Corticosteroids Can Be Nasty!

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We doctors like to hand out prescriptions for corticosteroids like we’re handing out scripts for M&Ms. Add to that the fact that many physicians routinely inject steroids all over the body and this is one of the most widely used medications on the planet. Now new research shows that even small scripts for these powerful anti inflammatory drugs can cause serious problems.

What Is a Corticosteroid?

Corticosteroids are different from the anabolic steroids you’ve heard about that are commonly used by bodybuilders. Corticosteroids don’t build muscle, they instead suppress inflammation. Medically they have been used for decades in any situation where there is excessive inflammation. These drugs have names like cortisone, solumedrol, depomedrol, dexamethasone, betamethasone. prednisone, prednisolone, methylprednisolone, and triamcinolone. The drugs also have a serious dark side when it comes to side effects.

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Corticosteroid Side Effects

First, when you take a steroid pill or get injected with a corticosteroid, it’s a bit like dropping a nuclear bomb to take out a sniper. It works, but there is serious collateral damage. Let’s discuss that damage.

The first set of issues are systemic. Your body isn’t meant to handle doses of corticosteroids in the milligram range. While that doesn’t sound like much, it’s about a million times more steroid than your body deals with on a day to day basis. That physiologic amount is in the nanogram range. Yes, your body uses minute amounts of naturally occurring steroids for various reasons.

How much is a milligram more than a nanogram? If the height of a matchbook was a nanogram, the height of the Empire State building would be a milligram. Hence, when your body sees milligram steroids, it begins shutting down things like your natural cortisol system and this seriously messes with your blood sugar control. As another example, if you take steroids orally, they increase the likelihood of a serious bone disease called osteonecrosis.

Then there are the local effects. Steroids injected into tendons can damage the cellular structure of the tendon. Or if you inject a joint with steroids, the steroids can destroy the cartilage in the joint.

The New Research

A team of physicians in Taiwan compared health insurance claims in their national health system right before and then after corticosteroid use. With a paltry 3 days of steroid use, there was an 80% increase in GI bleeds, a doubling of the risk for a serious whole-body infection called sepsis, and a more than doubling of the risk for heart failure (1). These results mirror a US study that looked at health insurance claims for longer oral steroid use of up to 30 days (2). That research team found a greater than fivefold increase in the risk for sepsis, a more than threefold increase in the risk for blood clots, and a nearly twofold increase in the risk for fractures.

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Do Steroids Have Any Rational Use?

Yes, there are circumstances that warrant the use of corticosteroids. However, as you can see, we physicians need to stop using them for little issues like sciatica, acute flare-ups of pain, or when patients just seem to have a little too much inflammation. Our focus should be on serious conditions or problems. For example, I’ve used them very rarely to try to reverse the very unique patient who has way too much or serious inflammation, due to an orthobiologics procedure.

The upshot? We have a serious corticosteroid overuse problem. Given that these medications have potentially serious side effects, it’s time we physicians learn to go on a steroid diet!

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References:

(1) Yao TC, Huang YW, Chang SM, Tsai SY, Wu AC, Tsai HJ. Association Between Oral Corticosteroid Bursts and Severe Adverse Events: A Nationwide Population-Based Cohort Study [published online ahead of print, 2020 Jul 7]. Ann Intern Med. 2020;10.7326/M20-0432. doi:10.7326/M20-0432

(2) Waljee AK, Rogers MA, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ. 2017;357:j1415. Published 2017 Apr 12. doi:10.1136/bmj.j1415

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