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Steroid Side Effects: How to Reduce Corticosteroid Side Effects.¿Son efectivos los corticoides intratimpánicos en la enfermedad de Ménière? - Medwave |
Prednisone and other corticosteroids: Balance the risks and benefits - Mayo Clinic - Services on Demand
Prednisone efectos secundarios. Estos son los efectos adversos de la prednisona y otros corticoides
Kluger, et al. A randomised trial of differenciated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effects. Paulus, D. Di Primeo, M. Sanda, J. Lynch, B. Schwartz, J. Sharp, et al. Progression of radiographic joint erosion during low dose corticosteroid treatment of rheumatoid arthritis. J Rheumatol, 27 , pp. Rau, S. Wassenberg, H. Low dose prednisolone therapy LDPT retards radiographically detectable destruction in early rheumatoid arthritis.
Z Rheumatol, 59 ,. Zeidler, T. Kvien, P. Hannoven, F. Wollheim, O. Forre, H. Geidel, et al. Progression of joint damage in early active severe rheumatoid arthritis during 18 months of treatment: Comparison of low-dose cyclosporin and parenteral gold. Van Everdingen, J. Jacobs, D. Siewertsz van Reesema, J. Low-dose prednisone therapy for patients with early active rheumatoid arthritis: Clinical efficacy, disease-modifying properties, and side effects.
Ann Intern Med, , pp. Van Everdingen, D. Jacobs, J. The clinical effect of glucocorticoids in patients with rheumatoid arthritis may be masked by decreased use of additional therapies. Arthritis Rheum, 51 , pp. Jacobs, A. Van Everdingen, M. Verstapen, J. Followup radiographic data on patients with rheumatoid arthritis who participated in a two-year trial of prednisone or placebo.
Arthritis Rheum, 54 , pp. Capell, R. Madhok, J. Hunter, D. Porter, E. Morrison, J. Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial. Ann Rheum Dis, 63 , pp. Svensson, A. Boonen, K. Albertsson, D. Van der Heijde, C. Keller, I. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate.
Wassenberg, R. Rau, P. Steinfeld, H. Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years. Gotzsche, H. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis.
Cochrane Database Syst Rev, , pp. Bijlsma, A. Huisman, R. De Nijs, J. Glucocorticoids in rheumatoid arthritis. Effects on erosions and bone. Ann NY Acad Sci, , pp. Sambrook, N. Best Pract Res Clin Rheumatol, 15 , pp.
Luengo, C. Picado, L. Montserrat, J. Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax, 46 , pp. Peel, D. Moore, N. Barrington, D. Bax, R. Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis.
Ann Rheum Dis, 54 , pp. Van Staa, H. Leufkens, L. Abenhaim, B. Zhang, C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology, 39 , pp. Bijlsma, W. Lems, R. Laan, H. Houben, et al. Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis. Rheumatology Oxford , 40 , pp. Saag, R. Koehnke, J. Caldwell, R. Brasington, L.
Burmeister, B. Steroids affect your metabolism and how your body deposits fat. This can increase your appetite, leading to weight gain, and in particular lead to extra deposits of fat in your abdomen. Steroids, especially in doses over 30 milligrams per day, can affect your mood. Just being aware that steroids can do this sometimes makes it less of a problem.
Sometimes, this side effect requires that the steroid dosage be decreased. When the steroids are absolutely necessary, sometimes another medication can be added to help with the mood problem. Make sure your family knows about this possible side effect. Because cortisone is involved in regulating the body's balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure.
Since cortisone is involved in maintaining normal levels of glucose sugar in the blood, long-term use may lead to elevated blood sugar or even diabetes. It is possible that steroids may increase the rate of "hardening of the arteries," which could increase the risk of heart disease.
This risk is probably much more significant if steroids are taken for more than a year, and if taken in high dose. By ; Theodore R. Understanding corticosteroid side effects With long-term use, corticosteroids can result in any of the following side effects. Increased doses needed for physical stress Steroid use for over two weeks can decrease the ability of your body to respond to physical stress.
