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