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What are 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.
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.
Inflammation is characterized by redness, warmth, swelling, and pain.
Steroids reduce the production of inflammatory chemicals in order to minimize tissue
damage. Steroids also reduce the activity of the immune system by affecting the function
of white blood cells.
When are steroids given?
Steroids are used to treat a variety of conditions in which the body's defense system
malfunctions and causes tissue damage. Steroids are 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 as the main treatment for certain inflammatory conditions, such as:
- Systemic vasculitis (inflammation of blood vessels)
- Myositis (inflammation of muscle)
Steroids might also be used selectively to treat inflammatory conditions such as:
- Rheumatoid arthritis (chronic inflammatory arthritis occurring in joints on both sides
of the body)
- Systemic lupus erythematosus (a generalized disease caused by abnormal immune system
function)
- Sjцgren's syndrome (chronic disorder that causes dry eyes and a dry mouth)
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 might prevent the progression 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. Temporary 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 occurrence 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.
Monitor the patient closely to detect the development of serious side effects.
If possible, use local steroids for local problems.
Use the minimal dose required to gain control of the disease.
Reduce the dose gradually as long as the disease remains under control.
Monitor blood pressure often and treat if necessary.
Prescribe calcium supplements to help maintain bone density.
There are other ways to prevent certain side effects, and these should be discussed
individually with your physician.
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