Self-care tips: Discuss this possibility with the surgeon or dentist, etc. Your physician or surgeon may not feel you need to take the extra steroid at the time of surgery, but if they know you have been on corticosteroids they can watch you more carefully after surgery. Self-care tips: If you get symptoms like these when you taper your steroids, discuss them with the doctor.
Your physician will work with you to continually try to taper your steroid dose, at a safe rate of decrease, depending on how you are doing. On each visit, discuss with the physician whether it is possible to decrease your steroid dose. Note that even if you are having a steroid side effect, however, steroids still must be tapered slowly.
When used for less than two weeks, more rapid tapering of steroids is generally possible Infection Long-term steroids can suppress the protective role of your immune system and increase your risk of infection. Self-care-tips: Since steroids can decrease your immunity to infection, you should have a yearly flu shot as long as you are on steroids. Your physician will take your age and risk factors into account when deciding which vaccinations you need.
If you have a history of tuberculosis, exposure to tuberculosis, or a positive skin test for tuberculosis, report this to your doctor. Gastrointestinal symptoms Steroids may increase your risk of developing ulcers or gastrointestinal bleeding, especially if you take these medications along with non-steroidal anti-inflammatory drugs NSAIDs , such as ibuprofen or aspirin.
Self-care tips: Report to your physician any severe, persisting abdominal pain or black, tarry stools. Take the steroid mediation after a full meal or with antacids , as this may help reduce irritation of the stomach. Steroids can increase your appetite. Osteoporosis Steroid therapy can cause thinning of the bones osteopenia and osteoporosis , and increase the risk of bone fractures. See this reference from the National Institutes of Health about how much calcium you need for your sex and age, and how to get as much as possible from diet.
The minimal daily requirement of vitamin D is international units UI daily, and most people on corticosteroids should take this amount. Your physician may check your vitamin D level and see if you actually need a higher dose. Smoking and alcohol increase the risk of osteoporosis, so limiting these is helpful. Weight-bearing exercise walking, running, dancing, etc is helpful in stabilizing bone mass. Figura 3 Indicaciones de corticoterapia n GC: paradigma de medicina traslacional.
Medicina B. Suh S, Park MK. Glucocorticoid-Induced diabetes mellitus: An important but Overlooked problem. Endocrinol Metab Seoul. Diabetes e hiperglicemia inducida por corticoides. Med La Paz. Steroid-induced insulin resistance and impaired glucose tolerance are both associated with a progressive decline of incretin effect in first-degree relatives of patients with type 2 diabetes.
Novel insights into glucocorticoid-mediated diabetogenic effects: towards expansion of therapeutic options?. Eur J Clin Invest. Acute and 2-week exposure to prednisolone impair different aspects of beta-cell function in healthy men.
Eur J Endocrinol. Acta Med Iran. Ghrelin directly stimulates glucagon secretion from pancreatic alpha-cells. Mol Endocrinol. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. Glucocorticoid-induced diabetic ketoacidosis in acute rheumatic fever.
J Cardiovasc Pharmacol Ther. Management of hyperglycemia in the non-intensive care patient: Featuring subcutaneous insulin protocols.
❾-50%}Corticosteroid Adverse Effects - StatPearls - NCBI Bookshelf - Prednisone and other corticosteroids
Capell, R. Madhok, J. Hunter, D. Porter, E. Morrison, J. Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial. Ann Rheum Dis, 63 , pp. Svensson, A. Boonen, K. Albertsson, D. Van der Heijde, C. Keller, I. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate.
Wassenberg, R. Rau, P. Steinfeld, H. Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years. Gotzsche, H. Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis. Cochrane Database Syst Rev, , pp. Bijlsma, A. Huisman, R. De Nijs, J. Glucocorticoids in rheumatoid arthritis.
