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Doctor... How Do I Avoid The Side-Effects Of Steroid Medicines?

Jan 16, 2008
Mention steroids and the first thought that comes up is that of a beefy athlete whose head is two sizes too large for his body.

What many people don't realize is that there are two different kinds of steroids. The first kind, anabolic steroids, are the ones you read about in the sports pages. These build muscle mass among other properties.

The second type of steroid is that used to treat inflammatory disease like arthritis. These are the catabolic steroids such as prednisone. These types of steroids actually break down muscle mass. Their advantage though is that they are powerful anti-inflammatory drugs. These anti-inflammatory steroids - also called corticosteroids- are often used in the treatment of diseases such as arthritis.

In fact, corticosteroids are used by up to 75 per cent of patient with rheumatoid arthritis.

A major concern, though, is how to avoid the potential side-effects of these drugs and that is the subject of this article. The first step in avoiding side-effects is to take the lowest effective dose possible.

Although sometimes, high doses are given intravenously for serious condition such as lupus or extremely active rheumatoid arthritis, maintenance doses are typically in the range of 10 mgs of prednisone or less per day. Your physician should try to lower the dose when possible if your disease is stable.

When corticosteroids are lowered, they must be tapered slowly to avoid symptoms of withdrawal such as headache, increased joint and muscle pain, drop in blood pressure, nausea, vomiting, or fever.

People who have been on long term corticosteroids must be extra cautious. The longer one has taken these drugs, the slower the taper must be.

The reason is that when synthetic corticosteroids are given, the body's adrenal glands reduce the production of normal cortisone. If the synthetic supply is stopped abruptly, the adrenal glands can't produce enough cortisone to compensate. The result is a severe medical condition called adrenal crisis. This syndrome presents with shock-like symptoms such as sweating, chills, weakness, loss of consciousness, and sometimes death.

Another side effect is insomnia. Taking the steroid dose in the morning can minimize this side effect. Lowering the amount of caffeine consumed throughout the day is also beneficial.

Another serious side effect is osteoporosis. Corticosteroids reduce the ability of the body to absorb calcium and they also increase the amount of calcium excreted buy the body. The end result is a weakening of the bones with an increased likelihood of fracture.

To guard against this, periodic bone density tests to assess bone loss, along with regular calcium and vitamin D supplementation is needed.

Drugs to prevent osteoporosis such as risedronate (Actonel) and alendronate (Fosamax) may be needed.

Alternate day dosing of corticosteroid- taking the steroid on one day and not the next- may allow control of disease with fewer risks of side effects. While this regiment may be effective for lupus, inflammatory muscle disease, and vasculitis, it is not effective for rheumatoid arthritis, polymyalgia rheumatica, or giant cell arteritis.

Drugs such as methotrexate and azathioprine may have a steroid sparing effect. In other words, they may allow the use of lower doses of prednisone.

Make sure you ask your rheumatologist about your steroid dose and whether it is possible to reduce the total amount of steroid drug you take.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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