent certain side effects, and these need to be discussed individually with your physician.