Effects on erosions and bone. Ann NY Acad Sci, , pp. Sambrook, N. Best Pract Res Clin Rheumatol, 15 , pp. Luengo, C. Picado, L. Montserrat, J. Vertebral fractures in steroid dependent asthma and involutional osteoporosis: a comparative study. Thorax, 46 , pp. Peel, D. Moore, N. Barrington, D.
Bax, R. Risk of vertebral fracture and relationship to bone mineral density in steroid treated rheumatoid arthritis. Ann Rheum Dis, 54 , pp. Van Staa, H. Leufkens, L. Abenhaim, B. Zhang, C. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology, 39 , pp. Bijlsma, W. Lems, R. Laan, H. Houben, et al. Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid treated patients with rheumatoid arthritis.
Rheumatology Oxford , 40 , pp. Saag, R. Koehnke, J. Caldwell, R. Brasington, L. Although it is usually reversible, critical illness myopathy can lead to prolonged ICU admissions, increased length of hospital stays, severe necrotizing myopathy, and increased mortality. Osteonecrosis can be seen especially with long-term use of prednisone more than 20 mg daily. Patients with SLE and children are at higher risk.
Hips and knees are the most commonly involved joints with less common involvement of shoulders and ankles. Pain is the initial feature, which may eventually become severe and debilitating. Magnetic resonance imaging is the most sensitive test, especially for early detection. Plain radiographs may be negative initially but can be useful for follow-up. Systemic glucocorticoids cause a dose-dependent increase in fasting glucose levels and a more significant increase in postprandial values in patients without preexisting diabetes mellitus, but the development of de novo diabetes in a patient with initially normal glucose tolerance is uncommon.
Risk factors for new-onset hyperglycemia during glucocorticoid therapy appear to be the same as those for other patients. However, patients with diabetes mellitus or glucose intolerance exhibit higher blood glucose levels while taking glucocorticoids, leading to increased difficulty with glycemic control. The development of cushingoid features redistribution of body fat with truncal obesity, buffalo hump, and moon face and weight gain are dose and duration-dependent and can develop early.
Cushingoid features showed a linear increase in frequency with dosing. Glucocorticoid therapy is the most common cause of Cushing syndrome. The clinical presentation in the pediatric population is similar to that in adults and includes truncal obesity, skin changes, and hypertension.
In children, growth deceleration is also a feature. Administration of glucocorticoids can suppress the hypothalamic-pituitary-adrenal HPA axis decreasing corticotropin-releasing hormone CRH from the hypothalamus, adrenocorticotropic hormone ACTH from the anterior pituitary gland, and endogenous cortisol. Prolonged ACTH suppression cause atrophy of adrenal glands, and abrupt cessation or rapid withdrawal of Glucocorticoids in such patients may cause symptoms of adrenal insufficiency.
The clinical presentation of adrenal suppression is variable. Adrenal suppression is the most common cause of adrenal insufficiency in children and is associated with higher mortality in the pediatric population. In adults, the symptoms of adrenal suppression are non-specific; therefore, the condition may go unrecognized until exposure to physiological stress illness, surgery, or injury , resulting in an adrenal crisis.
Children with adrenal crisis secondary to adrenal suppression may present with hypotension, shock, decreased consciousness, lethargy, unexplained hypoglycemia, seizures, and even death. The impairment of growth in young children and delay in puberty commonly presents in children receiving glucocorticoids for chronic illnesses like nephrotic syndrome and asthma. The effect is most pronounced with daily therapy and less marked with an alternate-day regimen and can also occur with inhaled glucocorticoids.
Although growth impairment can be an independent adverse effect of corticosteroid therapy, it can also be a sign of adrenal suppression. Moderate to high dose use of glucocorticoids poses a significant risk of infections, including common mild infections as well as serious life-threatening infections.
There is a linear increase in the risk with dose and duration of therapy, especially with common bacterial, viral, and fungal pathogens.
