Corticosteroids or glucocorticoids—commonly referred to as steroids—are prescription medications that reduce inflammation in the body. Inflammation can be caused by various factors, including allergic reactions and autoimmune diseases such as lupus and multiple sclerosis (MS). Our bodies produce their own glucocorticoids as well as something called adrenocorticotropic hormone, or ACTH, which is produced by the pituitary gland. ACTH stimulates steroid production and is sometimes prescribed instead of glucocorticoids.
Common steroids like prednisone, cortisone, and dexamethasone inhibit chemicals that cause inflammation and are often prescribed for reducing the inflammation and swelling at the sites of lesions on the spine and brain in MS, for example. In myasthenia gravis, steroids help signals get through from nerves to muscles to improve muscle strength. The goal of steroids is to calm the immune system and alleviate symptoms such as pain, swelling, and weakness quickly. Sometimes relief occurs within days. In other cases, it can take weeks or months.
Steroids can be administered via injection, by intravenous (IV) infusion, orally, or topically. To reduce pain, steroids are typically injected in and around the painful area. The route and frequency of steroids depends on the underlying disease. For sciatica, for example, a steroid nerve block may need to be repeated every few months, while an MS flare might be treated with IV steroids every day for a few days as needed to treat the attack.
Side effects of steroids, however they are administered, include weight gain, high blood pressure, high blood sugar levels, osteoporosis, high cholesterol levels, acne, easier bruising, water retention, stomach irritation and ulcers, muscle weakness, mood swings, insomnia, and increased body hair. The longer people are on steroids, the more likely they are to experience side effects. The same is true for people who have other health problems such as diabetes (steroids can raise blood sugar) and osteoporosis (steroids can exacerbate bone density loss).
Taking proton pump inhibitors—over-the-counter tablets—can lower the risk of ulcers by reducing stomach acid, but they should not be used for extended periods. Check with your doctor about the dose and how long to use proton pump inhibitors. If you have to stay on them for a long time, your doctor may prescribe antibiotics to help prevent pneumonia, since reducing stomach acid can lead to bacterial overgrowth. Doctors also may advise taking calcium and vitamin D supplements because proton pump inhibitors can deplete those.
Some side effects, such as increased appetite and weight gain, are temporary and disappear after the medication has been discontinued. Others, such as mood changes and trouble sleeping, may last longer. People with diabetes or gestational diabetes should alert their physicians before taking steroids and be monitored for high glucose levels during treatment.
Because steroids suppress the immune system, people are at greater risk of infection if they are on them for an extended period. People should be aware of any signs of infection, such as fever or wounds not healing, and report them to their physicians. Anyone due for a flu or COVID-19 vaccine should get shots before starting steroid treatment to reduce the risk of infection. People taking steroids should also mask, wash their hands, and steer clear of anyone who is ill.
Dr. Cutsforth-Gregory is associate professor of neurology in the division of neurologic education at Mayo Clinic in Rochester, MN.
