Corticosteroids are highly effective drugs that are used to treat many inflammatory and allergic diseases.

With arthritis, corticosteroids are prescribed to fight inflammation, which causes pain, swelling and a feeling of heat in the joints.

Examples of corticosteroids: prednisolone, methylprednisolone, triamcinolone, dexamethasone.

These substances are similar in action to the natural hormone of the adrenal cortisol, but can be tens of times stronger than it. Cortisol regulates many functions in the body, so a person can not live without it.

Corticosteroids are sometimes confused with sex hormones, but these are completely different things. Sex hormones regulate sexual and reproductive function, and corticosteroids do not affect the sexual sphere. Doctors sometimes call these drugs simply steroids. But, again, this is not the same as the anabolic steroids that athletes use.

There are dozens of corticosteroid preparations that can be supplied in the form of tablets, syrups for children, aerosols and ampoules. These drugs can differ significantly in strength of action, application features, at a price. Corticosteroids are always prescribed by a doctor! In Western countries, these medicines are almost impossible to buy without a prescription, and that is why.

Why are corticosteroids used for arthritis?.

Corticosteroids are used for arthritis for two reasons. First, they reduce inflammation. Many patients with rheumatoid arthritis suffer from pain, redness and swelling of the joints due to a violent inflammatory reaction. Inflammation can occur in the joints (arthritis), tendons (tendinitis) or in many organs and tissues at the same time (for example, with lupus erythematosus).

In rheumatic diseases, one of the goals of corticosteroids is to limit joint damage. So-called non-steroidal anti-inflammatory drugs (NSAID or NSAIDs) are often prescribed to reduce inflammation, but they may not be strong enough for some patients. If NSAIDs (diclofenac, ibuprofen) are poorly tolerated, the doctor may add corticosteroids - this will reduce inflammation and will reduce the dose of other drugs.

Secondly, corticosteroids suppress the immune response (immunosuppression). This means that they help patients with autoimmune inflammation of the joints. Let us dwell on this in more detail. A healthy immune system fights disease-causing viruses and bacteria. But in autoimmune diseases (lupus, rheumatoid arthritis), immunity begins to affect their own tissues, perceiving them as alien. It is then that the ability of corticosteroids to suppress the immune response. However, thanks to this ability, corticosteroids make the body more susceptible to infections.

The benefits and risks of different doses.

Arthritis affects people in different ways. For this reason, doctors select doses and ways of introducing corticosteroids individually, depending on the course of the disease and the characteristics of the patient's body.

The benefits and risks of corticosteroids depend on many factors:.

• Dose of the drug. With some types of arthritis, treatment starts with very high doses (pulse therapy), which can cause more side effects.

• Duration of treatment. The course of treatment for arthritis can last from several days to several months, and even years.

• Drug form of the drug.

• Specific joint disease.

• Features of the patient (sex, age, concomitant diseases).

American experts from the Department of Orthopedics of the University of Washington give a tablet with an approximate assessment of the benefits and risks of different doses of a common drug of prednisone:.

Low dose (up to 10 mg / day). This level is comparable to the normal level of corticosteroids in the human body. Side effects may occur with prolonged treatment.

The average dose (10-20 mg / day). In the first month of treatment, the risk is usually small. After a month, the likelihood of side effects increases, but for most patients the benefit still exceeds the risk.

High dose (20-60 mg / day). High risk of side effects. Because of the high probability of serious side effects, this dose should be used when it is absolutely necessary. Despite this, such doses save many lives and prevent complications of severe illnesses in thousands of patients.

Ultra-high dose (more than 100 mg / day). A very dangerous dose, which can be used only in exceptional cases, which threatens the life of the patient.

Varieties of arthritis.

Corticosteroids are used to treat many forms of arthritis.

American doctors give such an incomplete list of diseases that respond to treatment with corticosteroids:.

• Bursitis.

• Vasculitis.

• Giant cell arteritis.

• Dermatomyositis.

• Osteoarthritis.

• Gout.

• Poliomyositis.

• Pseudogout.

• Rheumatic polymyalgia.

• Rheumatoid arthritis.

• Systemic lupus erythematosus.

• Scleroderma.

• Tendonitis.

• Fibromyalgia.

The use of corticosteroids.

Corticosteroids are often prescribed in the form of tablets, but there may be other options. For the treatment of osteoarthritis or bursitis, drugs can be injected directly into the affected joint. For other diseases, corticosteroids can be administered intravenously.

Doctors can prescribe a so-called pulse therapy with corticosteroids - the administration of high doses of drugs in a short period of time. This is done, for example, for the treatment of severe lupus. Pulse therapy is rather risky, because the probability of serious side effects with it is maximal. Such treatment is carried out only in a hospital, under the constant supervision of doctors.