Concomitant use of other immunosuppressive agents and the elderly age further increases the risk of infections. Patients taking glucocorticoids may not manifest common signs and symptoms of infection as clearly, due to the inhibition of cytokine release and the associated reduction in inflammatory and febrile responses leading to a failure in early recognition of infection.
Mineralocorticoid effects, especially as seen with cortisol and cortisone, can lead to fluid retention, edema, weight gain, hypertension, and arrhythmias by increasing renal excretion of potassium, calcium, and phosphate.
Hypertension usually occurs with higher doses only. Several cutaneous adverse effects can occur even at a low dose use of glucocorticoids, although the risk increases linearly with the increasing dose and duration of glucocorticoid therapy.
Although cutaneous adverse effects appear to be clinically significant by physicians, they are usually of most concern to the patients. The risk of cataracts is significantly high in patients taking prednisone more than 10 mg daily for more than one year, with a dose-dependence in a linear fashion. However, an increased risk of cataracts has been reported even with low-dose glucocorticoids.
After discontinuing systemic therapy, the elevation in intraocular pressure usually resolves within a few weeks, but the damage to the optic nerve is often permanent. A rare adverse effect of systemic or even topical use of glucocorticoids is central serous chorioretinopathy; this leads to the formation of subretinal fluid in the macular region, which leads to separation of the retina from its underlying photoreceptors.
This condition manifests as central visual blur and reduced visual acuity. Glucocorticoids increase the risk of adverse GI effects, such as gastritis, gastric ulcer formation, and GI bleeding.
Other complications associated with glucocorticoid use include pancreatitis, visceral perforation, and hepatic steatosis fatty liver that can rarely lead to systemic fat embolism or cirrhosis. Patients receiving glucocorticoids often experience an improved sense of well-being within several days of starting the medications; mild euphoria or anxiety may also occur. Hypomanic reactions and activated states are more common early in the therapy than depression, but the prevalence of depression is greater in patients on more longstanding therapy.
Psychosis can occur but does so almost exclusively at doses of prednisone above 20 mg per day given for a prolonged period. Disturbances in sleep are reported, especially with split doses that may interfere with the normal pattern of diurnal cortisol production. Akathisia motor restlessness is a common glucocorticoid side effect. The risk of developing a given neuropsychiatric disorder following glucocorticoid therapy may increase among patients with a history of the condition.
Rare cases of pseudotumor cerebri have also correlated with glucocorticoid use. There is specific documentation of neuropsychiatric adverse effects with glucocorticoid therapy in children with acute lymphoblastic leukemia ALL receiving dexamethasone or prednisone for the induction and maintenance of treatment. Preexisting conditions that should be assessed for and treated when starting glucocorticoids include:.
Before initiating long-term systemic glucocorticoid therapy, the clinician should perform a thorough history and physical examination to assess for risk factors or preexisting conditions that may potentially be exacerbated by glucocorticoid therapy, such as above. In children, the clinician should also examine nutritional and pubertal status. American College of Rheumatology has published specific guidelines addressing this issue to help prevent and manage GiOp.
The HPA axis should undergo assessment if the patient has received systemic corticosteroids for more than two consecutive weeks or more than three cumulative weeks in the last six months or if the patient has persistent symptoms of adrenal suppression.
Screening is by measuring early morning salivary cortisol after tapering off the dose of cortisol. If morning cortisol is normal, but the patient has symptoms of adrenal suppression, perform a low-dose ACTH stimulation test to confirm the diagnosis.
Consider endocrinology referral for confirmation of diagnosis. Growth in children and adolescents on chronic glucocorticoid therapy shall be monitored every six months and plotted on a growth curve. Lipid profile shall be monitored one month after glucocorticoid initiation and then every 6 to 12 months. Glycemic control requires assessment via screening for classic symptoms at every visit: polyuria, polydipsia, weight loss.
