Introduction to Steroids
Steroids (short for corticosteroids) are synthetic drugs that closely resemble cortisol, a hormone that your body produces naturally. Steroids work by decreasing inflammation and reducing the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions.
Corticosteroids are different from anabolic steroids, which some athletes use to build bigger muscles. Examples of corticosteroid medications include triamcinolone, cortisone, prednisone, and methylprednisolone.
How Are Steroids Given?
Steroids can be given topically (cream or ointment), by mouth (orally), or by injection. When injected, they can be given into a vein or muscle, directly into a joint or bursa (lubricating sac between certain tendons and the bones beneath them) or around tendons and other soft tissue areas.
How Do Steroids Work?
Steroids decrease inflammation and reduce the activity of the immune system. Inflammation is a process by which the body's white blood cells and chemicals protect the body against infection and foreign organisms such as bacteria and viruses.
In certain diseases, however, the body's defense system (immune system) doesn't function properly and is overactive. This may cause inflammation to work against the body's own tissues and cause tissue damage. Inflammation is characterized by redness, warmth, swelling and pain.
Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells.
Side Effect of Steroids to Treat Arthritis
No one factor causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated at the time of puberty or due to other hormonal changes. Sebum (oil) is a natural substance that lubricates and protects the skin. Associated with increased oil production is a change in the manner in which the skin cells mature, predisposing them to plug the follicular pore. The plug can appear as a whitehead if it is covered by a thin layer of skin, or if exposed to the air, the darker exposed portion of the plug is called a "blackhead." The plugged hair follicle gradually enlarges, producing a bump. As the follicle enlarges, the wall may rupture, allowing irritating substances and normal skin bacteria access into the deeper layers of the skin, ultimately producing inflammation. Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); if the inflammation is deeper still, it forms a cyst.
Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone [Deltasone, Orasone, Prednicen-M, Liquid Pred] or the steroids that bodybuilders or athletes sometimes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium (Eskalith, Lithobid). Most cases of acne, however, are not drug related.
What Conditions Are Treated With Steroids?
Steroids are used to treat a variety of conditions in which the body's defense system malfunctions and causes tissue damage. Steroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle). They may also be used selectively to treat inflammatory conditions such as rheumatoid arthritis, lupus, Sjögren's syndrome, or gout.
What Are the Benefits of Steroids?
When inflammation threatens to damage critical body organs, steroids can be organ saving and, in many instances, life-saving. For example, they may help prevent the progression of kidney inflammation, which can lead to kidney failure in people who have lupus or vasculitis. For these people, steroid therapy may eliminate the need for kidney dialysis or transplant.
Low doses of steroids may provide significant relief from pain and stiffness for people with conditions including rheumatoid arthritis. Temporary use of higher doses of steroids may help a person recover from a severe flare-up of arthritis.
Why Are Steroids Injected?
Injecting steroids into one or two areas of inflammation allows doctors to deliver a high dose of the drug directly to the problem area. When doctors give steroids by mouth or IV, they cannot be sure an adequate amount will eventually reach the problem area. In addition, the risk of side effects is much higher with oral or IV steroids.
What Conditions Are Treated With Steroid Injections?
Steroids often are injected directly into joints to treat conditions such as rheumatoid arthritis, gout, or other inflammatory diseases. They also can be injected into an inflamed bursa or around tendons near most joints in the body.
Some people report relief from osteoarthritis when steroids are injected directly into swollen or painful joints.
What Are the Expected Benefits of Steroid Injections?
Steroid injections into a specific area are generally well tolerated and are less likely than other forms of steroid drugs to produce serious side effects. Also, the injections may help avoid the need for oral steroids or increased doses of oral steroids, which could have greater side effects.
What Role Do Steroid Injections Play in an Overall Treatment Program?
Steroid injections can be added to a treatment program that may already include anti-inflammatory pain medications (NSAIDs), physical therapy, occupational therapy, or supportive devices such as canes and braces. Whether one or more of these treatment methods are used depends on the nature of the problem.
For example, in an otherwise healthy person, tendinitis may be adequately treated with only a steroid injection into the inflamed area. However, in a person with rheumatoid arthritis, injections are generally a small part of a multifaceted treatment approach.
When Should Steroid Injections Not Be Used?
Steroids should not be injected when there is infection in the area to be targeted or even elsewhere in the body because they could inhibit the natural infection-fighting immune response. Also, if a joint is already severely destroyed, injections are not likely to provide any benefit.
If someone has a potential bleeding problem or is taking anticoagulants (often referred to as blood thinners), steroid injections may cause bleeding at the site. For these people, injections are given with caution.
Frequent steroid injections, more often than every three or four months, are not recommended because of an increased risk of weakening tissues in the treated area.
What Are the Side Effects of Steroid Injections?
Steroid injections are one of the most effective ways to decrease pain and improve function, yet they generally do not cure the illness.
In rare instances, the following side effects might occur:
- Allergic reactions
- Bleeding into the joint
- Rupture of a tendon
- Skin discoloration
- Weakening of bone, ligaments, and tendons (from frequent, repeated injections into the same area)
Not everyone will develop side effects and side effects vary from person to person. If steroid injections are infrequent (less than every three to four months), it is possible that none of the listed side effects will occur.
What Are the Possible Side Effects of Oral Steroids?
Side effects are more common with a higher dose and longer treatment. Side effects are much more common with oral drugs. Some side effects are more serious than others. Common side effects of oral steroids include:
Please note: The side effects listed are the most common side effects. All possible side effects are not included. Always contact your doctor if you have questions about your personal situation.
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Does Everyone Develop Side Effects of Steroids?
No. How often any side effect occurs varies from person to person. If steroid use is brief (from a few days to a few weeks), it is possible that none of the listed side effects will occur. The side effects listed generally do not occur when occasional steroid injections are given for arthritis, tendinitis, or bursitis.
However, if steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects may occur.
How Can Steroid Side Effects Be Minimized?
To minimize the side effects of steroids, doctors follow these guidelines:
- Use steroids only when necessary.
- Monitor closely to detect the development of serious side effects.
- If possible, use steroid injections for problems in a specific area.
- Use the minimal dose required to gain control of the disease.
- Reduce the dose gradually if the disease remains under control.
- Monitor blood pressure often and treat if necessary.
- Recommend calcium supplements, vitamin D, and bone-building prescription medications to help maintain bone strength (this is done especially if steroids will be taken for a long period of time).
- Have your bone density checked every one to two years.
Who Should Not Take Steroids?
Steroids, as with other drugs, are not recommended for everyone. In general, people with the following conditions should not take steroids:
How Do I Know If Steroid Treatment Is Right for Me?
The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, your overall health, and other drugs you are taking. Your doctor also will make sure you understand the potential benefits and risks of steroids before you start taking them.
WebMD Medical Reference
Medically Reviewed on 6/13/2017
Agency for Healthcare Research and Quality: "Rheumatoid Arthritis Medicines: A Guide for Adults."
UpToDate for Patients: "Patient Information: Rheumatoid Arthritis Treatment."
The Johns Hopkins Arthritis Center: "Rheumatoid Arthritis Treatment."
AGS Foundation for Health in Aging: "Arthritis Pain."
Medline Plus: "Cushing Syndrome."
Reviewed by David Zelman, MD, on June 13, 2017