The potent effect of corticosteroids can result in serious side effects which mimic Cushing's disease, a malfunction of the adrenal glands resulting in an overproduction of cortisol. The list of potential side effects is long and includes:
- increased appetite and weight gain
- deposits of fat in chest, face, upper back, and stomach
- water and salt retention leading to swelling and edema
- high blood pressure
- black and blue marks
- slowed healing of wounds
- muscle weakness
- thinning of the skin
- increased susceptibility to infection
- stomach ulcers
- increased sweating
- mood swings
- psychological problems such as depression
- adrenal suppression and crisis
Side effects can be minimized by following doctor's orders and taking the lowest effective dose possible. It is also important to avoid self-regulation of the dose, either by adding more or stopping the medication without a schedule.
Corticosteroids - Short-Term Vs. Long-Term Therapy
When used as a short-term treatment, prednisone is usually prescribed at a moderate dose and reduced or "tapered" over a one or two-week period. The purpose is to achieve a sudden improvement in symptoms, but not prolong the duration of corticosteroid use.
Long-term therapy is usually reserved for severe cases of rheumatoid arthritis or related diseases. The dose is usually 5-7.5 milligrams of prednisone a day continued over the course of months or years.
High-dose steroids are given occasionally for the most rare, most severe cases of inflammatory disease. A high dose is considered daily doses of prednisone at 1 milligram per kilogram of body weight, or approximately 60 milligrams a day, given in divided doses. In such cases, the steroids are "tapered" as soon as possible.
To reduce potential side effects, the lowest dose of corticosteroid possible, still yielding a positive impact, should be given. In other words, the lowest, effective dose is optimal.
How to Stop Taking the Drugs
Corticosteroids must be gradually reduced in order to permit the adrenal glands to resume natural cortisol production. Eliminating doses too quickly can result in adrenal crisis (a life-threatening state caused by insufficient levels of cortisol).
In cases where corticosteroids were taken in low doses for long periods of time, tapering can continue for months or years. Sometimes, doses are lowered one milligram at a time to prevent flare-ups. When steroids are taken for shorter periods of time, tapering is more rapid and decreases in dosage can be larger.
Another possible complication associated with discontinuation of steroids is steroid withdrawal syndrome, or rebound effect, which is the body's exaggerated response to removal of the drug. Rebound effect can result in fever, muscle pain, and joint pain making it hard for the physician to differentiate between withdrawal symptoms and a flare of the disease itself.
Equivalent Doses of Various Corticosteroids
- 0.6 mg-0.75 mg of betamethasone
- 25 mg of cortisone
- 0.75 mg of dexamethasone
- 20 mg of hydrocortisone
- 4 mg of methylprednisolone
- 5 mg of prednisolone
- 4 mg of triamcinolone
- Corticosteroid Converter: Calculate equivalent dosages of various corticosteroids. Easy-to-use conversion tool, from GlobalRPh.com
Injection Versus Oral Corticosteroids
A steroid shot, also referred to as corticosteroid injection or intra-articular therapy, is the injection of a steroid directly into the affected joint. This method allows doctors to use high doses of corticosteroid directly at the site of inflammation. Since it is localized, the rest of the body is spared the high concentration of the drug.
Infection at the site of injection is a possible side effect. Frequent injections into the same joint can also cause cartilage damage. Doctors use this treatment sparingly, after other options have failed, and attempt to limit the number of injections to once every few months and few in total for a particular joint.
The Bottom Line
Corticosteroids are powerful drugs which can improve symptoms and provoke incredible results. There are potential consequences associated with their use that should not be ignored. The power of corticosteroids should not be feared, but must be respected.
The Duke University Medical Center Book of Arthritis, David S. Pisetsky M.D.
Arthritis: What Works, Sobel & Klein