Monitor glucose parameters for at least 48 hours after glucocorticoids initiation, then every 3 to 6 months for the first year and annually afterward. Las variables laboratoriales fueron: glicemias basales, glicemias postprandiales, HbA 1C , urea y creatinina,. Figura 1 Hemoglobina glicada en pacientes con corticoterapia n Figura 2 Antecedente de diabetes mellitus en pacientes con corticoterapia n Figura 3 Indicaciones de corticoterapia n GC: paradigma de medicina traslacional.
Medicina B. Suh S, Park MK. Glucocorticoid-Induced diabetes mellitus: An important but Overlooked problem. Endocrinol Metab Seoul. Diabetes e hiperglicemia inducida por corticoides. Med La Paz. Steroid-induced insulin resistance and impaired glucose tolerance are both associated with a progressive decline of incretin effect in first-degree relatives of patients with type 2 diabetes. Novel insights into glucocorticoid-mediated diabetogenic effects: towards expansion of therapeutic options?.
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If your dose is low, your risk of serious side effect is quite small, especially if precautions, as discussed below, are taken. Reading about these side effects may make you uncomfortable about taking steroids. You should be well aware of the risks before starting these medications. However, please be reassured that many people take steroids with minor or no side effects. Please also remember that steroids are often extremely effective and can be life-saving.
If any of the suggestions here is unclear, or seems irrelevant to you, please discuss it with your physician. With long-term use, corticosteroids can result in any of the following side effects. However, taking care of yourself as discussed below may reduce the risks.
Steroid use for over two weeks can decrease the ability of your body to respond to physical stress. A higher dose of steroid may be needed at times of major stress, such as surgery or very extensive dental work or serious infection. This could be needed for as long as a year after you have stopped steroids.
Taking these anti-inflammatory steroids can suppress the hypothalamus, as well as the pituitary gland, which are all involved the process of stimulating the adrenal gland to make cortisol. For example, the pituitary gland production of ACTH which stimulate the adrenal to make cortisol can be inhibited.
The adrenal gland itself can also show some suppression of its ability to make cortisol. Rapid withdrawal of steroids may cause a syndrome that could include fatigue, joint pain, muscle stiffness, muscle tenderness, or fever. These symptoms could be hard to separate from those of your underlying disease.
Even with slower withdrawal of steroids, some of these symptoms are possible, but usually in milder forms.
At times, rapid withdrawal of steroids can lead to a more severe syndrome of adrenal insufficiency. This can cause symptoms and health problems such as drops in blood pressure, as well as chemical changes in the blood such as high potassium or low sodium.
Sometimes this can be set off by injuries or a surgical procedure.
Published studies are primarily clinical and epidemiological research but also basic. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.
Los glucocorticoides GC son un elemento fundamental en el tratamiento de la artritis reumatoide AR. Glucocorticoids GC are a mainstay of the therapy in rheumatoid arthritis RA. Currently, and despite their extensive use, the discussion about the benefits and adverse effects of low dose GC in the management of RA persists.
In recent years, a number of clinical trials have attempted to establish the benefits of long-term GC use as a disease-modifying antirheumatic drug in RA, and to define their side effects.
Results of these clinical trials provide solid evidence that low-dose GC can inhibit radiographic damage in early RA, and that side effects of GC, when used in that clinical framework, are limited to hyperglycaemia, cataracts, and transient weight gain. ISSN: Instructions for authors - Submit an article.
Open Access Option. Previous article Next article. Issue 6. Pages November - December Export reference. More article options. DOI: Uso de glucocorticoides en la artritis reumatoide. Use of Glucocorticosteroids in Rheumatoid Arthritis. Download PDF. Corresponding author. Hospital Universitario Puerta de Hierro. This item has received.
Article information. Palabras clave:. Artritis reumatoide. Results of these clinical trials provide solid evidence that low-dose GC can inhibit radiographic damage in early RA, and that side effects of GC, when used in that clinical framework, are limited to hyperglycaemia, cataracts, and transient weight gain. Key words:. Rheumatoid arthritis. Full text is only aviable in PDF. A comparison of cortisone and aspirin in the treatment of early cases of rheumatoid arthritis.