Other diseases that are treated with corticosteroids.

Some skin diseases, such as psoriasis, are also treated with corticosteroids, which are usually applied externally (ointments, creams). Some inflammatory processes in the eyes are treated with eye drops with corticosteroids. Allergic diseases respond well to nasal sprays with corticosteroids. In inflammatory bowel diseases, such as nonspecific ulcerative colitis, corticosteroids are administered orally.

Side effects of corticosteroids.

In low doses, corticosteroid drugs are unlikely to cause serious problems, especially if treatment is short-lived. But, like any other medicine, corticosteroids have side effects. It is especially dangerous to take these drugs without the supervision of a doctor.

Most of their side effects are predictable and dose-dependent. Some phenomena occur in almost all patients who take corticosteroids. Others are unpredictable: you can not say for sure whether they will arise from you.

Very frequent side effects of COP:.

• Weight gain. Most of the weight gained when using these medicines is caused by a water retention in the body. But steroids contribute to the recruitment of fat mass. They increase appetite with all the ensuing consequences. If you have previously had swelling, tell your doctor about it.

• Mood Changes. Some people find that corticosteroids elevate their mood, while in others they cause anxiety and depression. There may be nervousness and problems with falling asleep, especially if taking the medication in the evening. People with serious mental illness should tell the doctor about their history.

Frequent side effects of CS:.

In patients who take corticosteroids continuously for several weeks, these side effects are possible:.

• Weak muscles of the arms and legs.

• Unclear vision.

• Hair growth disorder.

• Light skin.

• Slow healing of wounds.

• The appearance of acne.

• Rounding of facial features.

• Slow growth in children.

• Thinning of bones (osteoporosis).

Rare side effects of COP:.

In patients who take corticosteroids continuously for several months in high or medium doses, these side effects are possible:.

• Increased blood pressure.

• Increase of blood sugar level.

• Appearance of red or purple marks on the skin.

• Irritation of the stomach or the formation of ulcers, especially when combined with NSAIDs.

Corticosteroids can aggravate arterial hypertension, diabetes mellitus, or peptic gastric ulcer if you have already been sick. In this case it is very important to inform your doctor about your illness!.

Very rare side effects of COP:.

• Development of glaucoma.

• Unclear vision caused by cataracts.

• Fractures resulting from osteoporosis.

• Osteonecrosis, in which the blood supply to the bone deteriorates.

• Severe muscle weakness (myopathy).

• Psychosis and severe mental disorders.

• Risk of serious infections due to immunosuppression.

How to minimize side effects?.

Side effects from corticosteroids are less likely if you use drugs in strict accordance with the doctor's recommendations, and also practice a healthy lifestyle (exercise, eat and rest properly).

To minimize the risk, follow the simple advice of experts from the American Arthritis Foundation:.

• Follow all doctor's instructions, do not skip doses.

• Take the pill in the morning, unless the doctor has indicated otherwise.

• Visit your doctor frequently to identify side effects.

• Wear a special identification bracelet on your arm.

• Immediately inform your doctor of extreme heat, severe joint pain, permanent visual impairment, severe muscle weakness, or unusual changes in your behavior.

• Eat right. Limit fatty and salty foods. Add to the diet foods rich in calcium and vitamin D for the prevention of osteoporosis.

• Exercise to maintain the health of the musculoskeletal system.. Naturally, with arthritis you can not perform many exercises. Consult a physician about exercise therapy.

Pregnancy and corticosteroids.

Despite many side effects, taking corticosteroids, especially prednisone, is relatively safe in pregnancy. However, the doctor will decide whether to prescribe these medicines based on your condition. If you are taking corticosteroids and plan to become pregnant, do not forget to discuss this with your doctor! If you become pregnant while taking these medications, do not stop taking it suddenly - it can be unsafe!.

Corticosteroids are able to penetrate into breast milk, so children in breastfeeding may experience side effects from these drugs. Discuss alternative treatment with your doctor or transfer the baby to breastfeeding.

Symptoms of withdrawal.

Reduce the dose of corticosteroids or discard them can be difficult. If you take these drugs for a long time, then sudden cancellation is dangerous.. Your body must produce corticosteroids in response to stress, but with a sharp withdrawal of the drugs, the adrenal glands can not quickly rearrange and increase the synthesis of their own hormone.

That's why doctors gradually reduce the dose, eventually completely canceling the medicine.

If you took steroids for weeks or months, then during a period of dose reduction, you may experience unpleasant withdrawal symptoms. These can include pain in the muscles, bones and joints, nausea, weight loss, headache, and even fever. Fortunately, these symptoms are usually slightly pronounced and soon pass.

After the abolition of corticosteroids, you must visit a doctor within the next year.

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