Corticosteroids - Once a Miracle "Cure"?
Corticosteroids or glucocorticoids, often just called "steroids", were once thought to be almost miraculous. In 1948, at the Mayo Clinic in Rochester, Minnesota, a group of arthritis patients were given daily injections of a corticosteroid. The results were so striking and the improvement so dramatic that it was thought that the "cure" for arthritis had been discovered. However, as the use of corticosteroids expanded over the years, side effects emerged and it was realized that high doses given over prolonged periods of time turned steroids into "scare-oids". Patients were warned of the potential problems, the use of corticosteroids became more conservative, and some patients were so frightened of them they even declined treatment.
Corticosteroids are powerful drugs that can have valuable effect if administered within proper guidelines. Understanding how they work and how they can be safely taken is very important.
What Are Corticosteroids?
Corticosteroids are drugs closely related to cortisol, a hormone which is naturally produced in the adrenal cortex (the outer layer of the adrenal gland).
Corticosteroid Drugs Include:
- Betamethasone (Celestone)
- Budesonide (Entocort EC)
- Cortisone (Cortone)
- Dexamethasone (Decadron)
- Hydrocortisone (Cortef)
- Methylprednisolone (Medrol)
- Prednisolone (Prelone)
- Prednisone (Deltasone)
- Triamcinolone (Kenacort, Kenalog)
The Role of Cortisol
Cortisol plays an important part in controlling salt and water balance in the body, and regulating carbohydrate, fat, and protein metabolism. When the body becomes stressed, the pituitary gland at the base of the brain releases ACTH, adrenocorticotropic hormone, which stimulates adrenals to produce cortisol. The extra cortisol allows the body to cope with the stress such as infection, trauma, surgery, or emotional problems. When the stressful situation ends, adrenal hormone production returns to normal.
The adrenal glands usually produce about 20 milligrams of cortisol per day, mostly in the morning, but can produce five times that much when needed.
How Do Corticosteroids Work?
Corticosteroids act on the immune system by blocking the production of substances that trigger allergic and inflammatory actions, such as prostaglandins. However, they also impede the function of white blood cells which destroy foreign bodies and help keep the immune system functioning properly. The interference with white blood cell function yields a side effect of increased susceptibility to infection.
What Conditions Do Corticosteroids Treat?
Corticosteroids are widely used for many conditions. They are also used to control inflammation of the joints and organs in diseases such as:
- rheumatoid arthritis
- lupus (systemic lupus erythematosus)
- ankylosing spondylitis
- juvenile arthritis
- inflammatory bowel disease
- mixed connective tissue disease
- behcet's (behçet's) disease
- polymyalgia rheumatica
- scleroderma (systemic sclerosis)
- giant cell arteritis (temporal arteritis)
Corticosteroids are not used systemically for osteoarthritis, though they are sometimes used as a local injection into an affected joint.
How Are Corticosteroids Administered?
Corticosteroids are versatile in their mode of application. They can be given:
- injected into the vein or muscle
- applied locally to the skin
- injected directly into inflamed joints
Corticosteroid drugs can also be used as ingredients contained in:
- eye products (to treat various eye conditions)
- inhalers (to treat asthma or bronchial disease)
- nasal drops and sprays (to treat various nasal problems)
- topical creams, ointments, etc. (to treat various skin problems)
Corticosteroids can be used in conjunction with other drugs, and are prescribed for short-term and long-term use.
Prednisone (brand names include: Cortan, Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M and Sterapred) is the most commonly prescribed synthetic corticosteroid for arthritis. Prednisone is four to five times as potent as cortisol. Therefore, five milligrams of prednisone is the equivalent of the body's daily output of cortisol. There are other synthetic corticosteroids available which differ in potency and half-life.