Br Med J, 29pp. A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis. Ann Rheum Dis, 18pp. Harris Jr, R. Emkey, J. Nichols, A. Low dose prednisone therapy in rheumatoid arthritis: a double blind study. J Rheumatol, 10pp. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. N Engl J Med,pp.
Hickling, R. Jacoby, J. Joint destruction after glucocorticoids are withdrawn in early rheumatoid arthritis. Br J Rheumatol, 37pp.
Van Gestel, R. Laan, C. Haagsma, L. Van de Putte, P. Van Riel. Oral steroids as bridge therapy in rheumatoid arthritis patients starting with parenteral gold. A randomized double-blind placebo-controlled trial. Br J Rheumatol, 34pp. Saag, L. Criswell, K. Sems, M. Nettleman, S. Low-dose corticosteroids in rheumatoid arthritis. A meta-analysis of their moderateterm effectiveness.
Arthritis Rheum, 39pp. Boers, A. Verhoeven, H. Markusse, M. Van de Laar, R. Westhovens, J. Van Denderen, et al. Randomised comparison of combined stepdown prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis.
Lancet,pp. Landewe, M. Verhoeven, R. Westhovens, M. Van de Laar, H. Markusse, et al. COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum, 46pp. Haagsma, P. Van Riel, A. De Jong, L. Van de Putte. Combination of sulphasalazine and methotrexate versus the single components in early rheumatoid arthritis: a randomized, controlled, double blind, 52 week clinical trial.
Br J Rheumatol, 36pp. Dougados, B. Combe, A. Cantagrel, P. Goupille, P. Olive, M. Schattenkirchner, et al. Combination therapy in early rheumatoid arthritis: a randomised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components.
Ann Rheum Dis, 58pp. Maillefert, B. Combe, P. Goupille, A. Cantagrel, M. Long term structural effects of combination therapy in patients with early rheumatoid arthritis: five year follow up of a prospective double blind controlled study.
Ann Rheum Dis, 62pp. Goekoop-Ruiterman, J. De Vries-Bouwstra, C. Allaart, D.
localhost › salud › medicina › estos-son-los-efectos-adversos-de-l. ¿Qué efectos secundarios puedo tener al utilizar este medicamento? This information from Lexicomp® explains what you need to know about this medication, including what it's used for, how to take it, its side effects. Informe a su reumatólogo. Corticosteroid drugs — including cortisone, hydrocortisone and prednisone — are useful in treating many conditions, such as rashes, inflammatory bowel. The autoimmune pathologies that most frequently required corticotherapy were systemic lupus erythematosus and rheumatoid arthritis. Make a thorough examination of your home and correct situations that might result in a fall, such as eliminating scatter rugs and any obstacles between bedroom and bathroom, and installing night lights.How to think about the suggestions below: Any suggestion here which is not clear or which you think may not apply to you should be discussed with the your physician. Note also that the side effects of steroids very much depend on the dose and how long they are taken.
If your dose is low, your risk of serious side effect is quite small, especially if precautions, as discussed below, are taken. Reading about these side effects may make you uncomfortable about taking steroids. You should be well aware of the risks before starting these medications. However, please be reassured that many people take steroids with minor or no side effects.
Please also remember that steroids are often extremely effective and can be life-saving. If any of the suggestions here is unclear, or seems irrelevant to you, please discuss it with your physician.
With long-term use, corticosteroids can result in any of the following side effects. However, taking care of yourself as discussed below may reduce the risks. Steroid use for over two weeks can decrease the ability of your body to respond to physical stress.
A higher dose of steroid may be needed at times of major stress, such as surgery or very extensive dental work or serious infection. This could be needed for as long as a year after you have stopped steroids. Taking these anti-inflammatory steroids can suppress the hypothalamus, as well as the pituitary gland, which are all involved the process of stimulating the adrenal gland to make cortisol. For example, the pituitary gland production of ACTH which stimulate the adrenal to make cortisol can be inhibited.
