The fact is, corticosteroids are powerful drugs that can be valuable, if they are administered within proper guidelines. Understanding how they work and how they can be used safely is essential.
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, as well as 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 the adrenal glands to produce cortisol. The extra cortisol allows the body to cope with stressful situations, 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 they can produce 5 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 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 Cortan, Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Prednicen-M and Sterapred) is the most commonly prescribed synthetic corticosteroid for arthritis. Prednisone is 4 to 5 times as potent as cortisol. Therefore, 5 milligrams of prednisone is equivalent to the body's daily output of cortisol. There are other synthetic corticosteroids available which differ in potency and half-life.