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Corticosteroids are useful in the treatment of a
variety of digestive disorders and other serious medical problems.
Corticosteroids include prednisone, prednisolone, Solu-Medrol, Deltasone, Medrol
Dosepak, and hydrocortisone.
These medications are usually given for one of three
reasons: They are very effective in suppressing inflammation.
They also suppress immune responses in conditions where the body
is reacting against itself. In some cases they can be given when
the body is unable to produce enough to maintain normal bodily
functions. These hormones are normally synthesized from cholesterol
by the adrenal cortex and have a wide range of normal physiological
functions. These are highly effective medications in conditions
such as ulcerative colitis, Crohn's, rheumatoid arthritis, lupus
and certain liver conditions. Occasionally, they can be given
for other conditions, such as drug reactions or long term control
of various skin rashes. The alternatives in digestive and liver
diseases to using prednisone include other anti-inflammatory drugs
or immunosuppressive medications, such as sulfasalazine, Asacol, Pentasa,
methotrexate, Imuran and 6-MP. The latter three medications
are considered strong immunosuppressives and have a number of
side effects.
Corticosteroids have been used in millions of people
since their introduction in 1942. In many cases, their use results
in marked improvement in quality of life and control of serious
diseases. It is very important to be aware of the potential adverse
effects of these medications.
These adverse effects include:
Patients on high dose continuous steroid therapy
may develop a characteristic appearance. This appearance includes
a fuller, more rounded face (a plethoric or moon face). In addition,
they may get fat deposits over the back of their neck. Their body
may get fatter while arms and legs may get thinner. Occasionally,
purple striae are seen on the thighs and lower abdomen. These
striae are similar to those markings found on women after they
give birth. In addition, using steroids, there may be a tendency
towards easy bruising. Occasionally, these corticosteroids may
react to reduce the effectiveness of the body's insulin giving
rise to a tendency towards high blood sugar levels or diabetes.
Rarely, patients may also develop muscle weakness which particularly
affects the thighs and upper arms (a proximal myopathy).
As with any immunosuppressive medications, there
may be increased susceptibility to infection.
It has been shown that these types of medication
cause increased turnover of bone and may reduce the density of
the bones in long term use. This can give rise to osteoporosis
or compression fractures of the vertebral bodies. More seriously,
and fortunately more rarely, avascular necrosis of the head of
the femur may occur. This gives rise to severe hip pain and may
require a hip replacement. Literally, the blood supply to the
hip joint gets disrupted.
Often people who take these medications get a sense
of euphoria. Occasionally, these may precipitate a depressive
illness. Sometimes, people find they are euphoric one moment and
depressed the next moment. In addition, when euphoria settles
in, there is frequently an increased appetite and this may contribute
to overall weight gain.
Long term corticosteroid use may also give rise to
cataracts, although this is a rare complication usually found
in children and reflects prolonged, high dose therapy.
Finally, there may be increased gastrointestinal
symptoms with an increase in upper abdominal discomfort.
While all these side effects sound very frightening,
generally, these side effects are predictable and will be closely
monitored by your doctor. People at particular risk from side
effects include those who must remain on steroids for long periods
of time, those people who have preexisting peptic ulceration,
severe high blood pressure or a tendency towards congestive heart
failure diabetes or osteoporosis.
It is important to realize that when you are given corticosteroids, these mimic the natural hormones produced from
your adrenal glands. Your body, in an attempt to regulate the
amount of steroids in your blood supply, shuts down it own normal
production from the adrenal gland. In time, this gland shrinks,
similar to a muscle which is not used. When long term corticosteroid
therapy is finally stopped, it may be 6 to 12 months before normal
adrenal function recovers. It is for this reason, that it is very
important to follow your doctor's advice regarding stopping these
medications. He/she will gradually taper you off corticosteroids,
as withdrawal must be undertaken cautiously and gradually.
If you have an accident, medical illness or must
undergo surgery, or have a severe infection while on corticosteroids,
or for 6-12 months after stopping them, be sure to tell any doctor
involved in your case. You may need supplemental corticosteroids
under those conditions, because your adrenal glands may not be
able to meet the increased demands of the stressful illness.
If you have any questions regarding the use of these
medications, your doctor will be happy to discuss them with you.
It must be stressed, that in spite of potential side effects from
this medication, these are predictable and generally, these medications
are highly effective in helping to control the effects of many
very serious diseases.
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