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Corticosteroids

Corticosteroid medications — including cortisone, hydrocortisone and prednisone — have great potential in the treatment of a variety of conditions, from rashes to lupus to asthma. But corticosteroids also carry a risk of side effects. Working with your doctor, you can take steps to reduce these medications' side effects so that the benefits of treatment outweigh the risks.


How do corticosteroids work?
Corticosteroids mimic the effects of hormones your body produces naturally in your adrenal glands, which sit atop your kidneys. When prescribed in doses that exceed your body's usual levels, corticosteroids suppress inflammation, which can reduce the signs and symptoms of inflammatory conditions, such as arthritis and asthma. Corticosteroids also suppress your immune system, which can help control conditions in which your body's immune system mistakenly attacks its own tissues, as in Autoimmune diseases.

How are corticosteroids used?
Dozens of corticosteroid medications are available today. The drugs are front-line treatments for rheumatoid arthritis, lupus, asthma, allergies and other conditions. They also serve as a source of externally administered steroids for conditions in which the body (adrenal glands) cannot produce enough on its own. Furthermore, they are used in transplant recipients to help prevent organ rejection.

You can take corticosteroids:

● By mouth. Tablets, capsules or syrups help treat the inflammation and pain associated with certain chronic conditions, such as arthritis and lupus.
● By inhaler and intranasal spray. These forms help control inflammation associated with asthma and nasal allergies.
● Topically. Creams, ointments and roll-ons can help heal many skin conditions.
● By injection. This form is used to treat such signs and symptoms as the pain and inflammation of tendinitis.

What side effects can corticosteroids cause?
Like all medications, corticosteroids carry a risk of side effects. Some side effects can cause serious health problems. When you know what side effects are possible, you can take steps to control their impact on your health.

Many of the side effects of corticosteroids are dose dependent, but nevertheless, despite the form used, corticosteroids can place you at a higher risk for:

● Elevated pressure in the eyes (glaucoma)
● Fluid retention, causing swelling in your lower legs
● Increased blood pressure
● Mood swings/Insomnia
● Hirsutism – Excessive growth of body hair
● Increased appetite
● Weight gain
● Redistribution of fat deposits to the back of the neck, referred to as a "buffalo hump"; Supraclavical "fat pads" at the base of the neck, just above the collarbones; "Moon face" increased roundness due to fat deposits in the face
● Impaired glucose or glucose intolerance

However, when taking oral corticosteroids on a longer term, you may experience:

● Cataracts
● Increased risk of infections- from minor fungal infections,"thrush", to life–threatening infections. The higher the steroid dose and the longer the duration of therapy, the greater the risk of infection. The risk can also increase when patients receive combinations of immunosuppressive medications.
● Loss of calcium from bones, which can lead to osteoporosis and fractures
● Menstrual irregularities
● Suppressed adrenal gland hormone production
● Thin skin, easy bruising and slower wound healing
● Abdominal striae – discolored thin stripes along the abdomen
● Gastrointestinal Ulcers or Bleeding- especially if you take these medications along with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin.

Injected corticosteroids can cause side effects near the site of the injection. Side effects may include:

● Pain
● infection
● Shrinking of soft tissue
● Hypopigmentation or loss of color in the skin.

Most, if not all, of these side effects tend to resolve upon decreasing or stopping the use of steroids. Doctors usually limit corticosteroid injections to no more than three or four a year, and more so its emphasized that not all side effects will occur in all patients.

Reduce your risk of corticosteroid side effects
Despite their side effects, corticosteroid drugs remain an important medical treatment. To get the most benefit with the least amount of risk:

● Make healthy choices during therapy. When you're on corticosteroid medications for a prolonged period, talk to your doctor about ways to minimize side effects.

○ Watch your diet, reduce the number of calories you eat
○ Increase physical activity and exercise
○ Take Calcium and Vitamin D supplements
○ Routine follow ups with blood tests, including blood sugar, cholesterol
○ Be aware of infections and new pains

● Take care when discontinuing therapy. If you take oral corticosteroids for prolonged periods, your adrenal glands produce less of their natural steroid hormones.

○ Rapid withdrawal of steroids, particularly if you have taken these medications for more than two weeks, may cause a syndrome that could include

■ Fatigue
■ Joint pain
■ Muscle stiffness
■ Muscle tenderness
■ Fever.

These symptoms could be hard to separate from those of your underlying disease. That's why steroids should never be withdrawn suddenly, but rather must be tapered slowly. Your doctor may reduce your dosage gradually over a period of weeks or even months.

Weigh the risks and benefits of corticosteroids

Despite the numerous potential side effects of corticosteroids listed below, their introduction into patient care
50 years ago revolutionized the treatment of many diseases, by relieving the inflammation, pain and discomfort of many different diseases and conditions. If you work with your doctor to make choices that minimize side effects, you may achieve significant benefits with a reduced risk of such problems. When used properly, these drugs save lives and avert threats to the function of important organs.

RS Venuturupalli, M.D.,Inc
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