"Steroids."
It's
a familiar word with typically negative connotations. No doubt you've heard about athletes
who abuse steroids. Or you may be all too aware of the bad
side effects associated with steroid medications.
It makes you wonder why physicians commonly prescribe them. But for many Lupus
Patients, it's one thing that makes you feel human again.
Medications mimic action of your own hormones
Steroids are a group of hormones with similar chemical
structures. Your adrenal glands, located on top of your kidneys, and your reproductive
organs (ovaries and testes) secrete dozens of these hormones.
Steroids help control metabolism, inflammation, immune function, salt and water balance,
development of sexual characteristics and your ability to withstand the stress of illness
and injury.
Steroid medications are chemically related to some of your body's own steroids and
duplicate their actions.
Corticosteroids mimic the hormones cortisone and hydrocortisone made by the outer portion
(cortex) of your adrenal glands. When prescribed in doses that exceed your natural levels,
corticosteroids suppress inflammation. They're the most commonly prescribed category of
steroids for medical conditions.
Although you don't often hear them called steroids, birth control pills and estrogen
replacement medications are also steroids. They're chemically similar to the hormones
estrogen and progesterone produced mainly by the ovaries.
Anabolic steroids are chemically related to the male sex hormone testosterone. These drugs
are a different class of medications from other steroids .
Cortisone was first steroid drug
In 1935, researchers at Mayo Clinic first isolated the hormone cortisone from adrenal
secretions. In 1948, Mayo physicians were first to use cortisone to treat severe
rheumatoid arthritis.
Cortisone proved to have a remarkable ability to relieve inflamed, swollen joints after
just a few days of use. People who couldn't rise from a chair, shave, open a door or lift
a cup, now could.
Today, pharmaceutical companies make dozens of different corticosteroid drugs to treat
allergies, asthma, skin inflammations, arthritis and connective-tissue diseases such as
lupus and arthritis (inflammation of the arteries).
They're also used in life-threatening conditions such as Addison's disease in which the
adrenal glands don't produce enough steroids. In transplant recipients, corticosteroid
drugs help prevent organ rejection by suppressing the immune system.
How steroids got a bad name
After dramatically improving arthritis symptoms in the 1940s, cortisone was hailed as a
"miracle drug." But problems emerged. People taking cortisone for months in
doses high enough to relieve inflammation routinely experienced harmful side effects.
Physicians now recognize that prolonged use of corticosteroids can lead to widespread
problems affecting:
Metabolism--Your body tends to accumulate fat in your abdomen, around your face
("moon face") and on the back of your neck. Also, levels of blood sugar
increase, sometimes leading to or worsening diabetes. Muscular weakness develops.
Bones--Formation of new bone is inhibited and calcium is lost in the urine. Osteoporosis
and, sometimes, joint damage result.
Eyes--Incidence of cataracts increases.
Skin--Thinning occurs. Blood vessels near the surface of your skin become more visible.
Skin bruises more easily. Wounds heal slowly.
Blood pressure--Elevations are common.
Immune system--Your body produces fewer disease-fighting antibodies, making you more
susceptible to viral, bacterial and fungal infections.
Emotions--Some people develop agitation, euphoria, insomnia and, rarely, psychosis.
Even though all these side effects are possible with use of corticosteroids, it's unusual
for one person to have them all. These side effects don't occur with birth control and
estrogen medications.
Better ways to prescribe steroids reduce side effects
Despite side effects, corticosteroid drugs remain a cornerstone of medical treatment.
One reason is their ability to control a debilitating inflammatory process when nothing
else will. Another reason is the development of drugs with varying strengths and lengths
of action.
These newer forms of corticosteroids allow physicians to prescribe and administer the
precise amount of drugs needed for the shortest period. Better ways of using steroids
reduce side effects.
New modes of administration include:
Intermittent and single doses--Doctors usually prescribe corticosteroids once a day or
every other day instead of several times a day. This allows your system a brief, yet
helpful, reprieve from the drug.
An every-other-day regimen avoids most side effects, but if followed for months, still
increases the risk of osteoporosis.
Injection--A single injection of a corticosteroid can relieve serious poison ivy reactions
or seasonal allergies.
Direct applications--For asthma, inhaled aerosol corticosteroids reach the lungs' surfaces
directly. By this method, drugs subdue inflammation and improve breathing without
affecting other areas of your body.
Directly applying corticosteroid creams to inflamed skin is virtually risk-free. However,
continual use on large areas, such as for psoriasis, can cause problems, including
thinning of your skin and reduced production of steroid hormones by your adrenal glands.
Use is a balancing act
Before prescribing a corticosteroid drug, your doctor considers alternatives and carefully
weighs the benefits against the risks. For acute conditions, corticosteroids are safe and
effective.
Sometimes, though, the only way to control an inflammatory disease is to prescribe a dose
of a corticosteroid that causes side effects. But with a disorder like arteritis, in which
corticosteroids can prevent blindness, side effects may be a risk you're willing to take.