Corticosteroids

Printer-friendly version

Corticosteroids are synthetic drugs that closely resemble cortisol, a hormone that the body produces naturally. They work by reducing inflammation and the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions.

Examples of corticosteroid medications include cortisone, prednisolone and methylprednisolone. However they should not be confused with the anabolic steroids, which some athletes use to build bigger muscles.

Steroids can be given topically, orally or by injection. There are many ways in which they can be injected, depending upon the site of the inflammation. They can be given into a vein or muscle, directly into a joint or bursa (lubricating sac between certain tendons and the bones beneath them) or around tendons and other soft tissue areas.

Inflammation is a process by which the body's inner defence mechanisms, the white blood cells and other substances protect the body against infection and foreign invaders such as bacteria and viruses.

In certain diseases, however, this immune system doesn't work properly and this may cause inflammation to cause damage by working against the body's own tissues. Inflammation is characterized by redness, warmth, swelling and pain.
Steroids reduce the production of inflammatory chemicals to help minimize tissue damage. They also reduce the activity of the immune system by affecting the function of white blood cells.

In low doses, steroids may provide significant relief from pain and stiffness for people with psoriatic arthritis. Temporary use of higher doses of steroids may help a person recover from a severe flare-up of the condition.

Steroids often are injected directly into joints to treat conditions such as psoriatic arthritis, gout or other inflammatory diseases. They also can be injected into inflamed bursae or around tendons near most joints in the body. Injecting steroids into one or two areas of inflammation allows doctors to deliver a high dose of medication directly to the problem area. When doctors give steroids by mouth or in a vein, they cannot be sure an adequate amount will eventually reach the problem area.

Injections into a specific joint are generally well tolerated and are less likely than other forms of steroid medications to produce serious side effects. Also, the injections may help avoid the need for oral steroids or increased doses of oral steroids, which could have greater side effects.

Steroid injections can be added to other medications including anti-inflammatory painkiller medications and physiotherapy. Whether one or more of these treatment methods are used depends on the nature of the problem.

Steroids should not be injected when there is infection in the area to be targeted or elsewhere in the body. Also, if a joint is already severely destroyed, injections are not likely to provide any benefit.

If someone has a potential bleeding problem or is taking anticoagulants, steroid injections may cause bleeding at the site. For these people, injections are given with great caution.

Frequent steroid injections, more often than every three or four months, are not recommended because of an increased risk of weakening tissues in the treated area.

Steroid injections are one of the most effective ways to decrease pain and improve function, yet they generally do not cure the illness.

In rare instances, the following side effects might occur:

  • Infection
  • Allergic reactions
  • Bleeding into the joint
  • Rupture of a tendon
  • Skin discoloration
  • Weakening of bone, ligaments and tendons (from excessively frequent, repeated injections into the same area)

Not everyone will develop side effects they will vary from person to person. If steroid injections are infrequent (less than every three to four months), it is probable that none of the listed side effects will occur.

With oral steroids the occurrence of side effects depends on the dose, type of steroid and duration of treatment. Side effects are much more common with oral medications since they travel around the whole body in the blood stream after being digested through the stomach. Some side effects are more serious than others. Common side effects of steroids include:

  • Skin conditions similar to acne
  • Blurred vision
  • Cataracts or glaucoma
  • An increased tendency for the skin to bruise
  • Insomnia
  • High blood pressure
  • Increased appetite & weight gain
  • Increased growth of body hair
  • Lower resistance to infection
  • Muscle weakness
  • Nervousness, restlessness
  • Osteoporosis
  • Stomach irritation
  • Sudden mood swings
  • Swollen, puffy face
  • Water retention, swelling
  • Worsening of diabetes

How often any side effect occurs varies from person to person. If steroid use is brief, up to a few weeks, it is possible that none of the listed side effects will occur. The side effects listed generally do not occur when occasional steroid injections are given for arthritis, tendonitis or bursitis?. However, if steroid use involves high doses taken for a few months to several years, an increase in the number of side effects may occur.

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

  • They prescribe steroids only when necessary.
  • They monitor the patient closely to detect the development of serious side effects.
  • If possible, they use steroid injections for problems in a specific area rather than oral steroids.
  • They use the minimum dose necessary to gain control of the disease.
  • They will reduce the dose gradually as long as the disease remains under control.
  • They will monitor blood pressure often and treat if necessary.
  • They may prescribe calcium supplements to help maintain bone density.

Steroids, as with other medications, are not recommended for everyone. In general, people with the following conditions should not take steroids:

  • Infection
  • Uncontrolled diabetes
  • Uncontrolled high blood pressure or congestive heart failure
  • Peptic ulcer
  • Osteoporosis

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

Current available Corticosteroids