Corticosteroids

Corticosteroids are the fastest and most efficient way to control inflammation. The trade-off is a range of side effects – some very serious. To reduce the risk of side effects, your doctor will usually prescribe a low dose for a short amount of time (three months or less). The longer you take the medication and the higher the dose, the greater the risk. Long-acting versions are more likely to cause side effects, too, especially adrenal suppression, which means your own adrenal glands stop making cortisol. Some people develop side effects after just a few doses, and some changes, such as diabetes and eye damage, may be permanent. Be sure you understand all the risks and benefits before starting any type of steroid therapy.

Corticosteroids work quickly and effectively, which is why they’re often used for a short time until other medications kick in or to stop a disease flare in its tracks. In cases of severe systemic inflammation, they can be life-saving. Corticosteroids shouldn’t be used long-term to treat inflammatory arthritis – or any disease – but they’re sometimes used for a few weeks or months to boost the effectiveness of DMARDs or other drugs.

Altered Response to Physical Stress

If you take corticosteroids for more than two weeks -- even if you then wean yourself off the medication -- your adrenal glands may become sluggish, and your body may not be able to respond normally to physical stress. This is called adrenal insufficiency, and it may last up to a year after you stop the medication. It’s potentially life-threatening because you’re not able to respond normally to a serious illness, surgery or an injury.

Solution: If you’re taking corticosteroids or have taken them in the past year, be sure to tell your dentist, doctor and any providers treating you in any emergency or during surgery. In such cases, your doctor’s likely to give you supplemental or “stress steroids” to make up for any adrenal insufficiency.

Blood Sugar Changes

A spike in blood sugar is a common side effect of corticosteroids; it’s often seen within hours of your first dose. Blood sugar usually returns to normal once you stop the medication, but some people develop permanent diabetes.

Solution: Work closely with your doctor to monitor your blood sugar level. If it’s too high, you may need medication to bring it down. If you already have diabetes, your doctor will try to find an alternative to steroid therapy.

Bone Loss and Bone Death

Bone loss (osteoporosis) may be one of the most serious consequences of corticosteroid therapy; thin, brittle bones can lead to fractures. Another problem, bone death (osteonecrosis), can occur as well.

Solution: Daily, weight-bearing or resistance training exercise such as walking, jogging or weight lifting is critical to keeping bones strong. Additionally, the American College of Rheumatology recommends getting between 1,000 mg to 1,200 mg of calcium and 600-800 IU of vitamin D every day; some people at moderate- to high-risk of fractures may need to take osteoporosis medication. Also, quit smoking, eat a balanced diet, limit alcohol consumption and maintain a healthy weight.

Weight Gain

Corticosteroids affect the way your body stores and uses fat. You may notice a swollen face (“moon face”) and increased fat on the back of your neck and around your middle.

Solution: Watch calories and exercise regularly to help prevent weight gain. Reduce your salt intake because it can cause you to retain fluid. Most people lose the extra pounds once they come off steroids, though it can take up to a year to get your former self back.

Cataracts and Glaucoma

Corticosteroids can increase your risk of cataracts (the clouding of your eye’s lens) and glaucoma (the buildup of pressure in your eye, which can lead to vision loss).

Solution: You should have a complete eye exam by an ophthalmologist before starting steroids and regular eye exams during and after you take them. Some eye damage can’t be reversed, so it’s important to catch it early.

High Blood Pressure

The hormone cortisol helps regulate the balance of water, sodium and other electrolytes in your body. When you take corticosteroids, you may retain excess fluid leading to a corresponding spike in blood pressure.

Solution: A low-sodium diet’s the best way to control your blood pressure. Look for low-salt versions of prepared foods, chips, canned soups and salad dressings or avoid them altogether. Your doctor should check your blood pressure often. Tell your doctor right away if you notice swollen ankles or other signs you’re retaining water.

Infections

Corticosteroids suppress your immune system, making you more vulnerable to infection. Even minor infections can become serious.

Solution: Wash your hands often and stay away from crowds and people you know are sick. If you notice any signs of infection – a fever, cough or painful urination – call your doctor right away.

Mood Changes

People rarely think of corticosteroids as mood-altering drugs, but in fact, they can cause a rollercoaster of emotions, ranging from agitation, anxiety, aggression or mania to deep depression.

Solution: Mood problems are much more common with high doses. Be sure to tell you doctor about your symptoms. Exercise, yoga, deep breathing and meditation might be helpful.

Skin Changes

Both topical and oral corticosteroids affect your body’s ability to produce collagen, the main structural protein in skin. This can lead to very thin skin as well as poor wound healing, easy bruising, broken blood vessels and stretch marks. Some of these symptoms aren’t reversible.

Solution: There’s little you can do to prevent thin skin, especially if it results from oral corticosteroids. But if you use topical steroids, applying a retinoid cream at the same time might help prevent some thinning.

Others

Steroids can cause a host of other side effects, including:

•    Blurred vision, eye pain or trouble reading
•    Dizziness
•    Headache
•    Irregular pulse or heartbeat
•    Numbness or tingling in your arms or legs
•    Pounding in your ears
•    Shortness of breath or trouble breathing when you’re not active
•    Trouble peeing, thinking or walking