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