The adrenal gland itself can also show some suppression of its ability to make cortisol. Rapid withdrawal of steroids may cause a syndrome that could include fatigue, joint pain, muscle stiffness, muscle tenderness, or fever.
These symptoms could be hard to separate from those of your underlying disease. Even with slower withdrawal of steroids, some of these symptoms are possible, but usually in milder forms.
At times, rapid withdrawal of steroids can lead to a more severe syndrome of adrenal insufficiency. This can cause symptoms and health problems such as drops in blood pressure, as well as chemical changes in the blood such as high potassium or low sodium.
Sometimes this can be set off by injuries or a surgical procedure. Because of this, make sure your doctors always know if you have been treated with steroids in the past, especially in the past year, so they can be on the alert for the development of adrenal insufficiency at times such as a surgical procedure. Long-term steroids can suppress the protective role of your immune system and increase your risk of infection. Steroids may increase your risk of developing ulcers or gastrointestinal bleeding, especially if you take these medications along with non-steroidal anti-inflammatory drugs NSAIDs , such as ibuprofen or aspirin.
If you are on low-dose aspirin for heart protection, your physician may want you to continue this when you take the prednisone, but might consdier adding a medication for stomach protection during the course of steroids.
Steroid therapy can cause thinning of the bones osteopenia and osteoporosis , and increase the risk of bone fractures. At the beginning or before your steroid therapy, many patients will be asked to have a bone density test, especially if the steroid dose is high.
If density is low, the bone density study It will be repeated in the future to assess the effectiveness of measures you will be using to prevent bone loss. Steroids affect your metabolism and how your body deposits fat. This can increase your appetite, leading to weight gain, and in particular lead to extra deposits of fat in your abdomen.
Steroids, especially in doses over 30 milligrams per day, can affect your mood. Just being aware that steroids can do this sometimes makes it less of a problem. Sometimes, this side effect requires that the steroid dosage be decreased. When the steroids are absolutely necessary, sometimes another medication can be added to help with the mood problem.
Make sure your family knows about this possible side effect. Because cortisone is involved in regulating the body's balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure. Since cortisone is involved in maintaining normal levels of glucose sugar in the blood, long-term use may lead to elevated blood sugar or even diabetes. It is possible that steroids may increase the rate of "hardening of the arteries," which could increase the risk of heart disease.
This risk is probably much more significant if steroids are taken for more than a year, and if taken in high dose. By ; Theodore R. Understanding corticosteroid side effects With long-term use, corticosteroids can result in any of the following side effects.
Increased doses needed for physical stress Steroid use for over two weeks can decrease the ability of your body to respond to physical stress. Self-care tips: Discuss this possibility with the surgeon or dentist, etc.
Your physician or surgeon may not feel you need to take the extra steroid at the time of surgery, but if they know you have been on corticosteroids they can watch you more carefully after surgery. Self-care tips: If you get symptoms like these when you taper your steroids, discuss them with the doctor. Your physician will work with you to continually try to taper your steroid dose, at a safe rate of decrease, depending on how you are doing.
On each visit, discuss with the physician whether it is possible to decrease your steroid dose. Note that even if you are having a steroid side effect, however, steroids still must be tapered slowly. When used for less than two weeks, more rapid tapering of steroids is generally possible Infection Long-term steroids can suppress the protective role of your immune system and increase your risk of infection. Self-care-tips: Since steroids can decrease your immunity to infection, you should have a yearly flu shot as long as you are on steroids.
Your physician will take your age and risk factors into account when deciding which vaccinations you need. If you have a history of tuberculosis, exposure to tuberculosis, or a positive skin test for tuberculosis, report this to your doctor. Gastrointestinal symptoms Steroids may increase your risk of developing ulcers or gastrointestinal bleeding, especially if you take these medications along with non-steroidal anti-inflammatory drugs NSAIDs , such as ibuprofen or aspirin.
