What are glucocorticoids?
- Glucocorticoids are also known as corticosteroids, or just steroids.
- They are synthetic products which mimic cortisol, the body’s naturally occurring glucocorticoid made in the adrenal cortex.
- Glucocorticoids should not be confused with the type of performance enhancing steroids some athletes have used.
What are different types of glucocorticoids?
- Prednisone is the most common type taken by mouth. It usually comes in 1mg, 5mg, and 50mg tablets. Some patients are on a combination of different strength tablets. It is important not to confuse the different strengths; this can be very dangerous.
- Glucocorticoids can also be given by injection directly into joints. Examples include methylprednisolone (Depomedrol), & triamcinolone.
How do glucocorticoids work?
- Glucocorticoids can suppress and modulate the body’s immune system, making them a powerful option in the treatment for some autoimmune diseases.
What are some conditions that are treated with glucocorticoids?
- Joint injections with glucocorticoids can be provided for most types of arthritis, including rheumatoid arthritis, osteoarthritis, and gout.
- They may also be appropriate for some patients with other inflamed tissues, such as a bursitis.
- In some circumstances, oral glucocorticoids may be appropriate for the treatment of inflammatory arthritis, such as rheumatoid arthritis, as well as Systemic Lupus Erythematosus (SLE, or Lupus).
- Glucocorticoids are always given early in the treatment for most types of vasculitis and myositis. They are also the primary treatment for Polymyalgia Rheumatica (PMR).
How soon will I feel the effects of glucocorticoids?
- Oral prednisone can begin to have an effect as early as 30 minutes after administration.
- Joint injections with glucocorticoids take from 1 day to a few weeks to take effect, depending on the underlying reason for the injection.
What are the possible side effects of having a joint injected with a glucocorticoid?
- Steroid injections are generally considered safe. However, the following complications are possible:
- There is a small risk of bleeding anytime the skin is pierced with a needle.
- There is a small risk (1/10,000) of introducing an infection into the joint. If this happens, the joint will become more painful, red, hot and swollen usually 2-4 days after the injection occurred.
- There is a 1% chance of a post-injection flare, which can look like an infection, but occurs in the first 24 hours after the injection.
- There is a risk of causing some soft tissue shrinking or discoloration of the skin surface if the steroid is not injected directly into the joint. The body usually repairs this over time.
- Some steroid will leave the joint and affect the entire body. Most people do not feel this effect and it is short lived.
- For injections near tendons, there is a small risk of causing a tendon rupture if the steroid is mistakenly injected into the tendon itself. Fortunately, your physician can usually tell if this is the case prior to providing the injection.
Is there anything I can do to reduce these side effects?
- Make sure both you and your physician are comfortable with steroid injections.
- After receiving the injection, ice the area for 10-15 minutes a few times the day of and day after the injection.
- Notify your physician immediately or go to the nearest emergency department if there are any signs of an infection.
Oral Clucocorticoids (Prednisone)
What are the possible side effects of taking Prednisone (oral glucocorticoids)?
- Prednisone has many more risks asssociated with it compared to steroid injections, as it affects the entire body. The risk of these side effects increase with higher doses and longer duration of use. Possible side effects include:
- Poor sleep
- Increasing weight
- Increasing appetite
- Mood changes or disrupted thinking
- Thinning of the skin
- Weaker muscles
- Increased risk of developing stomach ulcers, diabetes, glaucoma,
- cataracts, hypertension and heart disease
- Increased risk of developing serious infections
- Increased risk of developing osteoporosis and bone fractures
- Disruption of the body’s own ability to make cortisol
Is there anything I can do to reduce these side effects?
- Discuss with your doctor to ensure you are always on the lowest dose possible with shortest duration to effectively and safely treat your condition. Different conditions require different dose regimens.
- Take your prednisone in the morning, not the evening. This is similar to the body’s natural cortisol production and may decrease any negative effects on sleep.
- While prednisone can cause weight gain, try to control the urge to increase your caloric intake.
- Take Calcium 500mg three times daily and Vitamin D 1000 units daily for bone protection, in addition to regular physical activity. Discuss with your doctor if you need to take any other medications to reduce the risk of osteoporosis.
- Let your doctor know if you are at increased risk for any diseases, particularly diabetes, so you can be monitored more closely.
- Make sure you follow your doctor’s advice on how to safely reduce your prednisone dose. It can be very dangerous to suddenly stop prednisone.
What should I do if I miss a dose?
- If you miss your dose, you can take it as soon as you remember it. If you forget entirely, do not take an extra dose the next day; just resume your regular dose.
How do I safely stop glucocorticoids?
- Glucocorticoids cannot be stopped suddenly, particularly for those patients who have been taking them for greater than 2 weeks. This can be very dangerous to your health.
- Always consult with your physician to determine a safe and effective strategy to stop your steroids.
For more information about glucocorticoids, or for questions that are specific to your situation, always consult your physician.