Corticosteroids (Prednisone-Medrol® Solu-Medrol®, ...)

Corticosteroids (steroids), a category of drugs that includes medications such as prednisone, Medrol and Solu-Medrol, are potent medications that decrease inflammation related to a wide variety of conditions. Most of the serious illnesses of rheumatology are caused by, at their core, excessive inflammation. The process of inflammation causes the primary problems of swelling, redness, warmth, pain and loss of function in many of these conditions. Prime examples of inflammatory diseases include rheumatoid arthritis, lupus, vasculitis, and polymyositis. Steroids are used to treat these conditions and many others.

The most common oral steroid is prednisone (also known as orasone and deltasone).

The dose of steroids is arbitrarily divided into three main categories: low, medium and high. Each of us normally produces a related corticosteroid compound in the adrenal gland called cortisol. The amount of cortisol produced is roughly equal to 7.5 mg of prednisone; therefore, doses of 10 mg of prednisone or less are considered low. Doses of 10 mg to 30 mg are considered modest or medium, and above 30 mg high.

The potential side effects of steroid therapy can range from minimal to serious. It is most important to emphasize that side effects are primarily related to the dose and duration of therapy.

• Low dose treatment is usually well tolerated and rarely causes significant consequences.
• Medium dose therapy is more likely to lead to complications, but usually requires continuous levels for many months or years.
• High dose treatment, if used for many weeks or months on end, almost universally will cause some problems.

Nearly always, we try to taper the dose to the lowest acceptable levels and eventually, if possible, to discontinue it entirely. As a result, the risks during an individual course of treatment may fluctuate, depending upon the doses used.

Other potential side effects include:

• increased energy
• increased appetite
• weight gain
• "puffy" face
• mood swings
• tremulousness
• thinning of the bones
• increased risk of cataracts
• elevation in blood sugar
• thinning of the skin
• increased bruising
• acne

With high doses and particularly in lupus patients, there is a small risk of avascular necrosis, which can cause permanent damage to a joint.

You can help prevent some side effects by not overeating and taking calcium and vitamin D supplements. Further treatments to protect the bones, including medications such as Fosamax® and Actonel® ,may be prescribed. If you are on high doses of steroids for an extended period, sometimes an antibiotic called trimethoprim/sulfamethoxazole is prescribed to protect you from some infections.

Steroids act rapidly to suppress inflammation, often within a few days.

If you are on chronic steroid therapy and you have surgery or become very ill, you may need to be given extra oral or intravenous steroids to help with the stress of the event.