Self-care tips: Report to your physician any severe, persisting abdominal pain or black, tarry stools. Take the steroid mediation after a full meal or with antacids , as this may help reduce irritation of the stomach. Steroids can increase your appetite. Osteoporosis Steroid therapy can cause thinning of the bones osteopenia and osteoporosis , and increase the risk of bone fractures. See this reference from the National Institutes of Health about how much calcium you need for your sex and age, and how to get as much as possible from diet.
The minimal daily requirement of vitamin D is international units UI daily, and most people on corticosteroids should take this amount.
Your physician may check your vitamin D level and see if you actually need a higher dose. Smoking and alcohol increase the risk of osteoporosis, so limiting these is helpful. Weight-bearing exercise walking, running, dancing, etc is helpful in stabilizing bone mass. Assess risk of falls. Make a thorough examination of your home and correct situations that might result in a fall, such as eliminating scatter rugs and any obstacles between bedroom and bathroom, and installing night lights.
Weight gain Steroids affect your metabolism and how your body deposits fat. Self-care tips: Watch your calories and exercise regularly to try to prevent excessive weight gain.
But don't let weight gain damage your self-esteem. Know that the weight will be easier to take off in the six months to a year after you discontinue steroids. Insomnia Steroids may impair your ability to fall asleep, especially when they are taken in the evening.
Self-care tips: If possible, the physician will try to have you take your entire daily dose in the morning. This may help you sleep better at night evening doses sometimes make it difficult to fall asleep.
Mood changes Steroids, especially in doses over 30 milligrams per day, can affect your mood. Self-care tips: Simply being aware that steroids can have an effect on your mood can sometimes make it less of a problem.
But, at times, this side will require that the steroid dosage be decreased. If maintaining the same steroid dosage is absolutely necessary, sometimes another medication can be added to help with the mood problem. Make sure your family and friends know about this possible side effect so they will know what's going on if you respond to them in unexpected ways.
Ideally, tell your family and friends about this possible side effect as you start the medication, so that they can help you detect any changes in your behavior. Fluid retention and elevated blood pressure Because cortisone is involved in regulating the body's balance of water, sodium, and other electrolytes, using these drugs can promote fluid retention and sometimes cause or worsen high blood pressure.
Self-care tips: Watch for swelling of your ankles , and report this to your doctor. Occasional patients benefit from diuretics water pills. Low sodium diet helps reduce fluid accumulation and may help control blood pressure. Have your blood pressure monitored regularly while you are on steroids, especially if you have a history of high blood pressure. Steroids can raise blood pressure in some patients.
Elevated blood sugar Since cortisone is involved in maintaining normal levels of glucose sugar in the blood, long-term use may lead to elevated blood sugar or even diabetes.
Self-care tips: Your blood sugar should be followed while you are on steroids, especially if you are a diabetic, since corticosteroids can raise blood sugar. Eye problems Steroids can sometimes cause cataracts or glaucoma increased pressure in the eye. Self-care tips: If you have a history of glaucoma or cataract follow up closely with the ophthalmologist while on steroids.
If you develop any visual problems while on steroids, you will need to see the ophthalmologist. Temporarily blurred vision when you start corticosteroids is often not a serious problem, but ophthalmology evaluation should always be arranged if you experience other, new visual symptoms while taking steroids. Atherosclerosis hardening of the arteries It is possible that steroids may increase the rate of "hardening of the arteries," which could increase the risk of heart disease.
Self-care tips: Low cholesterol diet may help. If you develop signs suggesting heart problem, such as chest pain, get medical attention quickly. Work with your physician to address any heart risks that can be modified, such as exercise, weight and cholesterol level. Aseptic necrosis Steroids, particularly at higher doses for long periods of time, can sometimes lead to damage to bones, called aseptic necrosis also known as osteonecrosis or avascular necrosis.
This can happen in a number of joints, but the hip is the most common. Self-care tips: Hip pain, especially if you have no known hip arthritis, could be an early sign of this damage. Report this to your doctor. In-person and virtual physician appointments.
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