| Mention steroids and the first thought that | | | | glands reduce the production of normal |
| comes up is that of a beefy athlete whose | | | | cortisone. If the synthetic supply is stopped |
| head is two sizes too large for his body. | | | | abruptly, the adrenal glands can't produce |
| | | | enough cortisone to compensate. The result is |
| What many people don't realize is that there | | | | a severe medical condition called adrenal |
| are two different kinds of steroids. The | | | | crisis. This syndrome presents with |
| first kind, anabolic steroids, are the ones | | | | shock-like symptoms such as sweating, chills, |
| you read about in the sports pages. These | | | | weakness, loss of consciousness, and |
| build muscle mass among other properties. | | | | sometimes death. |
| | | | |
| The second type of steroid is that used to | | | | Another side effect is insomnia. Taking the |
| treat inflammatory disease like arthritis. | | | | steroid dose in the morning can minimize this |
| These are the catabolic steroids such as | | | | side effect. Lowering the amount of caffeine |
| prednisone. These types of steroids actually | | | | consumed throughout the day is also |
| break down muscle mass. Their advantage | | | | beneficial. |
| though is that they are powerful | | | | |
| anti-inflammatory drugs. These | | | | Another serious side effect is osteoporosis. |
| anti-inflammatory steroids - also called | | | | Corticosteroids reduce the ability of the |
| corticosteroids- are often used in the | | | | body to absorb calcium and they also increase |
| treatment of diseases such as arthritis. | | | | the amount of calcium excreted buy the body. |
| | | | The end result is a weakening of the bones |
| In fact, corticosteroids are used by up to 75 | | | | with an increased likelihood of fracture. |
| per cent of patient with rheumatoid | | | | |
| arthritis. | | | | To guard against this, periodic bone density |
| | | | tests to assess bone loss, along with regular |
| A major concern, though, is how to avoid the | | | | calcium and vitamin D supplementation is |
| potential side-effects of these drugs and | | | | needed. |
| that is the subject of this article. The | | | | |
| first step in avoiding side-effects is to | | | | Drugs to prevent osteoporosis such as |
| take the lowest effective dose possible. | | | | risedronate (Actonel) and alendronate |
| | | | (Fosamax) may be needed. |
| Although sometimes, high doses are given | | | | |
| intravenously for serious condition such as | | | | Alternate day dosing of corticosteroid- |
| lupus or extremely active rheumatoid | | | | taking the steroid on one day and not the |
| arthritis, maintenance doses are typically in | | | | next- may allow control of disease with fewer |
| the range of 10 mgs of prednisone or less per | | | | risks of side effects. While this regiment |
| day. Your physician should try to lower the | | | | may be effective for lupus, inflammatory |
| dose when possible if your disease is stable. | | | | muscle disease, and vasculitis, it is not |
| | | | effective for rheumatoid arthritis, |
| When corticosteroids are lowered, they must | | | | polymyalgia rheumatica, or giant cell |
| be tapered slowly to avoid symptoms of | | | | arteritis. |
| withdrawal such as headache, increased joint | | | | |
| and muscle pain, drop in blood pressure, | | | | Drugs such as methotrexate and azathioprine |
| nausea, vomiting, or fever. | | | | may have a steroid sparing effect. In other |
| | | | words, they may allow the use of lower doses |
| People who have been on long term | | | | of prednisone. |
| corticosteroids must be extra cautious. The | | | | |
| longer one has taken these drugs, the slower | | | | Make sure you ask your rheumatologist about |
| the taper must be. | | | | your steroid dose and whether it is possible |
| | | | to reduce the total amount of steroid drug |
| The reason is that when synthetic | | | | you take. |
| corticosteroids are given, the body's adrenal | | | | |