Corticosteroids for Arthritis.

Last updated Thursday, December 30, 2004

Risks and side effects

Do corticosteroids have side effects?

When taken as prescribed, corticosteroids can provide welcome relief from pain and inflammation. However, like any other medication, corticosteroids can cause side effects and serious medical problems if not carefully monitored by a doctor. It is very important to understand the differences between safe, proper use and improper use of these powerful drugs.

Most side effects are predictable and related to the dose. Some side effects occur in almost anyone who takes them. Other side effects are unpredictable; they may or may not occur.

How are dosage of corticosteroids and risks of side effects related?

The following table is an example of how the risk increases as the dosage for the corticosteroid prednisone increases.

What are very common side effects of corticosteroids?

• Weight gain. At first, most of the weight is water retention only, but as time goes by, corticosteroids also may increase your body fat. Corticosteroids also will increase your appetite. Anyone with a history of heart trouble or swelling in the legs should consult his or her doctor, since corticosteroids could affect such conditions.
• Mood swings. Some people find that corticosteroids make them feel more positive and uplifted while others feel sad, anxious, or depressed. Nervousness may occur, and difficulty in sleeping is common, especially if a dose is taken later in the day. People with a history of serious mental health problems should consult their doctor about how to deal with these risks.

What are common side effects of corticosteroids?

In people who take corticosteroids continuously for more than a few weeks:

• Mild weakness in the muscles of arms or legs
• Blurred vision
• Hair growth: both thinning and excessive growth
• Easy bruising of the skin
• Slow healing of cuts and wounds
• Acne
• Round face
• Slowed growth in children and adolescents
• Osteoporosis (loss of bone calcium), especially in women, people with chronic kidney disease, those with a history of osteoporosis in the family, people who smoke, and people who are not physically active

What are occasional side effects of corticosteroids?

In people who take corticosteroids for weeks to months, especially at moderate to high doses:

• High blood pressure
• Elevated blood sugar
• Red or purple stretch marks on the skin
• Stomach irritation or stomach ulcers, especially when also taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids can make high blood pressure, diabetes, blood sugar problems, or ulcers suddenly worse. If you have had any of these conditions and need to take corticosteroids, it is very important to consult your doctor.

What are less common side effects of corticosteroids?

In people whose corticosteroid use is moderate or prolonged:

• Blurred vision from cataracts
• Glaucoma
• Fractures due to osteoporosis, most often in the hip and spine
• Osteonecrosis, a serious and painful condition that occurs most often in the hip or shoulder when the bone is deprived of circulation
• Severe weakness of the muscles (myopathy)
• Psychosis, which is a severe disturbance of thinking
• Serious infections due to suppression of the immune system

How can the side effects of corticosteroids be minimized?

Corticosteroid use is less likely to cause side effects when you take your medication as prescribed and practice healthy habits (exercise regularly, eat nutritious foods, get enough rest). Following is a list of suggestions to help minimize side effects that can result from corticosteroid use.

1. Take your corticosteroids and other medications exactly as prescribed. Do not increase, decrease, or stop your dosage unless specifically instructed to do so.
2. Unless told otherwise, take a once-a-day dosage of corticosteroids early in the morning. It is more effective and less harmful that way.
3. Visit your doctor frequently to prevent side effects or to detect them at an early stage.
4. Contact your doctor if you develop high fevers with chills or shakes, severe pain in a joint or bone, persistent blurred vision, or severe muscle weakness. Also contact your doctor if you notice drastic mood changes that affect your behavior.
5. Wear a medical identification tag because of the possibility of side effects. Ask your doctor about how to get one.
6. Make sure you eat a healthy diet. Limit foods that are high in fat and salt. Also make sure your diet provides enough calcium and vitamin D. Dairy products such as milk and yogurt are good sources of both nutrients. As an option you can take calcium and vitamin D supplements. Your doctor can recommend the most suitable sources and the proper dose.
7. Exercise to maintain healthy bones and muscles. While it may seem harder to exercise when you're on steroids because of weight gain or muscle weakness, it's worth doing. Try a steady routine of walking, biking, or hiking three or four times a week, without overdoing it. A physical therapist or your doctor should prescribe an exercise program for you.

Can corticosteroids be taken while pregnant?

In spite of the many possible side effects, corticosteroids, especially prednisone, can be used with relative safety during pregnancy. If you see different doctors for your rheumatic disease and for your pregnancy, both need to be involved in the decision of whether or not to use corticosteroids. If you are taking corticosteroids and planning a pregnancy, be sure to discuss this with your doctor. If you are taking corticosteroids and are pregnant, don't stop the medications suddenly--you must see your doctor and discuss this first. Since corticosteroids get into breast milk, nursing babies may experience side effects just like adults do, except more so. Discuss the alternatives with your doctor if you wish to nurse your baby.

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