The corticosteroids, commonly called "steroids" are a group of drugs related to cortisone and hydrocortisone, two natural hormones produced by the adrenal glands. When the body suffers stress such as a surgical operation or infection, the pituitary gland in the brain signals to the adrenal glands to produce more hormones. Corticosteroids are among the most powerful and effective anti-inflammatory drugs known to man. They can arrest the inflammatory process, thus reducing pain and swelling of joints. They also suppress the immune system of the body. These 2 actions probably account for the dramatic effects on certain rheumatic diseases by Corticosteroids.

How are Corticosteroids Given?

Corticosteroids are generally given in 3 ways: orally, by intravenous injection or by injection directly into an affected joint. They can be used in high or low dose therapy. In general, high-dose therapy is used in connec-tive tissue disease when there is evidence of major organ involvement e.g. brain, heart, lungs or kidney. Low-dose therapy may be used in combination with other modes of treatment.

Can Corticosteroids Be Taken With Other Arthritis Medication?

Yes. Corticosteroids are often given with other drugs, such as aspirin, non-steroidal anti-inflammatory drugs, slow-acting anti-rheumatic drugs and immunosuppressives. It is important to make a list of all the drugs you are taking for your condition when you start on corticosteroids. Concomitant consumption of traditional medicines is discouraged as the latter may contain steroids in unpredictable amounts, thus rendering your doctor's assessment of your disease control and his titration of your steroid dosage difficult.

What are the Important Side-effects of Corticosteroids?

Corticosteroids have many side-effects, especially when they are taken continuously for several months or years. As such, high doses are only used as initial therapy or during periods of disease flare-up in order to suppress the inflammation quickly. The dosage is then tailed gradually over weeks or months to as low a level as necessary to control the disease, often with the aid of slow-acting anti-rheumatic drugs or other immuno-suppressives with far fewer side-effects. Long term steroid usage is known to afford a sense of general well-being, and it is often for this reason that some patients may resist their doctor's attempt to tail off steroids. The common side-effects are:

Not every patient develops all these side effects and it often takes several years on large doses for some of them to occur. Some of these side-effects are reversible when the drug dosage is reduced. Others can be minimised by giving the drug on alternate days, if the disease condition permits.

What Should I Do if I Experience Side-effects?

Because corticosteroids are powerful drugs, you must visit your doctor regularly to have the dose kept at the lowest possible level needed to control the disease. When a steroid drug is introduced into the body, the pituitary gland is prevented from sending its stress signals to the adrenal glands. When subjected to stress, the body may not make sufficient hormones needed in stressful situations. This is important to remember as one should not stop taking steroids abruptly. Rather, lowering the dose of corticosteroids is usually made very slowly. DO NOT stop or drasti-cally reduce the amount of corticosteroids you are taking on your own, even if you are feeling well. Sudden withdrawals can lead to shock.

Important Reminders