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Corticosteroids are often called steroids. However, the word steroid can be confusing. Corticosteroids are very different from the steroids some athletes take to do better in their sport. 

Corticosteroids are hormones produced naturally by your body. One corticosteroid in your body is called cortisone. Corticosteroids are important for your body metabolism. This means they help your body convert the food you eat into the energy you need to do things.

Corticosteroids are also very powerful medicines. They work by affecting the immune system to help to control or turn off inflammation quickly.  They have been used for more than 50 years and are one of the most common medications used by rheumatologists.

Corticosteroids work much faster than the slower acting NSAIDs. Corticosteroids can improve your symptoms in as little as 48 hours. Corticosteroids can be given in different ways:

• children and teenagers with severe JIA who need treatment while waiting for other medications to start to work

• children and teenagers with systemic JIA

• children and teenagers where other medications have not worked.

What are the side effects of corticosteroids?

Corticosteroids may have more side effects than NSAIDs. They can affect almost every type of tissue and organ in your body. If you need to take corticosteroids, your doctor will use the smallest dose for the shortest period of time. The dose of steroids is based on your size and weight. A higher dose may be used initially but the dose will be lowered as your condition improves. Sometimes steroids are used for a few days but are sometimes required for longer periods of time like months.

Corticosteroids may be used for:

• children and teenagers with severe JIA who need treatment while waiting for other medications to start to work

• children and teenagers with systemic JIA

• children and teenagers where other medications have not worked.

Types of corticosteroids

The following are corticosteroids commonly used to treat JIA. Two of these are given orally, and one is given by IV. Prednisone is the most commonly used oral corticosteroid in the treatment of JIA.

 

Generic name Most common brand name How it is given How the medication comes Side effects
Prednisone Prednisone By mouth, 1-2 times daily Liquid or pill Early side effects:

  • Increased appetite
  • Stomach ache or burning, nausea
  • Trouble sleeping, mood changes
  • Headaches
  • Facial flushing

Late side effects:

  • Weight gain, puffy face, acne, increased body hair and stretch marks
  • Stomach ache or burning, nausea
  • Trouble sleeping, mood changes
  • Changes in menstrual pattern
  • May reduce the activity of the immune system and you may see more frequent infections
  • Fluid retention/swollen feet and/or ankles
  • High blood pressure
  • Cataract formation
  • High blood sugar (increased thirst frequent urination)
  • Reduced blood flow to bone causing bone softening (avascular necrosis)
  • Osteoporosis (fractures, back or rib pain)
  • Slowing of growth in height
Prednisolone Redipred/Predmix By mouth, 1-2 times daily Liquid
Methyl-prednisolone Solu-Medrol Intravenously Injection

Important safety points about taking corticosteroids

• Stomach upset can frequently be avoided by taking the medication with food. If you continue to have stomach aches with this medication, your doctor may prescribe a medication to help protect your stomach. One of the rare side effects of corticosteroids is stomach ulcers. Signs of an ulcer may include vomiting blood or passing a bloody or black stool. If this occurs, you should see your doctor immediately.

• If you have a fever, chills, or other symptoms of infection, see contact your doctor as soon as possible.

• You should not take live vaccines (MMR, varicella) while taking steroids.

• If you have not had chicken pox and are exposed to someone who has chicken pox, contact your doctor as soon as possible.

• If you are in an accident or need surgery, the emergency medical personnel should be informed that you might need extra medication. Your body needs extra cortisone during these times .

• If you miss a dose of steroids promptly seek medical advice.


It is important to speak to your doctor about the side effects of corticosteroids. You may not like taking corticosteroid medication because of its side effects. In fact, you may feel like stopping it. However, corticosteroids should never be stopped suddenly. They should be gradually reduced according to your doctor’s instructions. This allows your body to start producing its own corticosteroids again. Stopping corticosteroids too quickly can lead to serious side effects. Remember, talk to your doctor or nurse about any concerns you might have about taking corticosteroids.


Tips for managing side effects of oral corticosteroids

It is hard to take a medication that can change the way you look. The changes will depend on how much corticosteroid you need to get better. If your face gets rounder, remember that this will go away when your dose is lowered. The toughest part for most teenagers is the increased appetite. Here are a few tips for managing the side effects of corticosteroids.

• Take your corticosteroids with food. Try taking your pills with breakfast, lunch or dinner. If you need to take your medications at school, carry a small snack with you.

• Corticosteroids are best taken in the morning.

Eating right and staying active will help to minimise side effects such as weight gain, osteoporosis, increased cholesterol, and changes in blood pressure. Your rheumatology health care team can help to review your diet. They may suggest avoiding too many salty, fatty and sugary foods. Other tips for planning your diet while on corticosteroids can be found in the article titled “Nutrition and JIA.” Choosing a healthy alternative rather than high calorie foods will minimise side effects of weight gain.

• Corticosteroids can make your bones weaker. You can help reduce this by taking in enough calcium and vitamin D in your diet along with staying active. You may need to take vitamin supplements. Talk with your doctor or nurse about how much you should take.

• To minimise acne, wash regularly with soap and water. If that does not help, speak to your doctor about other lotions that help to control acne caused by corticosteroids.

• To help with stretch marks, try to maintain a healthy diet. Avoid excessive sun exposure to the stretch mark or use sun protection. Apply vitamin E to the stretch mark.

• Increased risk of infection on high dose steroids so consult your nurse or doctor if you are unwell with a fever, vomiting or respiratory symptoms.

 

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