Corticosteroids

Corticosteroids are a class of versatile medications, widely utilized for their rapidly acting anti-inflammatory and immunomodulatory properties. These drugs have been prescribed since the middle of the 20th century, so much is known about their potential benefits and adverse effects. 

Corticosteroids, which include medications like prednisone, methylprednisolone, and triamcinolone, are commonly referred to as the abbreviated term “steroids”. This is unfortunate because it creates much confusion and anxiety. “Steroids” more accurately refers to a much larger group of compounds that also includes cholesterol, vitamin D, and sex hormones like estrogen and testosterone.

Corticosteroids are not the same as anabolic steroids, agents that can be abused by athletes for performance enhancement.

Systemic corticosteroids

Taken orally, by intramuscular injection, or intravenously infused, corticosteroids can exert anti-inflammatory effects throughout the body and are often prescribed to treat chronic systemic inflammatory conditions like lupus, rheumatoid arthritis, or sarcoidosis, particularly when a rapid therapeutic response is desired. Systemic corticosteroid therapy may also be appropriate to treat episodes of inflammation associated with crystalline arthritic diseases such as gout or pseudogout.

Topical corticosteroids

Corticosteroid ointments, shampoos, and creams are used to treat skin inflammation such as eczema or psoriasis, as well as skin conditions caused by systemic diseases, such as cutaneous lupus. Corticosteroid eye drops may be appropriate for inflammatory eye diseases such as uveitis. Even corticosteroid oral pastes are available for some forms of mouth ulcers.

Corticosteroid injection therapy

Corticosteroid injections, colloquially known as “cortisone shots,” are used to treat local inflammation of the joints and soft tissues (muscles, tendons, bursas, etc.) caused by various causes such as arthritis, sports injuries, or traumas. Epidural steroid injections (ESIs), for example, deposit medications around neural structures in the spine to offer relief from pinched nerves due to disc herniations (“slipped discs”) and/or arthritis of the spine.

Side effects of corticosteroids

The list of potential side effects associated with corticosteroids is very lengthy. The likelihood of side effects is directly related to the degree of exposure. Hence, an overriding principle is to use as little as necessary and as briefly as possible. Chronic systemic therapy is more likely than occasional soft tissue injections to cause problems. Some adverse effects can be common such as worsening bone density (that is, osteopenia and osteoporosis), weight gain, or poor glucose control, while others are rare such as avascular necrosis, tuberculosis, or major mood changes. Discussion with your physician is important to assess the potential benefits and risks of the nature of corticosteroid therapy being recommended.

Updated: 4/28/2023